Insurers and PBMs Taking Action on Opioid Abuse 

Opioid health risk and medical crisis with a prescription painkiller addiction epidemic concept as a group of people running away from a dangerous falling bridge of pills as a medicine addict problem with 3D illustration elements.

Pharmacy Benefit Mangers (PBMs), which run the drug plans for health insurers, are paid on the volume of drugs they sell and have been criticized for lack of transparency and focus on profits. Likewise, health insurers are generally focused on controlling claims costs and don’t fully consider the effects of their decisions to limit access… [Read More]

Insurers, Providers and Employers on a Collision Course 

Insurers, Providers and Employers on a Collision Course 

Trying to control healthcare costs is like trying to pick up Jell-O pudding with a pair of chop sticks. It is virtually impossible. The employer-based healthcare system relies on their intermediaries – primarily the large national insurers – to negotiate discounts, provide claims-paying acumen, fraud oversight and clinical expertise, among other things, in the administration of… [Read More]

Insurers Digging Through the Numbers on Oncology Treatments

Insurers Digging Through The Numbers On Oncology Treatments

One of the most difficult issues we face as a society is the cost of care for people who are terminally ill. In fact, most of a person’s lifetime healthcare spend is incurred at the end of their lives. With the advent, and ongoing issue, of skyrocketing pharmaceutical costs insurers are looking closely at the… [Read More]

Good News – the Stop Loss Market Is Vibrant

Good News – the Stop Loss Market Is Vibrant

Uncertainty and frustration abound in the healthcare market today, especially with all of the brewing legislative changes and tension over the market’s response. On the employer-sponsored plan side of things the challenge to improve affordability goes on as well – but you can only make so many plan design changes to keep up. High deductible… [Read More]

Cost-Control Over Risk: More Employers Embrace Self-Insurance

cost-control-over-risk

More and more employers are embracing self-insurance; according to the U.S. Department of Health & Human Services, more than 80% of companies with 500 or more employees have self-insured plans. That’s astounding in the context of historic statistics which showed that only the largest employers used this funding mechanism. And since new products from traditional… [Read More]

Politics and the Exchanges

Politics and Exchanges #3

We are all watching this train wreck unfold before our eyes. The individual exchanges were ill-conceived and poorly implemented from the onset. There is a bloodletting from the insurers, bankrupted co-ops, increased participant premiums, reduced plan options, and politicians looking to make the fixes (again). On one side, the government reports that costs are not increasing… [Read More]

Consumer-Driven Plan Enrollment Still Elusive in the Middle-Market

Consumer-Driven Plan Enrollment Still Elusive

High-deductible plan enrollment continues to grow across the country, but the enrollment is coming from the small group and exchange arena where most other traditional products have all but evaporated. National account segment customers have historically had an aggressive total replacement strategy toward these plans and make up a disproportionate percentage of the total enrollment. So… [Read More]

My Recent Experience with Opioid Based Rxs

Rx Prescription #2

There seems to be an increasing focus on the opioid epidemic engulfing our country. Growing addictions to prescription painkillers and heroin are wreaking havoc on our communities, destroying lives and families. How did we get here? Voters in the State of New Hampshire recently ranked drug abuse, especially opioid addiction, as the most important issue facing… [Read More]

Telling It Like It Is

Flag and Stethoscope

During this electoral primary season, I find it interesting – but not remarkable – that our candidates rarely speak the truth about healthcare in the United States. Uttering the cold hard truth would be telling our populace what they really don’t want to hear. The fact is that the cost of healthcare in our country… [Read More]