November's Top 5 Stories in Managed Care Pharmacy
Ethan Heidorn, PharmD
Senior Research Director, Market Access Consulting at Formulary Insights
*Note: I understand this is a long read so be on the look out for the podcast-able version later this month! As a podcast addict myself, I'm trying to meet people where they're at!
Cigna Launches Gene Therapy Management Solution
Cigna launches new benefits solution aimed at making gene therapy more affordable
Article Summary:
What: “Cigna is launching a new solution as part of its health services business aimed at mitigating the high cost of emerging gene therapy treatments. The Embarc Benefit Protection platform brings together expertise on medical management, health services and specialty pharmacy from Express Scripts, eviCore, Accredo and CuraScript SD, Cigna announced. The model is designed to alleviate high cost-sharing for patients and also prevent shock claims for employers and plan sponsors. At present, Cigna has listed two products for the program: Luxturna and Zolgensma. CAR-T is also being built out in the model."
Why: Our healthcare system is not capable of easily accommodating one-time, large sum payments for gene therapies. Payment solutions are required to address these new therapies with the understanding these frameworks will change over time. As the first major insurer to formally announce gene therapy solutions, the press release is worth a look.
Opinions and Insights:
Branding their product as “The Embarc Benefit Protection” Cigna is leveraging their suite of assets, including their recent purchase of ESI, to deliver an end-to-end solution for the management of gene therapies. To participate, the plan sponsor will pay a PMPM fee for access to this network. The goal is to allow Embarc to be the single payer for all drug and ancillary costs of the gene therapy in an effort to deliver a lower and predictable price for which the payer will accept the associated PMPM fee/premium (suspected to be under $1).
“Physicians will be required to submit a PA, but once they’re approved a patient will not be charged a copay at the pharmacy counter or physicians office.”
From the press release it appears that the patient will not be subjected to any associated cost-sharing with physician visits etc although that cannot be ruled out yet; certainly a positive outcome for patients. Given the million dollar cost of these therapies, it would be almost cruel to subject those patients to their $5,000 deductible considering its percentage of the overall cost (0.2% for Zolgensma) and the impact that burden may have on the family already dealing with this disease. Forcing a co-pay on these patients would be like going to a Vikings game at US Bank Stadium: I paid $300 for tickets, $20 for parking, $200 for a jersey, lost $100 gambling on us beating the Packers, and now I have to pay $10 for water????? To quote the infamous segment from Keyshawn Johnson on Monday Night Countdown….C’MON MAN!!!
Cigna is making the gamble that the reduced risk combined with administrative headache relief through continuity of service will lead payers to contract with Embarc. In advice to employers, STAT emphasized knowing the PMPY cost, the risk (overall disease incidence), employee demographics (child-bearing age, geography, risk factors), current insurance coverage (health plan +/- stop-loss coverage), and program specifics (network channeling, misaligned incentives, pricing transparency) in making an informed decision. It is reasonable to seek clarity on what other form of revenue is being generated in this payment model (direct manufacturer contracting) and are we truly reaching the lowest net cost over dealing with these players individually? For their part, Steve Miller postures that 'Cigna is not trying to profit off Embarc' likening it to a cost recovery model. He also suggests that if products for patients with known conditions like sickle cell anemia and hemophilia join the offering, 'reserves created by the fees could abate the cost of those therapies' although that may require they [fully] 'convert this from a services company to truly a type of insurance product that we'd underwrite the participants." Personally, this is where my interest lies. As gene/cell therapy approvals approach 50 in coming years, will we have a separate gene therapy benefit?
We already have supplementary vision and dental benefits why not a supplementary gene therapy insurance?
Will Embarc pioneer or lay the ground work for this type of solution as that $1 PMPM fee increases? Will enough medium-sized self-funded employers and/or health plans join the network to sufficiently spread the risk? Cigna believes so as Miller was also quoted to be anticipating 10 million members in the program by y/e 2020. The pipeline might force answers here; certainly the type of risk gymnastics required by the system to accommodate these therapies. I'd say your self-funded unions or pensions, with essentially no room for adding revenue, are your biggest target for this service. We do not want to end up with another Strensiq situation on our hands where:
"[For] every hour that one of the union’s 16,000 members worked, 35 cents of his or her pay went to Alexion."
