In Focus

News & Insight from Chelko Consulting
Reality Check: PBMs Make Commissions for Selling Drugs

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?

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…

A Question of Transparency

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

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

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 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…

Embracing a Fiduciary Mindset

Embracing a Fiduciary Mindset

One of the most important lessons I’ve learned over my long career has been the role an advisor can play in helping health plan sponsors embrace a fiduciary mindset. This means employers taking on the widespread lack of transparency and prevalence of conflicts of interest for the benefit of their employees/plan members.

All too often, plan sponsors assume they have little opportunity to control or reduce their healthcare spend. They accept the status quo and do not challenge brokers who are receiving financial incentives to keep them in poorly managed arrangements with specific insurers. read more…

What About Us?

What About Us?

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! read more…

CONTACT

Main Office
24651 Center Ridge Rd, Suite 110
Westlake, Ohio 44145

Phone: 440.892.2600
Fax: 440.892.8920
Email: info@chelkogroup.com

Employee Phone Directory