Linda Cahn, Author at National Prescription Coverage Coalition

‘PBM Busters’ Find Employers Unaware of Price Mark-Ups By Drug Middlemen

By Lucas Sullivan. December 24, 2018.

CVS Caremark Wants To Make Drug Rebates a Thing of the Past

December 6, 2018.

CVS Boasts That A New Pricing Model Will Lower Drug Costs For Health Plans. Will It?

By Ed Silverman. December 5, 2018.

FDA Promised a ‘Lower-Cost Option’ to Epi-Pen, But the Price Isn’t Any Lower

By Ed Silverman. November 27, 2018.

What Rebates? Express Scripts Touts A New Plan To Appease Critics Of The Opaque Drug-Pricing System

By Ed Silverman. November 13, 2018.

More States, Including Pa., Are Taking On Pharmacy Benefit Managers, Demanding To See the Savings In Medicaid

By Catherine Dunn. November 9, 2018.

The Unclear Benefits of Drug Price Coalitions

By Bob Herman. September 27, 2018.

Never Mind the Rebates. Maybe Behind-the-Scenes Fees Are Boosting Drug Prices

By Ed Silverman. August 16, 2018.

Create Rational Quantity Limits For Specialty Drugs

Any Plan that wants to control its prescription coverage costs needs to control the “days supply” of Specialty Drugs that will be dispensed by its PBM. Your Plan can’t afford to squander precious money on Specialty Drugs that your Plan beneficiaries may never use and may instead flush down the toilet. Therefore, if you haven’t […]

In Prescription Drug Business, Will Amazon Partner with PBMs, Or Seek to Conquer Them?

By Casey Ross. July 16, 2018.

Ohio Peels Back The Curtain On A Lucrative PBM Profit Center

By Ed Silverman. June 22, 2018.

What New Jersey’s Drug Plan Do-Over Says About the Industry

By Bob Herman. May 16, 2018.

Decreasing Drug Costs – Here’s How We Achieved Them

We’re thrilled to report yet again that the National Prescription Coverage Coalition has achieved striking savings for our Coalition Members.

Based on year-end analyses, our Coalition Members decreased their prescription coverage costs by approximately 20% to 30%.

Drug prices continue to climb despite barrage of criticism

By Angelica LaVito. March 21, 2018.

More Drug Price Increases

Remember when several drug manufacturers promised last year to limit their drug price increases to single digits and claimed other drug manufacturers drastically increasing their drug prices were “outliers”? If those manufacturers’ words made you think the days of price gouging were over, think again.

UnitedHealthcare will pass some rebates to consumers, but will this really lower drug prices?

By Ed Silverman. March 6, 2018.

Washington is taking aim at drug industry middlemen. But can it break their grip on a captive market?

By Casey Ross. February 16, 2018.

Long-Dreaded Amazon Threat to Drug Middlemen Draws Closer

By Robert Langreth and Zachary Taylor. January 30, 2018.

Your Plan Can Decrease Its Prescription Coverage Costs (But You Need To Take Action To Do So)

We’re thrilled to report yet again that the National Prescription Coverage Coalition has achieved striking savings for our Coalition Members. Based on year-end analyses, our Coalition Members decreased their prescription coverage costs by approximately 20% to 30%. Sound too good to be true? It’s not. These savings resulted from our Coalition Members implementing dozens of ongoing recommendations provided by our Coalition experts, such as: […]

PBMs: Will the Amazon Cometh?

By Robert Calandra. December 1, 2017.

Congress Needs the Political Courage to Defy the Drug Manufacturer Lobby

Linda Cahn, Op-Ed Contributor. November 17, 2017.

Act Now – Block Lyrica CR Preemptively

If your Plan wants to control its prescription coverage costs – and minimize disruption to your plan beneficiaries – your Plan needs to act preemptively to block certain drugs before they even enter the market. Lyrica CR exemplifies why.