Embarc may be a white-label offering for consideration by the other vertically integrated giants (CVS Health, Anthem, and UHG). There has been limited public information from these players, however, a spokeswoman for CVS Health said 'the company is developing alternative payments models, including annuity payments and stop-loss insurance products designed specifically for gene therapies in addition to outcomes-based contracts.' Clearly, CVS Health would be well-positioned with their assets to make a dive into an Embarc-esque solution or work towards developing their own stop-loss insurance program in conjunction with their Aetna members (makes the most sense that way). The stop-loss product would certainly draw underwriting clues from the organ transplant insurance that exists in the market place today. Gene therapy management is a prime copy-cat market and we may certainly see parallel solutions in the future.
As mentioned, physicians and drug companies will be paid by Embarc/eviCore for the therapies thus bypassing buy and bill percentages and eliminating the need for providers to float that type of capital. The idea of Embarc taking on the buy and bill portion of the supply chain may subsequently allow value-based agreements to take place outside of the anti-kickback statute (AKS) which currently limits VBF’s for fear of the impact on best price. Current rules proposed by the HHS OIG around 'value-based enterprises' excluded manufactures from VBE exceptions 'out of fear they might misuse the proposed safe harbors primarily as a means of offering remuneration to practitioners and patients to market their products' (LMAO). PhRMA isn't alone as the OIG clamored Dracarys once again by concluding with 'we also are considering for the final rule excluding PBMs, wholesalers, and distributors from the definition of 'VBE participant' for reasons comparable to those for excluding pharmaceutical manufacturers.' (ROFLMAO)
However, the OIG did explicitly state in their proposed ruling:
We may also consider specifically tailored safe harbor protection for value-based contracting and outcomes-based contracting for the purchase of pharmaceutical products in future rulemaking.
Sigh ??. Existing arrangements like that between Novartis and Accredo have allowed for these types of outcomes-based and/or amortized-based contracting to occur on an exception basis. Whether the Embarc arrangement is capable of skirting the current laws or we wait on amendments to the Federal AKS is yet to be determined. One could easily argue that outcomes-based contracts are most effective in gene therapies given the one-time high costs, early treatment failure identification, and life-long rewards. Why agree to a non-refundable $2.1 million dollar payment if the patient doesn’t respond to therapy? (Next month, we'll get to look at what could be with Bluebird's proposed gene therapy payment structure in Europe)
Cigna Press Release:
Minnesota Legislature Requests Comments on PBM Licensure Bill
What: “The PBM licensure act was passed during the 2019 Minnesota legislative session. The Act establishes the requirement that all PBMs contracting with plan sponsors doing business in Minnesota must have a valid license as of January 1, 2020. The department is also considering rules needed to finalize requirements related to data collection, transparency reporting, enforcement standards, and other items needed as they come up.”
Why: Well, it’s fairly obvious why. Every insurance company in the state is regulated under the rules of the insurance commissioner. Currently, PBM’s do not truly function as an insurer through not taking on true financial risk in the form of premium collection for services delivered (they do engage in risk-based or performance-based contracts with clients). However, they have gained such an important position in the intricate web of the broader healthcare insurance landscape, cemented by their consolidation with health insurers, it would be reasonable to regulate or license them as we do insurers. We may not get the MLR as discussed in May’s article, but we may crawl closer to contractual transparency. Retail pharmacies will be intensely concerned with this legislation, for obvious reasons. Although the bill was signed in May, as we approach the finalization for comment it seems appropriate to take a brief look at the pending legislation.
Opinions and Insights:
The licensure of PBM’s has felt inevitable given their growing influence in a highly politicized field, consolidation with insurers, frustrating asymmetry of information and our progressive state.
From a consumer perspective, it makes absolutely zero sense to lack licensure in an important, oligopolistic industry.
