New Valuable Pharmacy App Solves a Big Problem

Pills on US dollars.

Why does pharmacy have to be so difficult? There seems to be a huge disconnect and a lot of finger pointing when it comes to prescribing drugs. A patient goes to the doctor and at the end of the visit gets prescribed medication to address the issue. Patients accustomed to the drill start to sweat… [Read More]

Another Band-Aid: Pharmacists Shopping for Patients

Cropped shot of shelves in a pharmacy

As anyone who has ever filled a prescription knows, the arcane and mind-numbingly complex pricing framework for drugs makes it both impossible to know what the drug will cost in advance of filling the prescription and similarly challenging to shop for a lower-cost alternative. With hundreds, if not thousands, of pharmacy benefit manager (PBM) and… [Read More]

Take Politics Out of Healthcare

Medical politics and health reform challenges or universal healthcare system stress concept as a group of opposing ropes pulling on a doctor stethoscope as a medicine management symbol with 3D illustration elements.

Three additional states have joined California in an investigation of the third largest insurer in the United States – Aetna – alleging their medical director denied a $20,000-per-dose infusion, admitting in a deposition that he never looked at [the] patient’s medical records. The media and public have cried out that the insurer has put profits over patient… [Read More]

Chipping Away at the Affordable Care Act Isn’t Getting to the Real Issue

Health Care Reform sign

So, the Affordable Care Act’s (ACA’s) individual mandate penalty has been reduced to zero, the Cadillac Tax has been delayed for two more years (and may likely never be implemented) and the Children’s Health Insurance Program (CHIP) has been funded for six years. Now more than 1.75 million children in 20 states, who were at risk of losing their healthcare, can breathe… [Read More]

CVS-Aetna – a Few Weeks Later

Doctor sitting at table and working with tablet. Medical icons in hexagonals in front. Only hands seen. Concept of medical help.

So the CVS-Aetna deal has been seasoning a bit and I really haven’t heard of any major roadblocks to approval. And early integration planning is starting. Not that integration teams are that much of an indication as they didn’t portend a good result for the Aetna-Humana or Anthem-CIGNA mergers. It would seem that horizontal integration is… [Read More]

A Call to End Drug Rebates

Drug Cost  Specialty Pharmacy

Healthcare can be transformative and the ability to extend and improve life continues to rapidly roll in. But while medical advances are explosive, our creative skills in controlling costs proceed at a snail’s pace. I realize that change is hard, but it boggles my mind that we can’t take simple steps to reduce cost trends. Regulating drug… [Read More]

Donald J. Trump – To the Tune of “Alexander Hamilton”

ThinkstockPhotos-92369411crop

A common theme discussed in this blog this year has been remaking healthcare as we watch the twists and turns unfold in the legislative circus of healthcare reform. To close out 2017, we’ve put a musical spin on healthcare in America. SHARE THIS!

Are Drugs Cheaper Using Cash?

The concept of paid medicine with pills on a money background

This past weekend, a far-reaching exposé was published by the New York Times and ProPublica highlighting how, in many instances, individual members can save money paying cash when compared to using their insurance for their generic prescriptions. While this is not a new issue, the investigation reviewed the top one hundred prescribed medications, finding that 40% of the time… [Read More]

Stop Loss Insurance… More Important Than Ever

Stop Loss Insurance... More Important Than Ever

With the increase in popularity of self-insurance, health plan sponsors must take the time to fully understand the “safety net” that is typically purchased alongside these plans to protect them from unexpected costs. There are two elements of stop loss: Individual (or Specific) Stop Loss (ISL) protects against the costs of any one claimant exceeding… [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]