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]

Oscar – Is It For Real?

healthcare cost

The Wall Street Journal reported yesterday that technology giant, Google, invested $32.5 million in healthcare insurance startup, Oscar. Oscar hopes to remake healthcare by better connecting with users. So far about 40,000 individuals in New York and New Jersey have signed in for this gamification of healthcare. At the current valuation, that means the company is… [Read More]

Preventive Service – Or Is It?


Most health insurance plans these days cover “preventive services” at 100% with no member liability. However, as a result of recent changes due to the ACA, there are some unexpected and unwelcomed billing surprises in store: tests and services that used to be covered as preventive may no longer be considered preventive by your insurance… [Read More]