Getting Creative in Combating Rising Specialty Drug Costs

Pills dollar symbol

High cost drugs are the most significant cost driver in healthcare today. Because of their therapeutic value (they cure illness), it is very difficult to manage the cost of these specialty medications. Prior approval, quantity limits and high cost-sharing have proven to be among the most effective utilization mechanisms. A study published in The Journal… [Read More]

Specialty Pharmaceuticals in the Spotlight


It seems I am writing a lot about drugs. And for good reason. In a recent National Business Group on Health survey, 80% of employers report specialty pharmaceuticals as one of the top three cost drivers of healthcare, and 31% say that specialty pharmacy is the highest driver. Still, only 1-2% of the population use… [Read More]

Pharmacy Shenanigans

Prescription Drug Cost

In evaluating the cost of a medical benefits program, prescription drug costs and in particular, specialty drugs, stand out as the fastest growing and the most difficult to manage cost. As I review programs with clients, I find myself often pointing out that pharmacy is where all the profits are hidden. This has been no… [Read More]

Controlling Specialty Drug Spending

Drug Cost  Specialty Pharmacy

Another commentary from the National Blue Cross Consortium. As I mentioned in prior posts, large claims are on the rise. Last year, Blue Cross paid their first individual claim for more than $15M, and the frequency of claims over $1M tripled from 2010 to 2015. Specialty medications are a real focus area. There is a… [Read More]

Ebola Epidemic and Your Healthcare Plan


Anyone who has turned on a television or read a newspaper over the last few weeks has come to recognize what a significant humanitarian threat Ebola is presenting to the international community. What started as a dreadful disease in West Africa has now spread to 9 countries including the United States and Spain. In fact,… [Read More]

Our Complex Healthcare System: No Loophole Will Go Undetected by Profit-Seekers


In 2012, in an effort to promote cost transparency, new regulations were issued requiring pharmacies to list all drugs included in a compounded medicine when seeking reimbursement. Previous protocol required that only the most expensive drug be listed, and reimbursement was based on the cost of that drug. At the same time, drug manufacturers escalated… [Read More]

Healthcare Tradeoffs and Sovaldi: The Conversation We Must Have


A revolutionary new drug that treats Hepatitis C is igniting a critical debate at the heart of healthcare delivery. Sovaldi, the biotech drug, carries a price tag of nearly $100,000 for less than three months of treatment and has the industry in a panic: Patients demand it but insurers and the federal government fear they… [Read More]

A Tale of Two Cities: Healthcare Inflation vs. Healthcare Premiums


PWC, in its 2014 healthcare survey, reports medical inflation at 6.5%, the lowest level in years. Consumerism is working; patients are actually looking at bills and questioning reimbursement. Hospitals and other providers are under intense pressure to control costs. System intermediaries (like brokers and insurance carriers) are being squeezed. Many blockbuster drugs are moving to generic… [Read More]