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 […]
Read MoreIt’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 […]
Read MoreNew 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 […]
Read MoreFix 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 […]
Read MoreNew 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 […]
Read MoreIt’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 […]
Read MoreExpress 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 […]
Read MoreLessons 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 […]
Read MoreStriking 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 […]
Read MoreBloomberg 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 […]
Read MoreManufacturers 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 […]
Read MoreDon’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 […]
Read MoreDon’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 […]
Read MoreMessage 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 […]
Read MoreTake 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 […]
Read MorePay 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 […]
Read MoreMORE 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 […]
Read MoreThe 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 […]
Read MoreEnd 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 […]
Read MoreHep 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 […]
Read MoreControlling 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 […]
Read MoreProtect 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 […]
Read MoreControl 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 […]
Read MoreStop 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 […]
Read MoreWhen 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 […]
Read MoreStop 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 […]
Read MoreProtect 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 […]
Read MoreIt’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 […]
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