Monday, December 11, 2017

Prescription Drugs May Cost More With Insurance Than Without It

There are a lot of bad faith actors, on the PBM sell-side, engaged in concealing the truth. Employers, their brokers and advisors, must be fully engaged to uncover said truth. Full engagement requires a maintenance period which extends for an indeterminate period of time far beyond renewals and reading standard reports. If you read my blog, follow me on LinkedIn or done business with me you know I intend to help.

Reference Pricing for Rx's (Click to Enlarge)
Consequently, this help comes at a price. It makes me unpopular in the eyes of just about everyone except the commercial payers who benefit from the information I share. To this I say so what...right is right, wrong is wrong. It is stories like the one below which tighten the knot in the pit of my stomach.

This article was written through collaboration between The New York Times and ProPublica, the independent, nonprofit investigative journalism organization.

Having health insurance is supposed to save you money on your prescriptions. But increasingly, consumers are finding that isn’t the case.

Patrik Swanljung found this out when he went to fill a prescription for a generic cholesterol drug. In May, Mr. Swanljung handed his Medicare prescription card to the pharmacist at his local Walgreens and was told that he owed $83.94 for a three-month supply.

Alarmed at that price, Mr. Swanljung went online and found Blink Health, a start-up, offering the same drug — generic Crestor — for $45.89.

It had struck a better deal than did his insurer, UnitedHealthcare. “It’s completely ridiculous,” said Mr. Swanljung, 72, who lives in Anacortes, Wash.

Tyrone's Comment:  That Blink Health struck a better deal is doubtful. Most likely, UHC struck a better deal but tacked on a huge mark-up for itself (it did not pass back all the savings it negotiated). Because the mark-up is hidden in the plan sponsor's final [ingredient] cost, this is the reason for the higher cost with insurance.

[Read More]

Thursday, December 7, 2017

Reference Pricing: "Gross" Invoice Cost for Popular Generic and Brand Prescription Drugs (Volume 196)

This document is updated weekly, but why is it important?  Healthcare marketers are aggressively pursuing new revenue streams to augment lower reimbursements provided under PPACA. Prescription drugs, particularly specialty, are key drivers in the growth strategies of PBMs, TPAs and MCOs pursuant to health care reform. 

The costs shared here are what the pharmacy actually pays; not AWP, MAC or WAC. The bottom line; payers must have access to actual acquisition costs or AAC. Apply this knowledge to hold PBMs accountable and lower plan expenditures for stakeholders.

How to Determine if Your Company [or Client] is Overpaying

Step #1:  Obtain a price list for generic prescription drugs from your broker, TPA, ASO or PBM every month.

Wednesday, December 6, 2017

"Don't Miss" Webinar: How to Slash PBM Service Costs, up to 50%, Without Changing Vendors or Benefit Levels

How many businesses do you know want to cut their revenues in half? That's why traditional pharmacy benefit managers don't offer radical transparency and instead opt for hidden cash flow opportunities such as rebate masking. Want to learn more?

Here is what some participants have said about the webinar.

"Thank you Tyrone. Nice job, good information." David Stoots, AVP

"Thank you! Awesome presentation." Mallory Nelson, PharmD

"Thank you Tyrone for this informative meeting." David Wachtel, VP

Recertification Credit Hours: 2
"...Great presentation! I had our two partners on the presentation as well. Very informative." Nolan Waterfall, Agent/Benefits Specialist

A snapshot of what you will learn during this 30 minute webinar:
  • Hidden cash flows in the PBM Industry such as formulary steering, rebate masking and differential pricing 
  • How to calculate cost of pharmacy benefit manager services or CPBMS
  • Specialty pharmacy cost-containment strategies
  • The financial impact of actual acquisition cost (AAC) vs. effective acquisition cost (EAC)
  • Why mail-order and preferred pharmacy networks may not be the great deal you were sold

Tyrone D. Squires, MBA  
3960 Howard Hughes Pkwy., Suite 500  
Las Vegas, NV 89169  
866-499-1940 Ext. 201

P.S.  Yes, it's recorded. I know you're busy ... so register now and we'll send you the link to the session recording as soon as it's ready.

Monday, December 4, 2017

CVS buying Aetna in deal valued at $69 billion

This is vertical integration at the highest level. The deal forces competitors to deliver more value and clients of PBMs to be even more sophisticated in their contract negotiations. For some tips on what to look out for see my earlier post Specialty Drugs Paid Under Medical Benefit Circumvent Cost Control Measures.

CVS, though, has been mired in a prolonged sales slump — pharmacy same-store sales slid 3.4% in the third quarter — and some analysts believe the Aetna deal has less to do with improving healthcare services than finding other ways to grow amid the threat of competition from Amazon and Wal-Mart Stores.

Source: Managed Care Magazine
CVS Health is buying Aetna for $69 billion in cash and stock in a long-expected deal that reflects a rapidly shifting health care landscape. A key component of CVS' business is its CVS Caremark pharmacy benefit management subsidiary. The deal could help CVS encourage Aetna's health plan participants to use the CVS/Caremark mail order prescription system and shop at the pharmacy company's retail stores, which will be able to offer more in-store health services.

If CVS-Aetna is approved, the union could ignite additional mergers in health care. Amazon is poised to enter the drug business in some fashion, leading to further disruption and uncertainty in the industry.

[Read More]