Minnesota will be looking to enact the most comprehensive PBM licensure bill in the country. Other states like CA, AK, GA, IA, NC, etc. all have previous or concurrent PBM licensure bills hitting their state legislatures; language is always key in this process and I believe Minnesota’s to be the most air-tight. ERISA limits the laws required to follow on the state level by self-insured plans, thus the impact of the bill may be limited in certain business segments. The proposed legislation has a few highlights seeking transparency and consumer protection:
MAC Pricing
- MAC list updated every seven business days, with changes noted
- Disclose sources utilized to set price
- Drug not MAC-able if not available for purchase
Transparency to Plan Sponsor
- The aggregate WAC, amount of rebates and associated utilization discounts for each therapeutic category of drugs (all other fees)
- De-identified claim information (drug utilization info, claims, PA requirements, etc)
- Amount paid to pharmacy and amount charged to plan sponsor (spread)
Transparency to Insurance Commissioner
- All the information and more, auditing capabilities
PBM cannot require/prefer a more expensive drug (if therapeutically equivalent)
- Wording/interpretation is fascinating
Network Adequacy
- Sufficient access, excluding mail order
Pharmacy Audit Rules
- Clarifying DIR processes, fees, and recoupment
Pharmacy Ownership Interest
- Disclosure of spread pricing to sponsor if pharmacy is affiliated
- Steering, incentives for using affiliate pharmacy
If implemented, with even a fraction of the proposed language, this would be a ‘first-in-class’ licensure program for the state of Minnesota which will share its results with the parallel legislation elsewhere. Downstream effects must be considered and surely could be challenged in court by the PBM’s for limiting their competitive advantage through certain levels of transparency, although I might argue that’s driving a hard bargain. PBM’s and their combined clinical services and negotiating power bring an enormous value to the procurement, distribution, and payment of pharmacy benefits; but that value should not go unchecked. Or you might end up like Denzel Washington at the end of Training Day.
The overarching goal here is to inch closer to a fiduciary duty for PBMs, streamline auditing capabilities to ensure compliance and ethical practices, promote the best interests of patients and taxpayers, and to allow a more level playing field in facilitating an apples-to-apples comparison among the competitors.
Call me crazy but, occasionally a level of government regulation in big business can be a net positive.
Time will tell if this holds any significance or if I am simply rambling for the sake of being a naive idealist.
PBM Licensure Bill:
Congress Takes on Surprise Medical Bills
Insurers, hospitals diverge on how Congress should address surprise medical bills
What: Congress is looking at numerous proposals to address surprise medical billing if the market players cannot figure it out themselves. If you watched any amount of television this holiday weekend, you almost certainly watched the ad above.
Why: The difficulty in navigating your health insurance benefit during times of elective visits is already challenging enough, toss in emergency situations, and the consumer hardly stands a chance. You can go to an in-network hospital, be seen by an out-of-network ER doc or specialist, and be given a surprise medical bill. These unpleasant surprises may hold exorbitant costs that place financial pressures on families, having sent many into medical bankruptcy. As an advocate for consumer protection, we need to tackle this situation to limit the surprise billing hampering one in six of our fellow citizens. With amplified discussion around the topic at capitol hill, we will dive into the proposed legislation and the downstream effects imposed on each segment of the healthcare system.
Opinion and Insight:
Before we begin, let’s just set the stage for the stakeholders impacted by legislation around surprise medical billing. The hospital, the provider, the insurer/payor, and most importantly, the patient. I discussed a common surprise billing situation in the why section, but I want to leave an anecdotal story here in an appeal to your ethos. This is absurd: “Patient advocate Sonji Wilkes told her story about getting smacked with a $50,000 bill after her newborn son was diagnosed with hemophilia and spent several days in the neonatal ICU."
"The hospital where she'd delivered him was in-network, but the subcontracting company that ran the NICU just down the hall was not, she said.”
Again, you just read the words ‘the subcontracting company that ran the NICU’...................
How Did We Get Here? You can start with the inflated cost to provide care in the first place and finish with the concept of preferred networks; a network of physicians/physician groups, hospitals/hospital systems, emergency services (ambulances), etc. Consolidation in healthcare is purely about leverage and negotiating power through the formation of networks. Large insurers use access to their patients as a means to negotiate better rates with hospitals and physicians. In response, physicians formed physician groups to negotiate for better rates with insurers who need their patients to be cared for by someone. Naturally, the insurers then decided ‘better to buy than negotiate’ which set off a string of insurer-led purchases of physician groups; looking at you United HealthCare, the largest single employer of doctors in the US, for which it is safe to assume that, ‘the thirst is real’.
(Honestly, I don't know that I've ever been more proud of a self-generated meme in my life)
Naturally, at the same time the hospital/hospital system alignments have coincided to deliver better rate negotiation with insurers because, like with physicians, patients have to be hospitalized somewhere. (Obviously ACO's through the ACA huge piece to this). Once again, acting like insurers, hospitals began to buy up physician groups to bolster their bargaining power and more recently due to the lack of site-neutral payments by CMS (further evidenced by the increased proportion of Part B spend in hospitals over physician offices and 54% of oncology practices now being owned by hospitals/health systems!!!!). These market forces playing out over decades have resulted in very few independent hospitals and physicians, not dissimilar to the retail pharmacy space. This consolidation has lead to drastically different rates for in/out of network billing (many insurers outlaw balance billing for their members) combined with narrowing networks has manifested itself in these surprise bills. As a business practice, the formation of networks should lower rates for consumers through lower premiums, and it does. However, the percentage of that savings passed along to consumers through those vehicles may not outweigh the reduction in providers and the difficulty in avoiding out-of-network care. I tend to take the more cynical approach and view network development as a way to maintain profit margins without truly funneling the appropriate proportion of those savings down to members (COE being different).
