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]

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]

The New Media Focus Is Pharmacy – Can Regulators Keep Up?  How Should Employers Protect Themselves? 

Drug Cost  Specialty Pharmacy

Turing Pharmaceuticals – the vilified hedge fund-owned prescription drug peddler that increased the cost of their 62-year-old drug from $13.50 to $750 per tablet overnight – has raised new cries for the legislative involvement in pharmaceutical costs which I have been writing about for a while (see related posts here, here and here). A recent Reuters study… [Read More]

The Pharmacy Game

The Pharmacy Game

I spend a lot of time thinking about the Pharmacy Benefit Management (PBM) business. The dominant players – Express Scripts, CVS Caremark, and OptumRx – own the vast majority of the business. So, why do I get calls every week from little-known or newer players in the business telling me they can blow the doors… [Read More]

A Look at Specialty Pharmacy

Drug Cost  Specialty Pharmacy

It seems that every financial update meeting I attend focuses on spending for specialty pharmaceuticals. This is a frequent blog topic of mine because it is such a significant driver of healthcare cost trends. Recently, I reviewed a whitepaper on PCSK9 inhibitors. This is a new high-cost drug which, acting with statins (Crestor and Lipitor… [Read More]