Read this to understand Pfizer’s – and other manufacturers’ – ploys that prevent your Plan from saving money from generic drugs. And learn how you can counter manufacturers’ strategies by blocking certain newly-approved, but entirely unnecessary, drugs before your Plan beneficiaries start taking them.

Act Now – Block Lyrica CR

If your Plan wants to control its prescription coverage costs – and minimize disruption to your plan beneficiaries – your Plan needs to act preemptively to block certain drugs before they even enter the market. Lyrica CR exemplifies why. Lyrica CR was just approved by the FDA and will soon be sold in the United States. The […]

Hey, Amazon: As a pharmacy benefit manager, you could create real competition for drug prices

Op-Ed by Linda Cahn. November 15, 2017.

Time to Lift the Curtain on PBM Wheeling and Dealing

by Robert Calandra.

Plan Administrators: Limit Your Restasis Coverage

If you missed the latest example of drug manufacturer abuse, you need to learn about Allergan’s Restasis antics, understand your Plan’s resulting costs, and take action in response.

Why? Because you’ll not only save your Plan considerable money by acting on a single drug, you’ll also help teach Allergan a much-needed lesson and discourage other manufacturers from engaging in similar abuses.

It’s Time To Limit Your Coverage of Restasis

If you missed the latest example of drug manufacturer abuse, you need to learn about Allergan’s Restasis antics, understand your Plan’s resulting costs, and take action in response. Why? Because you’ll not only save your Plan considerable money by acting on a single drug, you’ll also help teach Allergan a much-needed lesson and discourage other manufacturers […]

Customized Restasis PA

New Rx Drugs: The “Latest” Is Not Necessarily The “Greatest” When It Comes To Drugs

Rx Alert – October 2014 The drug marketplace is constantly changing, and new prescription drugs are continually entering the marketplace. To protect your plan beneficiaries’ health – and your Plan’s financial resources – your Plan needs to position itself to monitor – and respond – to all these new drug developments. You may assume that […]

Fix Your Claims Data Errors – Or Lose Money & Eviscerate the Meaning of Your PBM Contract’s Financial Guarantees

It’s critically important that every health plan monitor its claims data to determine whether claims data errors are allowing your PBM to overcharge for drugs and misrepresent whether the PBM is satisfying contract pricing guarantees. As you read through our example of a claims data error – and the impact that it had – you’ll […]

New Hep C Realities: December 2014-January 2015

During the final days of 2014 and first week of 2015, newspapers around the nation announced three new developments that purportedly changed the prescription coverage world: On December 19th, the FDA finally approved another new treatment for hepatitis C, AbbVie’s Viekira Pak [1] Only days later, the largest Pharmacy Benefit Management company, Express Scripts, proclaimed […]

Plan Administrators and Fiduciaries: It’s Time To Take REBATE ACTION – File An Accounting Procedure!

As newspaper articles multiply describing PBMs’ questionable rebate conduct, every Plan administrator and fiduciary should consider filing a lawsuit against your PBM seeking an “accounting”. As a Plan administrator or fiduciary, you’re charged with ensuring your Plan receives all monies your Plan is entitled to receive. Moreover, through an accounting, you’re likely to discover your PBM has been hiding large amounts of monies that, if reimbursed, would significantly decrease your Plan’s costs. And given the amounts your Plan may recover, you’ll likely be able to locate a law firm to file a lawsuit on a contingency basis, meaning the litigation won’t cost your Plan a dime.

It’s Time To Determine How Much Your PBM Is Depriving Your Plan Of Rebates: File An “Accounting” Procedure

As newspaper articles multiply describing PBMs’ questionable rebate conduct, every Plan administrator and fiduciary should consider filing a lawsuit against your PBM seeking an “accounting”. As a Plan administrator or fiduciary, you’re charged with ensuring your Plan receives all monies your Plan is entitled to receive. Moreover, through an accounting, you’re likely to discover your PBM has been hiding large amounts of monies that, if […]

How Two Common Medications Became One $455 Million Specialty Pill

by Marshall Allen. June 20, 2017.