What Are We Trying to Do About It? One proposed solution is to limit out-of-network bills to a benchmark price based on the average billing of the same service by providers in the same area or a median of the in-network costs. The determination of this average price is an issue as “lawmakers were also clearly frustrated as they sought specific answers, such as how to calculate average prices that hospitals, doctors and payers could all agree to. ‘Why is it we can’t find an average when we start negotiating prices?’ Markwayne Mullin, R-Okla., asked." All of us working in healthcare and the associated cloak of pricing determinations find this tongue-in-cheek in that we grapple with the same question and lawmakers are just now expressing this concern. Continuing on through the frustration of answers lawmakers were receiving, Mullin, in classic Southern twang, espoused “If y’all don’t want to solve it, we’re going to. All we’re saying is, do it. Solve it." This was the not-so-idle threat of the lawmakers to the private market stakeholders to figure their shiz out, or legislation will figure it out for them.
And honestly, there is no way that a guy named Markwayne wasn’t touching the brim of his cowboy hat while issuing that threat.
The pointing Spidermans (Spidermen?) should probably work through this themselves or play ball with lawmakers in crafting legislation before the government steps in and makes those decisions for them.
What are the ramifications of benchmark pricing? In this environment, the hospital/provider would be eating that added bill while the insurer pays the lower negotiated network rates for these services. To further the concerns of hospitals “this solution suggests insurance companies will offer doctors artificially low in-network rates, which, in turn, will bring down out-of-network rates. Those low rates will make it hard for doctors and hospitals to make up for uncompensated care or low payment rates from Medicaid and Medicare patients. The concern is that this will make it difficult for emergency rooms and rural hospitals to operate and force them to close.” I’m not fully on board with this broad defense of the hospital system in reducing the safety net because I loathe Medicare payment rates being the boogeyman, but clearly eating revenue will limit their ability to provide service, offering the argument merit.
California has implemented this payment model by tying out-of-network costs to 125% of Medicare rates, which the California Medical Association believes “means that insurers can push doctors out of their network, by canceling contracts or demanding artificially low rates, in order to make the benchmark rate the default. In California, where a benchmark rate has been implemented, doctors report that insurance companies are already doing this and that Californians’ premiums are rising.” Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, responded saying that there is not enough data yet from California to say whether insurance companies are kicking doctors out of networks.
“Despite what the medical association is saying, we don’t have any evidence on this question one way or the other,” Adler said.
In terms of premiums rising I would argue back, isn’t that the point of insurance? If premiums rise, it would be a minimal amount, and that rise in premiums is to spread those out-of-network costs absorbed unfairly by a small percentage of patients across the entire plan. Again, insurers are managing risk and do not absorb those added costs, it passes on to patients, but as a metric to resolve surprise medical billing there may be a potential solution here. The setting of the market rates must have guidance and minimums in my opinion or the large insurers will rule the day with rate bullying our providers and hospitals.
What else are we trying to do about it?: The other solution being discussed is arbitration, which would send the insurers and healthcare providers through an independent review (IDR) to determine a fair price. On this front, we have existing evidence as this is an approach piloted in New York. “New York's law protects patients from owing more than their in-network co-payment, coinsurance or deductible on bills they receive for out-of-network emergency services or on surprise bills.” The idea is to take these two sides, providers and insurers, and try to find a middle ground for an agreed share of the remaining cost of the service through negotiation or arbitration. Channeling my inner McConaughey I'd say that sounds 'alright, alright, alright' and the majority of claims have been negotiated prior to reaching arbitration. However, the problem in New York is that the initial guidance in the law sought to ‘suggest’ arbitrators seek a price that is roughly 80% of the out-of-network rate of the service. Rather than serve as a suggestion, these arbitrators have essentially just towed that 80% line every time in their decision-making. This begs the question, why the hell is there even arbitration in the first place if the settlement is a number based on guidance? What sort of evaluation technique are these arbitrators even using? Seems like we may leave arbitration to terrible rookie baseball deal extensions that totally ARE NOT biased to the MLB’s favor AT ALL.
