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]

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]

Healthcare Has Been Screaming for a Disruptor

businessman screaming news, or adult who asks a job - communication

Someone heard. Rumors have been swirling that Amazon, the market status quo killer, was setting its sights on healthcare – one of the least transparent and most inefficient markets – which accounts for almost 20% of U.S. Gross Domestic Product (GDP). Today Amazon joined with market-savvy Berkshire Hathaway and JPMorgan Chase to announce that a new… [Read More]

Chipping Away at the Affordable Care Act Isn’t Getting to the Real Issue

Health Care Reform sign

So, the Affordable Care Act’s (ACA’s) individual mandate penalty has been reduced to zero, the Cadillac Tax has been delayed for two more years (and may likely never be implemented) and the Children’s Health Insurance Program (CHIP) has been funded for six years. Now more than 1.75 million children in 20 states, who were at risk of losing their healthcare, can breathe… [Read More]

CVS-Aetna – a Few Weeks Later

Doctor sitting at table and working with tablet. Medical icons in hexagonals in front. Only hands seen. Concept of medical help.

So the CVS-Aetna deal has been seasoning a bit and I really haven’t heard of any major roadblocks to approval. And early integration planning is starting. Not that integration teams are that much of an indication as they didn’t portend a good result for the Aetna-Humana or Anthem-CIGNA mergers. It would seem that horizontal integration is… [Read More]

Comparing Discounts in a Self-Insured Arrangement

Comparing Discounts in a Self-Insured Arrangement

In a self-insured plan, where 85% or more of cost is the actual payments made for medical claims, one of the most important factors to consider is the network; which one will provide the best access and which will yield the best provider discounts. Let’s start with access: which network most closely aligns with the providers your employees and… [Read More]

Healthcare. Okay. Now What Do We Do?

Flag and Stethoscope

What a week it’s been. I am not sure why President Trump thinks that his latest attempt to coerce the Republican Congress will work better than his past efforts. The Democrats relied on 50 votes to get the Affordable Care Act (ACA) through and now the Republicans are trying to rely on 50 votes to make… [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]