Most if not all medical third-party administrators (TPAs) use “shared savings” programs to reduce the cost of non-network claims.
In the absence of a shared savings program, plans pay billed charges without any discounts after members pay the higher non-network copay/coinsurance. But with shared savings programs, TPAs use secondary (aka “blind”) networks, or negotiate directly with providers for discounts. And in return for their efforts, TPAs usually keep 25% to 35% of the savings. Are you following? (more…)
The dance cards have sure changed over the last six months. Whatever happened to the Anthem and Cigna merger? What about Anthem’s partnership with Express Scripts? Did they ask CVS to dance instead? But now CVS is asking to dance with Aetna. And Cigna decided it wants to hit the floor with Express Scripts. (more…)
We recently wrapped up a series of roundtable meetings in various cities where we discussed results from an employer survey we conducted on Plan Design Considerations & Innovations. Attendees at each of the roundtables enjoyed spirited discussion of the survey findings in general and of specific plan management strategies. (more…)
Preparing to pay for a new era of effective gene therapy
Could you imagine seeing stars in the night sky for the first time or even the site of your own parents’ faces after ten or even twenty years of significant visual impairment? The Food and Drug Advisory Committee heard personal testaments like these from patients explaining their miraculous results as part of two experimental gene therapy trials.
More than 25 years in the making, the FDA approved Luxturna® (voretigene neparvovec-rzyl), the first gene therapy for an inherited disorder involving a progressive form of blindness, typically starting in early childhood. Currently, no pharmaceutical alternative is available for these patients. (more…)
Last week, Richard Thaler was awarded the Nobel Prize in economics for pointing out that individual behavior, with respect to investing for the future, is not rational. As someone said in a recent WSJ article on Thaler’s accomplishment, “We’re a nation of procrastinators, not a nation of portfolio managers.” (more…)
Specialty drug costs continue to vex most health plan sponsors. This article from NEJM Catalyst brings to light some of the key issues and opportunities for employers. It highlights the Cleveland Clinic’s recent effort to eliminate $8.5 million of annual waste associated with two commonly used cardiovascular drugs. Employers have got to like that result! (more…)