In Focus
News & Insight from Chelko Consulting
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. read 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! read 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. read 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? read more…
Can AI Solve the Problem of Rising Healthcare Costs?
It seems like artificial intelligence (AI) has been hyped by every news outlet on the planet recently. We may look back at 2023 as the year AI received as much press as when the internet forced its way into the public consciousness as a transformational global communications and information network. read more…
New Weight Loss Meds: Panacea or Problem?
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. read more…
A Question of Transparency
Transparency is a hot topic these days. Americans are searching for transparent drug pricing, transparent hospital pricing, transparent broker revenue, and more. Vendors are lining up to address this issue. Sometimes that’s responding to legal mandates for reporting. Sometimes it’s sales spin to meet market demand. And sometimes it’s actually a few companies that do business differently.
This is clearly an issue that most corporate health plan managers want to address. But how does a corporate buyer tell the difference between real transparency and the so-called variety? read more…
Let’s Take a Look Under the Hood
Something feels off with your car and you’re not quite sure what it is. It just doesn’t seem to be running as smoothly and it’s not getting the gas mileage it once did. On top of that, you mentioned something to your mechanic and all you got in return was a bill for some new filters and fluids.
Maybe it’s time you let somebody else take a look under the hood. read more…
No Field of Dreams: Point Solutions Take Work
“If you build it, they will come.” The iconic phrase from 1989’s baseball-themed film may be seared into our collective consciousness, but typically falls short when applied in the real world.
In this case, we’re specifically speaking of point solutions that have been added to enhance existing benefit programs. A point solution is typically offered by a new, innovative company looking to fill a gap in the healthcare system. read more…
October is Pharmacists Month
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. read more…
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