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

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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]

Rx Plan Costs: Peering into the Black Box

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Not knowing the true cost of prescription drug coverage still frustrates employers and employees alike—even with improved access to information. Plans that are fully insured get very little information on manufacturer rebates, dispensing fees, and discounts off of Average Wholesale Price, because these are closely guarded by the insurers and embedded in their costs. Self-insured… [Read More]