Politics and Healthcare – Nothing Is Easy

Pink cherry blossom and magnolia trees blooming at the White House in Washington, DC during the springtime

I had the pleasure of spending the day on Tuesday in Washington to discuss my favorite legislative topic – healthcare. First stop, the White House, where I met with the Special Assistant to the President for Health Policy. This was a lively discussion which covered rising drug prices, the opioid crisis, mental health parity and… [Read More]

Message Heard – Pharmacy Costs are in the Spotlight

Rx Prescription #2

No doubt the health insurance carriers are getting the message: pharmacy costs are too high, and pricing is not transparent. UnitedHealthcare has announced that they will begin passing rebates directly to retail purchasers at the point of purchase. Pharmacy rebates – which are usually shared between the pharmacy benefits manager (PBM) and the health insurer… [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]

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]

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]

Reviewing Contracts: An Essential Part of Health Plan Management

Reviewing Contracts An Essential Part of Health Plan Management

And you thought it was tough to decide on plan design, communication strategy and contributions for your medical benefits plan… Once the crush of implementation begins, the plan documents will start coming to your inbox and it’s critically important that you understand them completely. The obvious first steps would be to check the principal plan… [Read More]

Anthem Gets Tough with Hospitals

Anthem Gets Tough with Hospitals2

One of the greatest frustrations our self-funded (and to a lesser extent, fully-insured) clients voice is that – despite the hundreds of thousands or millions of dollars they pay the insurers to assist in managing their health plan spend – too often it appears the insurers are complicit in the rising healthcare spend by not… [Read More]

Fighting Pharmacy Inflation

Fighting Pharmacy Inflation

There is an inherent battle between employers and their pharmacy benefit managers. Simply put, PBMs get paid on the volume of drugs dispensed and have little incentive to control utilization of expensive medication. Even worse, drug rebate allocations skew incentives even more when PBMs or health plans use rebate sharing to enhance profits. Consider this:… [Read More]

Justice Department Finally Turns Attention to Pharmacy Collusion

justice-dept-pharmacy-collusion

One of the biggest frustrations echoing from our postings over the last couple of years has been the covert, if not outright overt, collusion in the pharmacy market between drug manufacturers and in many instances the PBMs—pushing up the list cost of pharmaceuticals. This has been an issue hitting our clients’ wallets hard because although… [Read More]

Pharmacy Cost Confusion

Pharmacy Cost Confusion

What is going on with the pharmaceutical industry? Sometimes I feel like they are taunting all of us. I have been writing about the abuses the industry has been imposing on our healthcare system (see related posts here, here and here). There is a lot of subterfuge and non-transparency surrounding costs and the vultures are circling. Pharmacy Benefit… [Read More]