How Two Common Medications Became One $455 Million Specialty Pill

by Marshall Allen. June 20, 2017.

Q&A (with Linda Cahn): Pharma and PBMs are in a ‘Two Step Dance’ that Raises Drug Prices

by Ed Silverman. June 13, 2017.

How ‘Price-Cutting’ Middlemen Are Making Crucial Drugs Vastly More Expensive

by Michael Hiltzik. June 9, 2017.

No Quick Cure for Express Scripts’ Ailing Shares

by Bill Alpert. June 5, 2017.

A Drug Quintupled in Price. Now, Drug Industry Players Are Feuding Over the Windfall

by Charles Orenstein and Katie Thomas. June 1, 2017.

Express Scripts Sues Manufacturer of Overdose Treatments

by Angela Mueller. June 2017.

Express Scripts Sues Maker of Overdose Drug, Intensifying Feud

by Katie Thomas and Charles Orenstein. May 31, 2017.

Express Scripts’ Lawsuit Reveals Striking Information About PBM Rebates

For years, PBMs have consistently refused to disclose any information about their secret “deals” with manufacturers to obtain “rebates” – that PBMs presumably pass through – and “other monies” – that PBMs collect from manufacturers but PBMs may retain for themselves.

But now, a new lawsuit filed by Express Scripts against the drug manufacturer kaleo reveals at least some information about Express Scripts secret deals. And the information is shocking. Express Scripts is clearly collecting mega-millions of dollars from manufacturers, and much of that money is labeled “administrative fees” and “price protection rebates” that Express Scripts may not be entirely passing through to its clients or the federal government. Every Plan administrator and fiduciary – and the federal government – should insist on learning more about the millions that Express Scripts and other PBMs are collecting.

Express Scripts Lawsuit Should Raise Everyone’s Eyebrows

For years, every PBM has refused to disclose the “rebates” that it earns on a drug-by-drug basis. As a result, no one has been able to detect the “net cost” of any drug (factoring in rebates), which means no one can assess whether a PBM’s formularies and programs favor higher-cost or lower-cost drugs. Every PBM has also refused […]

A Drug Quintupled in Price. Now, Drug Industry Players Are Feuding Over the Windfall

by Charles Orenstein and Katie Thomas. May 31, 2017.

Would Amazon Really Succeed As A Pharmacy Benefit Manager?

by Ed Silverman. May 18, 2017.

Want To Decrease Your Rx Coverage Costs? Pay Attention to Horizon Pharma’s 1st Quarter Report

Horizon Pharma – the manufacturer of three extremely expensive drugs – Vimovo, Duexis and Pennsaid – just released its Quarterly Earnings Report causing its stock to plummet. The Report should cause every Plan to stop providing coverage for all 3 of these drugs and stop relying on its PBM’s “standard” Formulary.

Lessons from Horizon Pharma: Stop Covering Vimovo, Duexis and Pennsaid and Stop Relying on Your PBM’s “Standard” Formulary

Horizon Pharma – the manufacturer of three extremely expensive drugs – Vimovo, Duexis and Pennsaid – just released its Quarterly Earnings Report causing its stock to plummet. The Report should also cause every Plan to stop providing coverage for these 3 drugs and to stop relying on its PBM’s “standard” Formulary. Read on, and we’ll explain […]

Drug Company Says Discount Program Will Lower Prescription Prices

Dayton Daily News. May 11, 2017.

Express Scripts and Some Drug Makers Say They Can Work Together To Lower Costs

by Ed Silverman. May 8, 2017.

Inside the ‘Scorpion Room’ Where Drug Price Secrets Are Guarded

by Neil Weinberg and Robert Langreth. May 4, 2017.

Striking Savings Are Possible (But Your Plan Needs To Act To Obtain Them)

We’re thrilled to report that yet another Coalition Member that followed our Coalition’s recommendations and took aggressive steps to control its prescription coverage costs has now achieved a 16% cost decrease.

