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…)
Obesity is clearly a national problem that impacts employee health and productivity, as well as health plan costs. Enter the wave of pricey new GLP-1 weight-loss and diabetes medications ꟷ a cost driver for plan sponsors and potential panacea for members. (more…)
October is American Pharmacists Month ꟷ a celebration of the invaluable work done by pharmacists and the vital role that they play in society. So, go hug your favorite pharmacist! [Wait a second. Check that. It may not be appropriate.]
How about we just take a moment to reflect on and appreciate the pharmacists who have played important roles in our lives. For me, that means giving a shout-out to Kelly Prymicz and Lucia Vescera ꟷ two PharmDs that I am so grateful to be able to work with each day. (more…)
The recently enacted Inflation Reduction Act includes a series of provisions intended to reduce prescription drug costs for Medicare beneficiaries. Because the bill got through Congress via the budget reconciliation process, it was not allowed to include drug pricing provisions that apply to the commercial market (i.e., employer-sponsored health plans).
So, the law couldn’t do it, but can employers do it on their own? Or maybe the bigger question is: Will they? Worse yet, will this law create a significant cost shift from Medicare to private sector plans? Only time will tell! (more…)
If you’re a plan sponsor, you’re probably familiar with the drug Humira. That’s undoubtedly because it appears toward the top of your list of costliest drugs. Well, that might change soon. Or maybe not. It’s tough to tell. (more…)
What keeps you awake at night? For a couple years now, we’ve written about the number of mega-expensive new cell and gene therapies in the development pipeline. By “mega,” we generally mean therapies costing more than a million dollars. (more…)