Arbitration could be a solution which yields positive results and allow those arbitrators to distinguish between predatory pricing on the hospital side and predatory rate setting on the insurer side, but can we trust individual arbiters to be the experts on those determinations? Not sure, that is a tough proposition, but I’m still hopeful in the power of effective arbitration. The reason to hold out hope is that “perhaps most importantly, IDR has not caused premiums in New York to climb higher than other states.”
Lets shut this down: As the stakeholders argue among themselves, Congress has made it abundantly clear: Leave the Patient Out of It. Again, it’s Congress so... grain of salt. On a state basis, we are limited by ERISA which aforementioned, protects self-insured plans from state laws for the most part.
Hence, sweeping federal legislation is the only resolve for surprise medical bills.
Lastly, and I want to press this, our current system stacks the deck for patients to lose in the surprise billing war through payment in full or collections. Regardless of the solution, insurers and hospitals/providers must eat that cost; none of those stakeholders are going to love the final solution. I realize this was a myriad of information while definitely missing some points, but I think we can all appreciate this issue being discussed as consumers and potential victims of surprise medical billing.
Doctors and Plans Argue Over Surprise Medical Bills:
Health System Tracker on Developments:
CVS Takes Aim at Hyperinflated Drug Prices
Strategic Formulary Removals Help Contain Costs
What: “Introduced in 2017, this strategy was designed to help blunt the impact of drugs with significant inflation from one year to the next. We continually review and identify drugs that are seeing high price increases and those that are outliers based on price, including new market entrants. The flexible approach and ongoing removals – rather than annual – helps ensure that clients can stay ahead of rapidly changing market trends, rather than simply reacting to market changes."
Why: “As part of our hyperinflation strategy, we removed five drugs from our template formularies in April. Utilization of the removed drugs dropped by 99 percent in the months following the move. These removals are projected to save clients $0.38 PMPM or $4.60 PMPY. In 2018, clients aligned with our template formularies with drug removals spent $88.30 on average per 30-day supply compared to $102.58 for those on formularies without drug removals.”
Opinions and Insights:
You’ve made it this far so I’ll be brief. Take a bow, congratulations, wow! Call me cynical but I’m only giving this is a golf clap the quality Chubbs gave after Happy makes the 10th putt on the first hole of his initial tournament; it was about time.
Now, I do not mean to condescend the program itself as I realize this is a press release and product intended to be marketable to clients, as you would expect from any smart company with a competent PR team. The condescending nature comes from my belief that these hyperinflated drug programs should be a staple of the pharmacy benefit rather than a marketable tool, so to be clear, this hyperinflated drug list is a valuable program with altruistic intentions. By that measure, I want to simply examine the value of these formulary removals. Most PBMs including Caremark have been doing a version of the hyperinflated drug program since at least 2017 and many much further back.
And yet, I have seen a client with Glumetza and Duexis scripts wasting nearly $200k in 2017.
We knew this then, like we know this now. It’s a pretty simple fix monitoring your drug benefit and being flexible to input these NDC blocks, hopefully without charging for them (does occur), to combat these inflated prices on low value drugs as they appear in the market. The fact Glumetza scripts still make it through a benefit these days is almost an indictment on the process itself. For their part, the PMPM savings in comparison to the control group formulary presented by Caremark in their program are impressive. The decision to remove metformin ER in particular was likely a large driver and clinically interesting given the documented differences in GI AE’s to the different dosage forms.
The continual market check on these hyperinflated drugs should be an essential part of a drug benefit to root out the Duexis’, Glumetza’s, Chlorzoxazone’s, Zegerid’s and Jublia’s of the world.
I would argue Optum's 'Vigilant Drug List' (part of their Premium Value Formulary) is the most effective while Navitus' ‘Dumb Drug List’ holds the most poignant name.
To be clear, very few of these are making it through the cracks, yet easy fixes could sure up the dam indefinitely, especially for self-insured clients absorbing those unnecessary costs. Not having these measures in place would be like allowing someone to still draft Kevin White in fantasy. Is he a guy that is capable of providing the service of being a WR on your team? Sure, but is he going to be worth the price you paid? Not a chance in the world. Take him out of the draft pool in your fantasy league and all owners will be much happier.