Striking Savings Are Possible (But Your Plan Has To Act To Get Them)

We’re thrilled to report that yet another Coalition Member that followed our Coalition’s recommendations and took aggressive steps to control its prescription coverage costs has now achieved a 16% cost decrease. Sound too good to be true? Our Coalition Member implemented a host of changes on January 1, 2017. Here’s a Table comparing the Coalition Member’s 4th quarter 2016 total prescription […]

A Secret Profit Formula Loved by Drug Middlemen Is At Risk

by Robert Langreth and Neil Weinberg. April 26, 2017.

The Hidden Monopolies That Raise Drug Prices: How Pharmacy Benefit Managers Morphed From Processors to Predators

by David Dayen. April 3, 2017.

Spread Pricing – Marking Up Drug Claims

As featured on The National Community Pharmacists Association (www.ncpanet.org).

Bloomberg Article on PBMs – quotes Cahn

Drug Costs Too High? Fire the Middleman Caterpillar’s lowered drug bills show why pharmacy benefit managers are under fire. by Neil Weinberg and Robert Langreth March 3, 2017 at 5:00:12 AM EST From Bloomberg News A decade ago, Caterpillar Inc. looked at its employee drug plan and sensed that money was evaporating. The bills for pills had increased […]

A New Senate Bill Would Require PBMs to Disclose Some Rebate Info

by Ed Silverman. March 15, 2017.

Drug Costs Too High: Fire the Middlemen

by Neil Weinberg and Robert Langreth. March 3, 2017.

For E.D., The Doctor is In But the Men Are Staying Away: Physicians Find Men Lack Interest In Seeking Medical Care If They Can’t Get Coverage for Erectile Dysfunction

by Joseph Burns.

Pull Back the Curtain on Manufacturers’ and Switch Operators’ Efforts To Undermine Your Plan’s Cost Savings Efforts

Like most health plans, your plan may be doing all it can to steer your plan beneficiaries to use lower-cost drugs. But manufacturers are paying switch operators (like Relay Health and Change Healthcare) to foil your efforts. If you don’t know what switch operators are or what they do – or your plan is not taking steps to counter switch operators’ machinations – you need to read this article.

Manufacturers Are Using “Switch Operators” To Undermine Your Plan’s Cost Saving Efforts

Plan Administrators: Have you ever heard of “switch operators”? Do you have any idea what they do? Most important, do you realize that drug manufacturers are surreptitiously paying switch operators to interfere with your copayment and deductible structures and likely causing your plan (and all other plans) significant financial harm? If your response to all these questions is […]

Pharmacy Benefit Managers Could Be In Legislative Crosshairs

by Christian Britschgi. January 3, 2017.

Don’t Be Fooled By Eli Lilly’s & Express Scripts’ New Diabetes Program

In December 2016, Eli Lilly and Express Scripts announced a new diabetes treatment program to provide 40% discounts on three Lilly diabetes drugs. But the program is anything but what it appears. We explain why in this article, and provide recommendations for health plans and our media friends.

Don’t Be Fooled By Eli Lilly’s & Express Scripts’ New Insulin Program

If you’ve been preoccupied with Trump’s latest cabinet appointments, you may have missed the news about a new program sponsored by Eli Lilly and Express Scripts. With great fanfare, the two entities reported that beginning on January 1, 2017, they’ll provide a 40% discount on three Lilly diabetes drugs: Humalog, Humulin and Basaglar. They’ll do so […]

Don’t Be Duped By Manufacturers’ Single Digit Price Increase Pledges

Two manufacturers – Allergan and Novo Nordisk – recently won headlines when each vowed to limit the company’s annual drug price increases to single digit numbers. But such increases are anything but laudatory. We explain why in this article.

