CSuitePharma的动态

Breaking News in Pharmacy Benefits: UnitedHealth Group's Optum Rx Sets a New Standard In a significant move for the pharmacy benefits management (PBM) industry, Optum Rx, UnitedHealth's PBM arm, announced it will now pass 100% of manufacturer rebates directly to its clients. This policy shift removes a long-standing point of contention and aims to address criticisms that PBMs drive up drug costs. Previously, Optum Rx retained a small percentage of rebates for certain clients who opted into specific compensation arrangements. According to UnitedHealth CEO Andrew Witty, this change is designed to eliminate distractions and reinforce Optum Rx's commitment to its clients' bottom line. The backdrop to this decision is the ongoing scrutiny of PBMs in Congress and across state legislatures, with critics accusing them of inflating drug prices to boost their revenue. This new approach from Optum Rx could pressure other major PBMs to follow suit, especially as discussions on legislation to increase transparency in the rebate process gain traction. Why It Matters: This policy adjustment not only positions Optum Rx as a leader in rebate transparency but also highlights a growing focus on accountability and trust in the benefits industry. Employers and employees alike stand to benefit from these changes, as cost savings from rebates may directly impact plan affordability and member out-of-pocket costs. The Bigger Picture: As the PBM landscape evolves, stakeholders—from employers to brokers—need to stay ahead of these developments to ensure their benefits strategies align with best practices and emerging trends. ?? Your Turn: What do you think this shift means for the future of PBMs and employer-sponsored health plans? Could full rebate transparency become the industry norm? Let’s discuss below! #PBMTransparency #BenefitsStrategy #HealthcareCosts #CheckoutBEN

Mark Williams, owner and CEO, True Rx Health Strategists, advises self-insured employers, advisors and benefits brokers on what to ask their pharmacy benefit manager. “The pharmacy benefit management (PBM) ecosystem is deeply broken,” he writes. “But nothing will change until employee benefits managers and other decision-makers start asking tough questions of brokers during the process of evaluating a PBM.” https://bit.ly/3O5cntj #pharmacybenefits #healthinsurance

"The pharmacy benefit management (PBM) ecosystem is deeply broken. Not only does the current system lead to?ultra-high pricing, particularly for specialty drugs, but it puts employees last, plain and simple." "Self-insured employers, advisors and benefits brokers all have?vital roles to play?in fixing this system and creating a personalized approach to member care while improving medication compliance and health outcomes." ? "But nothing will change until?employee benefits managers?and other decision-makers start asking tough questions of brokers during the process of evaluating a PBM." #employeebenefits #pbm #benefitsadvisor

New Survey Findings! Most employers are unaware of what pharmacy benefit managers (PBMs) do with their money. According to KFF Health News, only a small percentage receive the full rebates. Discover what this means for your business and employees: https://hubs.la/Q02Z_6jX0 #HealthcareCosts #EmployerBenefits

HR Benefit leads at employers hold such a crucial role in containing healthcare costs. Demanding info from the carriers to understand cost drivers and potential solutions is key. "Prices can be all over the map, even those charged by the same PBM, Ciaccia said. In a Medicaid study he recently conducted, a PBM was billing employers anywhere from $2,000 to $8,000 for a month’s worth of imatinib, a cancer drug that can be bought as a generic for as little as $30. PBM contracts often guarantee discounts of certain percentage points for generics and brand-name drugs. But the contracts then contain five pages of exclusions, and “no employer will know what they mean,” Ciaccia said. “That person doesn’t have enough information to have an informed opinion.” The KFF survey found that companies’ annual premiums for coverage of individual employees had increased from an average of $7,739 in 2021 to $8,951 this year, and $22,221 to $25,572 for families. Among employers’ greatest concerns was how to cover increasingly popular weight loss drugs that list at $2,000 a month or more."

KFF recent employer health benefits survey reveals a complex issue for companies navigating PBM contracts and rebate structures. Among employers with 500+ employees, only 19% report receiving the majority of rebates, while a large portion—37%—remain unsure about the return of savings. https://bit.ly/3Y9sYAH HealthLeaders #HealthPlans #payments

The latest KFF survey sheds light on a critical issue. Nearly 40% of large employers need to learn how much of the rebates negotiated by PBMs with drugmakers come back to them as savings. With only 19% reporting they receive most of these rebates, this lack of transparency highlights the need for companies to understand better the role PBMs play in their healthcare spending. https://bit.ly/3Y9sYAH HealthLeaders #healthcare #HealthPlans #payments

A new KFF survey reveals that most employers are in the dark about what pharmacy benefit managers (PBMs) do with the rebates they collect from drugmakers. Despite PBM claims that they pass most of the rebates back to employers, only 19% of companies report receiving significant savings. Many employers struggle to understand PBM pricing practices, leaving them vulnerable to high drug costs and lacking transparency. Critics argue that PBMs often conceal rebate amounts, and some even funnel money through overseas entities to hide profits. Meanwhile, companies face rising health premiums, with new concerns over expensive weight loss drugs like Wegovy, which only 18% of employers currently cover. https://lnkd.in/gnzmR4Ms #Caleg #PBMReform

Major Changes are coming for Employer sponsored health plans! Employers have been able to offer great benefit plans to Medicare eligible employees in recent years, but new guidelines are shaking things up. The majority of employer plans previously had creditable coverage ("qualifying alternatives") for pharmacy coverage, but changes to minimum coverages are set to impact most employers. Navigating these changes is crucial to avoid running afoul of regulators going into 2025. Working with a capable Broker partner to ensure they are working with your team on these and other compliance guidelines! #EmployerBenefits #Healthcare #Regulations #EmployeeWellness #MedicareChanges