Rebate Game on Overdrive

White Pills with a bottle and American Dollars

Every time I turn around there is another shell to watch in the game of rebate pricing. And just when you thought the pharmacy benefit manager (PBM) pricing structure couldn’t get more convoluted, it is… Most employers are already aware that PBMs provide significant rebates every time brand drugs are dispensed. As the cost of… [Read More]

The CREATES Act – Stepping Closer to Drug Pricing Justice?

A blank doctor's prescription from a pharmacy is placed on American flag.

I don’t know about you, but the headlines on pharmaceutical companies substantially raising prices over a short period of time (without good reason) appear far too often for my taste – and we write about drug pricing issues frequently on this blog. But a quieter game of drug company manipulation has been taking place at… [Read More]

Trump Opts for a Baby Step in the Drug Cost War – Not the Expected Leap Forward

Also drug dealing, dealer or trade concept.

Last week President Trump released his long-awaited “American Patients First” blueprint on attacking out-of-control pharmacy costs. Unfortunately, it’s more of a whimper than a roar. If the regulations are effectively written to support my understanding of the President’s intent, the incremental steps forward were not horrible, they are just not bold enough. Drug manufacturers will have to… [Read More]

More Pharmacy Fixes

hundreds of colorful pills on black background for medicine themes

The collateral effect of writing these blogs is that insurance companies (I am happy to say many of them follow me) and third parties are quick to provide additional information or clarification to the issue at hand. There was quite a bit of follow up about my pharmacy blog last week. UnitedHealthcare let me know… [Read More]

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]

Walmart-Humana and the Future of Healthcare

Fast speed dataflow.

Change and consolidation continue to sweep the insurance industry. Healthcare represents almost 20% of the U.S. economy. Costs are increasing and almost no one is happy. These are ingredients for change. The retail sales portion of the economy is also under extreme pressure – with thousands of stores closing and wildly-moving stock prices, this market is as ready for drastic… [Read More]

A Conversation with Dave Cordani, President and CEO of Cigna, About Express Scripts

White Speech Bubble Hanging on the Green Background

I had the opportunity to talk to Dave Cordani, President and CEO of Cigna regarding their planned purchase of Express Scripts. The health insurance carriers get it – they very much need to bring solutions to the market or solutions, which may not be optimal to the carriers, will be imposed upon them. Cigna’s intent is to create… [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 Few Suggestions to Simplify Healthcare

Path or way from A to B - solution strategy concept

I keep waiting for Bezos-Buffet-Dimon to call me (I know they will one day) but in the meantime, cyberspace is a good place to share my thoughts on healthcare redesign. The front door to healthcare delivery should be an easy-to-use smartphone application which is pre-populated with a healthcare calendar, set up with you and your doctor, to remind you… [Read More]