Don’t Be Duped By Manufacturers’ New “Single Digit Price Increase Pledges”

Recently, Novo Nordisk’s President became the second drug manufacturer to make a “Single Digit Price Increase Pledge.” Replicating Allergan’s vow three months ago, Novo’s Jakob Riis promised that Novo would “create affordability” by limiting price increases “to no more than singe-digit percentages annually.” Both manufacturers’ vows are certainly appealing, at least at first glance. And numerous commentators seem to be hoping that more […]

Message from Mylan: It’s Time For Every Health Plan To Address Rebate Issues

For more than a decade, our firm has called on every PBM to identify all rebates (and other monies) the PBM is receiving from manufacturers – as well as the “net costs” of every drug – to enable Plans and their beneficiaries to easily identify and favor the lowest-cost drugs in each therapeutic category. While we’ve had success in getting a […]

Message from Mylan: Pay Attention to Rebates

In recent testimony before a House Committee, Mylan’s CEO asserted that $334 of EpiPen’s list price of $608 – or 55% of the total $608 – could be attributed to PBMs and three other drug channel vendors extracting payments from Mylan.

Soon, other evidence emerged reflecting manufacturers’ price increases related to diabetes and rheumatoid arthritis drugs might be related to PBMs’ rebate activities. These new developments make clear that every Plan administrator needs to understand the complex world of drug manufacturer rebates and other payments, and develop strategies that will address these issues.

Take Action To Decrease Your Plan’s Crestor Costs

If you examine your Heath Plan’s claims data, it’s extremely likely you’ll discover that Crestor is costing your Plan a small fortune. Typically, Crestor represents more than 1% of a Plan’s total annual drug costs. As a result, Crestor almost always appears on a Plan’s list of “Top Twenty Most Expensive Drugs.” Frequently, Crestor is among the “Top Ten” – jockeying to collect even more money from Plans than many high-cost specialty drugs.

But as if manna has fallen from heaven, there is now a means to reduce your Health Plan’s costs. Details can be found in this article.

Take Action To Decrease Your Plan’s Crestor Costs

If you examine your Heath Plan’s claims data, it’s extremely likely you’ll discover that Crestor is costing your Plan a small fortune. Typically, Crestor represents more than 1% of a Plan’s total annual drug costs. As a result, Crestor almost always appears on a Plan’s list of “Top Twenty Most Expensive Drugs.” Frequently, Crestor is among the […]

Pay Attention to Your Metformin HCL ER Diabetes Costs

We regularly review our clients’ claims data to detect issues that, if corrected, can reduce our clients’ costs without harming their plan beneficiaries’ drug access. Read this short article about metformin HCL ER, and you’ll understand what we’re doing, and what every health plan can – and should – do as well.

Pay Attention to Your Metformin HCL ER Diabetes Costs

If you examine your claims data, you’ll likely discover that among your “Top 50 Most Expensive Drugs” is a line item for generic “metformin HCL ER”. Metformin HCL is a longstanding, very inexpensive diabetes treatment. And ER stands for “extended release”. There are metformin HCL ER treatments that are very inexpensive. So the question is: Why would this line item be among […]

Additional Information About New Drugs’ Dangers

We received multiple requests for additional information after we published our last article describing new drugs’ dangers based on recent developments related to hepatitis C drugs. Accordingly, we have written another brief article providing additional information reflecting why all health plan administrators should exclude – or limit – coverage of many new drugs.

MORE REASONS to Protect Your Beneficiaries Against New Drugs’ Dangers

We previously wrote about new drugs’ dangers, and received many requests for additional information. Accordingly, we thought our readers would benefit from the following additional information reflecting why all health plan administrators should exclude – or limit – coverage of many new drugs: In a 2014 JAMA Internal Medicine article analyzing boxed warnings and safety-related withdrawals of 522 novel […]

The FDA’s Latest Hep C Drug Warning Makes Clear Why You Should Protect Your Beneficiaries From New Drugs’ Dangers

The latest FDA Black Box Warning about hepatitis C treatments demonstrates why it’s imperative that your Plan implement methods for protecting your beneficiaries against the dangers of new drugs. After all, more than three years after the FDA approved the first of eight new hep C treatments, the FDA has just issued yet another warning about […]

Protect Your Plan Beneficiaries From New Drugs’ Dangers

The latest FDA Black Box Warning about hepatitis C treatments demonstrates why it’s imperative that your Plan implement methods for protecting your beneficiaries against the dangers of new drugs.