CVS Payer Solution:
https://payorsolutions.cvshealth.com/insights/blunting-the-impact-of-hyperinflated-drugs
Kaiser Releases Their 2019 Employer Health Benefit Survey
Kaiser Family Foundation publishes their annual market check on the health benefit offerings of US Employers
What: “Employer-sponsored insurance covers over half of the non-elderly population; approximately 153 million nonelderly people in total. To provide current information about employer-sponsored health benefits, the Kaiser Family Foundation conducts an annual survey of private and non-federal public employers with three or more workers. This is the twenty-first survey and reflects employer-sponsored health benefits in 2019.”
Why: Most all of us will be insured under an employer provided health benefits, therefore, we should probably have an understanding of the overall trends and landscape of the employer provided benefit. The numbers presented also give a frame of reference when discussing the commercial market and the impact that benefit design and clinical programs have on a large portion of us.
Opinions and Insights:
To be still reading at this point is nothing less than perspiration-earned perseverance on the part of your eyeballs. I’ll keep it light by simply aggregating some stats and graphs while giving emoji filled captions like I’m Healthcare Bleacher Report.
The Placated Premium
The average premium for single coverage in 2019 is $7,188 per year. The average premium for family coverage is $20,576 per year. We can see the increase in the family premium and our contributions over the decade below.
The most interesting finding to note is that:
In spite of narrow networks, limited choices, and higher deductibles: employee percentage of premium has not changed while the cost of the premium has exclusively increased.
The Dreaded Deductible
The deductible ties in with the premium, whereby a higher premium should mean lower deductibles. Obviously, both of these have risen, evidenced by the percentage of workers in a $2,000+ deductible plan having increased all while their percentage of the premium has remained the same. AKA increased shift in employee cost-share.
Among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,655, similar to last year.
The average annual deductible among covered workers has increased 36% over the last five years and 100% over the last ten years.
"Deductibles have increased in recent years due to higher deductibles within plan types and higher enrollment in HDHP/SOs. While growing deductibles in PPOs and other plan types generally increase enrollee out-of-pocket liability, the shift to enrollment in HDHP/SOs does not necessarily do so because many HDHP/SO enrollees receive an account contribution from their employers. Twenty-one percent of covered workers in an HDHP with an HRA/HSA, receive an account contribution for single coverage at least equal to their deductible, while another 22% of covered workers in an HDHP with an HRA/HSA receive account contributions that, if applied to their deductible, would reduce their actual liability to less than $1,000."
This means that about 45% of workers with HDHP's receive employer contributions to bring their deductible down to less than $1,000.
AKA a tax loophole for the employer whose HSA contribution is not taxed (neither is the employee contribution) as opposed to being taxed accordingly on a higher premium, lower deductible plan. Despite these numbers, over half of all members do not have this employer contribution or likely at a much smaller number.
Even with those facts in mind, enrollees in HDHP/SO increasingly face benefit designs with coinsurance as opposed to co-payments. This has contributed to the popularity and rise in GoodRx and discount programs as the exposure to the inflated AWP reduces the incentive to contribute to your $2k+ deductible. See Fein’s analysis on that tiering structure below
The Plan Funding
Self-Funding. Sixty-one percent of covered workers, including 17% of covered workers in small firms and 80% in large firms, are enrolled in plans that are either partially or completely self-funded. Seven percent of small firms report that they have a level-funded plan. These arrangements combine a relatively small self-funded component with stoploss insurance with low attachment points that may transfer a substantial share of the risk to insurers.
Prescription Drug Knowledge
Among employers offering health benefits with 1,000 or more employees, 27% say that they receive ‘most’ of the prescription drug rebate negotiated by their PBM or health plan, 32% say that they receive ‘some’ of the negotiated rebate, 18% say that they receive ‘very little’ of the negotiated rebate, and 23% do not know. Just an interesting tidbit on the dearth of employer knowledge of their prescription drug benefit and the appetite for clearer contractual language.
Congratulations team, against all odds you made it to the end. Take your Tiger 2019 Master's Redemption Moment.
KFF Summary:
https://www.kff.org/report-section/ehbs-2019-summary-of-findings/
Fein’s Synopsis:
https://www.drugchannels.net/2019/11/employer-pharmacy-benefits-in-2019-high.html
Catch Up on August's Top 5 Stories Here!
https://www.dhirubhai.net/pulse/augusts-top-5-stories-managed-care-pharmacy-ethan-heidorn/
Special Thanks
Special thanks to my mentors and other professionals that helped me gain a greater understanding of these stories.
Final Note
*All comments are opinion based and subject to fair criticism and disagreement or further enlightenment.
Self-funded Health Plan Management | PBM Consulting | Healthcare Analytics
5 年I enjoyed your post very much, Ethan. Excellent work!