5 Big Stories
The tide is turning in the PBM world! I’m here for it. In just the last few months here’s a snapshot of what’s transpired: (more…)
Preparing for Retirement: Health, Wealth, and Appreciating Each Day
As another year passes, it makes me think about planning for retirement. No, this isn’t a retirement announcement. I’m just doing some end-of-year self-reflection — an annual status check so to speak. And, for a change of pace, this year I am sharing my thoughts with whoever reads this. (more…)
Medicare Drug Prices: Why Should I Care?
We often get asked about the expected impact of Medicare’s new drug price negotiations on commercial (employer-sponsored) health plans.
The short answer: While there is no direct legislative impact, there may well be practical repercussions over time. (more…)
What to Do When You Can’t Attest
Among other things, the Consolidated Appropriations Act (CAA) requires group health plans to attest that they are in compliance with the CAA’s gag clause prohibition. TPAs and PBMs seem ready to attest (or sub-attest).
But what’s an employer to do if its plan is not in compliance? And what if the TPA or PBM doesn’t contractually restrict the data, but in practice restricts the data? Is it okay for a TPA or PBM to restrict information as long as they don’t contractually do so? This sure seems contrary to the intent of the law! (more…)
To be the Best, Prepare for the Worst
Whether we’re talking stop loss premiums, skyrocketing Rx costs, or even a fictitious avian flu outbreak, the recent Deep Dive Roundtable meeting sent a clear signal regarding the importance of staying vigilant when it comes to plan management.
Our seventh such annual gathering featured leading employers enjoying robust conversations around benefit strategies and spend for the roughly 50-company cohort, allowing attendees to explore how their plans stacked up against others in the market. (more…)
Reality Check: PBMs Make Commissions for Selling Drugs
Most PBMs would describe their mission as “managing” the cost of drugs and making them more affordable for customers (benefit plans and their members). They like to position themselves as loyal negotiators working on behalf of plans in dealing with drug manufacturers.
This role has led to two key pricing components: discounts and rebates. Both are touted by the industry as important ingredients in the effort to lower drug benefits costs. But are they really? (more…)