After all, more than three years after the FDA approved the first of eight new hep C treatments, the FDA has just issued yet another warning about a newly discovered danger related to these drugs.

End Your PBM’s Refill Pill Mill

Unbeknownst to health plans, many PBMs are dispensing through their subsidiary pharmacies far more pills than needed, at great cost to the health plans. Thus, if your health plan is trying to contain its costs, you need to investigate your PBMs’ refill practices and end all excessive dispensing by your PBM’s refill pill mill. Auto-fills […]

Hep C Drugs: Is Your Plan Really Benefiting From Your PBM’s “Deal”?

HR Execs: Do you think your PBM’s shake-down of hepatitis C manufacturers really decreased your health plan’s costs? If so, you should follow Ronald Reagan’s approach with the Russians: “Doveryai no Proveryai” – “Trust but verify.” Why? Because based on an in-depth investigation just completed by our firm: If you review your plan’s claims data, you’ll […]

Controlling New Specialty Drug Costs: Lessons from Farydak & Kalydeco

In February 2015, the FDA approved Farydak, a new treatment for multiple myeloma. The drug’s wholesale price: $6,860 for a 21 day cycle. But note that unless a health plan negotiates strong discounts with its PBM, a health plan’s costs are likely to be even higher than the wholesale price! With a recommended treatment of 8 cycles of […]

Protect Your Health Plan Against Astronomical Drug Price Increases

Drug prices were in the news this week because of a shocking 5000% increase in the cost of a single drug: Daraprim. But during the first 9 months of 2015, the average wholesale price (AWP) of almost 50 drugs more than tripled! Given this striking fact, unless your plan – or Coalition – positions itself to learn about […]

Control Testosterone Use – For Health & Cost Reasons

Spend a few minutes studying your health plan’s claims data, and you’ll very likely discover your plan is spending large sums of money on men’s testosterone products. In fact, you’ll likely discover your plan is spending several thousand dollars a year for each male beneficiary who is choosing to rub gel into his shoulders in the […]

Stop Covering Rx Drugs That Are Available Over-the-Counter

Virtually all health plans are spending a small fortune covering Proton Pump Inhibitors – drugs like Nexium, Prilosec and Prevacid, and their generic equivalents (esomeprazole, omeprazole and lansoprazole). Unfortunately, almost no PBMs are bothering to tell their clients how they can eliminate – or at least decrease – their Proton Pump Inhibitor costs. Therefore, health plans need to educate […]

When Drugs Lose Their Patent Protection, Change Your Coverage and Save!

If your Plan is like most Plans in the country, you are spending a small fortune on Abilify, even though Abilify lost its patent protection in 2015 and a generic equivalent is available at far lower cost. Your Plan is also likely spending even more on Crestor, which will lose its patent protection in May 2016. And then there’s Zetia, Benicar and Seroquel […]

Stop Paying For Drugs The FDA Has Never Even Approved

Approximately 100 years ago, at the turn of the twentieth century, anyone could market any concoction claiming it solved any – or every – health problem. Dr. Bull advertised a purportedly remarkable cough syrup. Lydia Pinkham marketed a cure-all Vegetable Compound. Lloyd Manufacturing even advertised cocaine toothache drops. You may assume that all such snake-oil remedies are things of […]

Protect Your Plan: Address Extreme Price Increases

You’ve undoubtedly heard that Turing Pharmaceuticals purchased a low-cost drug, Daraprim, and raised its cost by 5433% last year. And Turing’s smug CEO, Martin Shkreli, defended the price hike as perfectly reasonable. But are you aware that several other drug manufacturers are continually purchasing drugs and dramatically increasing their prices? And do you know that during the past 12 months […]

Does Your Health Plan Actually Need the Large Chain Pharmacies In Your Retail Pharmacy Network? (The Short Answer is “No!”)

