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]

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 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]

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]

Employers Find Solutions to Rx Gamesmanship That Increases Their Costs

Facing the erosion of profits due to high-cost brand name drugs coming off patent, the pharmaceutical industry has found a way to keep the profits rolling in. Pharma would like members who face higher copays and costs for name-brand medications with generic alternatives to stay on the branded drugs. To do so, they spend $3-$6… [Read More]

Medical Loss Ratios—Savings or Illusion?

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ACA legislation introduced a key cost control to the insurance market that aims to rein in insurers’ overhead. That’s supposed to save all of us—government, business, and consumers—money. Here’s how it works: Insurers must spend the bulk of the premiums they collect on actual medical claims (also called the medical loss ratio or MLR)—as opposed… [Read More]