Can Stop Loss Keep Living Up to its Name?

Can Stop Loss Keep Living Up to its Name?

Anyone who’s followed our firm lately has probably heard us talk about the $1 million+ drugs already here and those coming to market over the next few years. While early in the game, we’ve already had a few clients incur enormous claims for these budget-busting medications.

It’s likely many of you reading this are familiar with some of the well-known drugs out there, but according to our latest survey, 73% of employers do not have a plan in place to avoid surprises related to high cost therapies like the ones we’re discussing. And while some of you may have a stop loss policy in place as a safety net to protect against such catastrophic claims, unfortunately, that may not be a foolproof strategy. (more…)

It’s Time to Speak Up

It’s Time to Speak Up

When I was working in a large health system’s patient safety department, we empowered patients to be their own advocate. If something didn’t seem right, feel right, or had not been explained clearly, we encouraged them to speak up.

This is something I’ve been thinking about quite a bit lately as mega high-priced cell and gene therapies make their way on the market with only scant acknowledgement from plan sponsors. As evidenced by our frequent posts, webinars, and pretty much sharing with anyone who will listen (sorry Amazon delivery guy), our firm has been closely ― some would say obsessively ― following these emerging therapies. (more…)

Brace for Impact

Brace for Impact

We’ve all likely seen at least one of the countless movies sharing this plot. You know the script: Large rock hurtles through space on a collision course with earth, leading to what will result in a mass extinction level event. That is, of course, unless divine intervention or the planet’s greatest minds hatch a plan to divert path of said rock.

Forgive our sense of the dramatic (and love of clever word play), but this scenario recently came to mind as we awaited what we thought was the imminent market introduction of gene therapy Roctavian. If you follow these sorts of things, you would know that Roctavian just received a rejection from the FDA. (more…)

Meeting Demand for Rx Benefit Services: Chelko Adds Another Pharmacist

Meeting Demand for Rx Benefit Services: Chelko Adds Another Pharmacist

Responding to client needs within its rapidly expanding drug benefits management practice, the Chelko Consulting Group recently welcomed Lucia Vescera, PharmD, RPh.

Before joining Chelko, Vescera was instrumental in the opening and URAC accreditation of the Cleveland Clinic Specialty Pharmacy where her clinical focus was hepatology, infectious disease, and preventative cardiology. Her role also involved clinical consulting for solid organ transplant patients. (more…)

Be Prepared: New Wave of Costly Rx Claims on the Horizon

Be Prepared: New Wave of Costly Rx Claims on the Horizon

If recent events have taught us anything, it is to be prepared for the unexpected. While none of us could have fully predicted the dramatic impact of COVID-19 on our families, organizations, and the world economy, hindsight reveals safeguards we might have put in place to lessen the damage.

Ironically, this is a subject I had been wrestling with well before the coronavirus was receiving any attention from the international media. Those of you who follow our firm’s work know we have long been concerned about the growing economic threat posed by rising specialty drug costs to employer-funded health plans and their members. It actually dates back to 2005, when I first learned about a $125,000 oncology drug that didn’t save lives. On average, it only extended life by less than two months of sub-optimal living. (more…)