Most health plans’ prescription coverage programs allow plan beneficiaries to purchase drugs at virtually all retail pharmacies in the United States, regardless of the prices charged by those pharmacies.

But in a time of spiraling drug costs, every health plan administrator should consider excluding either – or both – of two of the highest-cost chain pharmacies: CVS and Walgreens. Read this article to find out why.

It’s Time To Exclude High-Cost Pharmacies From Your Retail Pharmacy Network

Most health plans’ prescription coverage programs allow plan beneficiaries to purchase drugs at virtually all retail pharmacies in the United States, regardless of the prices charged by those pharmacies. But in a time of out-of-control drug costs, every health plan administrator should be questioning this approach and asking two critical questions: How many retail pharmacies are needed in my plan’s pharmacy network […]

The ‘Gouge Factor’: Big Companies Want Transparency In Drug Price Negotiations

by Ed Silverman. August 2, 2016.

Pharmacy Benefit Managers Under Pressure

by Bill Alpert. Cover Story, July 23, 2016.

Pharmacy Managers Unleash Big Data

by Zachary Tracer. June 30, 2016.

Are You Taking Action To Protect Your Health Plan Against Extreme Drug Price Increases?

You’ve undoubtedly heard that Turing Pharmaceuticals purchased a low-cost drug, Daraprim, and raised its cost by 5433% last year. And Turing’s smug CEO, Martin Shkreli, defended the price hike as perfectly reasonable. But are you aware that several other drug manufacturers are continually purchasing drugs and dramatically increasing their prices? And do you know that during the past 12 months the prices of almost 150 brand drugs increased by 100% or more?

Most important of all: Do you realize that as your Plan’s administrator, you can take steps to protect your Plan against some of these outrageous price increases? Read this article to learn how to do so.

It’s Time To Stop Paying For Drugs That Were Never Even Approved By The FDA

Approximately 100 years ago, at the turn of the twentieth century, anyone could market any concoction claiming it solved any – or every – health problem. You may think that federal laws now prohibit the distribution of un-approved FDA drugs, but your assumption is dead wrong!

Moreover, you may have told your PBM – or insurer – that your health plan only covers FDA-approved drugs, but you are probably spending a small fortune for drugs that were never submitted to – let alone approved by – the FDA.

Just How Much Is Your Plan Spending On Abilify – and Other Drugs – That Have Recently Lost – Or Will Soon Lose – Their Patent Protection ?

If your Plan is like most Plans in the country, you are spending a small fortune on Abilify, even though Abilify lost its patent protection in 2015 and a generic equivalent is available at far lower cost. Your Plan is also likely spending even more on Crestor, which will lose its patent protection in May 2016. And then there’s Zetia, Benicar and Seroquel XR: Each is running up significant costs for Plans, and all will likely lose patent protection before 2016 ends.

It’s time for your plan to stop squandering money on high-cost brand drugs that have lost their patents! We explain exactly what you can do to control your costs here.

Drug Spending Increase Slowed to 5.2 Percent Last Year, Express Scripts Says

by Ed Silverman. March 14, 2016.

Secret Deals May Mean Consumers Pay More For Drugs

by Jayne O’Donnell. March 22, 2016.

Eliminate – Or At Least Decrease – Your Rx Coverage Costs For Proton Pump Inhibitors

Virtually all health plans are spending a large sum of money covering Proton Pump Inhibitors – drugs like Nexium, Prilosec and Prevacid, and their generic equivalents (esomeprazole, omeprazole and lansoprazole). Simply stated, health plans are wasting their money doing so.

Read this detailed article that will help you understand exactly how to eliminate – or at least significantly reduce – your Proton Pump Inhibitor costs.

Feds Call Prescription Drug Price 2014 Increase ‘Remarkable’

by Jayne O’Donnell. March 8, 2016.

Is Your Health Plan Controlling Its Testosterone Use?

Spend a few minutes studying your health plan’s claims data, and you’ll very likely discover your plan is spending large sums of money on men’s testosterone products.

In fact, you’ll likely discover your plan is spending several thousand dollars a year for each male beneficiary who is choosing to rub gel into his shoulders in the hope that the gel will enhance his sexuality.

But numerous previous studies – and an article in last week’s New England Journal of Medicine – make clear that covering testosterone products not only squanders your plan’s limited assets, but also subsidizes dangerous medical practices of dubious medical utility.

For an in-depth examination of the testosterone problem – and why you should take steps to address it – read this article. We’ll also provide a detailed description of precisely the steps you should take.

An Rx for Specialty Drug Management: Key to Success Lies in Better PBM Contracts, Plan Design Tweaks

by Bruce Shutan. October 2015.

Are You Protecting Your Health Plan Against Astronomical Drug Price Increases?

Drug prices were in the news this week because of a shocking 5000% increase in the cost of a single drug: Daraprim. But during the first 9 months of 2015, the average wholesale price (AWP) of almost 50 drugs more than tripled.

Given this striking fact, unless your plan – or Coalition – positions itself to learn about – and respond to – these steep price increases, as well as those that will inevitably occur in the future, your plan will not be able to control its costs. Read this article, to find out exactly how to do so.

The Frightening Implications of Farydak & Kalydeco

During the first six months of 2015, the FDA approved more than a dozen new high-cost Specialty Drugs. Two of those drugs – Farydak & Kalydeco – reflect the frightening financial implications of new specialty drugs, and steps every health plan should take to control their costs.

Here’s How To Investigate – And Then Cure – Your Hep C Drug Cost Problem

HR Execs: You’ve undoubtedly read about PBMs’ purported hep C manufacturer “shake-down,” which PBMs claim decreased health plans’ costs for hep C drugs.

But it’s reasonably likely that your plan didn’t actually receive any benefit from PBMs’ purported shake-down. In fact, it’s reasonably clear that only the PBMs actually benefited from their secret manufacturer deals.

To understand why your hep C costs are probably as high – or even higher – than they were before PBMs’ actions, read this article. We also describe what you should do to control your hep C costs.

End Unnecessary Costs From Your PBM’s Refill Pill Mill

PBMs’ refill practices are causing health plans to spend hundreds of thousands – or millions – of dollars for pills that will never be used. Every health plan should investigate its PBM’s refill practices, and insist they be changed.

Prescription Coalition Leader Warns About Increased Rx Costs From PBMs’ Refill Practices

as featured on StreetInsider.com

HR Execs: Take Note Of Hepatitis C Realities

For health plan execs that want to control their prescription coverage costs, recent hepatitis C developments provide critical lessons.

Make Sure Your Plan Continuously Monitors – and Responds to – Newly Approved Rx Drugs !

The “Latest” Is Not Necessarily The “Greatest” When It Comes To Drugs

The drug marketplace is continually changing, and new drugs are continually entering the market.

But there’s good reason to act to prevent your plan beneficiaries from using many newly approved drugs.

Read this article and learn why doing so will often protect – not harm – your Plan Beneficiaries, as well as conserve your Plan assets. And why you can’t depend on the FDA – or your PBM – to accomplish those goals.

Beware of Claims Data Errors – They Have Serious Implications!

It’s critically important that every health plan monitor its claims data to determine whether pharmacy claims data errors are allowing your PBM to overcharge for drugs and misrepresent whether it satisfied your PBM contract’s financial guarantees.

Your PBM has every reason to ignore all claims data errors. And your auditor may do so as well! But your Plan can’t ignore these errors, if you expect to control your costs.

Read this article and understand why.

Controlling Compound Drug Costs

Rx Alert – May 2014

Careful monitoring of new clients’ claims data reveals an abundance of new, high cost Compound Drug creams that are causing Plans’ costs to soar. And many – if not most – of the new compound drugs have no proven efficacy!

Read this article to understand the problem, and learn exactly what you need to do to ensure these compound drugs don’t cost your Plan immense sums.