 |
| Sep 30, 2009 |
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CDHP adoption rate rose among big employers, despite the economy |
| Sep 16, 2009 |
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Employees like their health plans, despite gaps in understanding |
| Sep 10, 2009 |
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Obama proposes controversial employer mandate, public option |
| Sep 1, 2009 |
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Hospital cracks down on ER visits |
| Aug 20, 2009 |
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COBRA enrollment soars, reports Hewitt |
| Aug 11, 2009 |
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NY law seen as harbinger of more state health reform |
| Aug 4, 2009 |
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Near-term health trends familiar, irrespective of reform |
| Jul 21, 2009 |
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Employers lukewarm on public-plan option, survey shows |
| Jul 17, 2009 |
|
House committee approves health reform bill |
| Jul 15, 2009 |
|
Senate committee passes health reform bill |
| Jul 7, 2009 |
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‘Pay or play’ not as painful as originally thought |
| Jul 1, 2009 |
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Five costly conditions to watch |
| Jun 30, 2009 |
|
Americans go online for health information |
| Jun 23, 2009 |
|
Pennsylvania passes mini-COBRA law |
| Jun 16, 2009 |
|
Health benefits taxation takes center stage |
| Jun 8, 2009 |
|
Obama alters stance on health reform proposals |
| May 28, 2009 |
|
Mail trail shows health insurers readying for reform |
| May 19, 2009 |
|
Health care costs hit women harder |
| May 7, 2009 |
|
To see a doctor, get in line |
| May 1, 2009 |
|
Considering the exit ramp: Employers rethink offering health benefits |
| Apr 23, 2009 |
|
Hard times tighten ‘use-it-or-loss-it’ bond to health benefits |
| Apr 13, 2009 |
|
COBRA subsidy expected to be costly |
| Apr 6, 2009 |
|
Workplace wellness bill reintroduced with greater support |
| Mar 24, 2009 |
|
New COBRA model notices released |
| Mar 10, 2009 |
|
Twelve ways to slash medical bills |
| Mar 1, 2009 |
|
Self-insuring is a way for employers to get 'a whole lotta cannoli' |
| Feb 23, 2009 |
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Employers turn to eligibility audits, voluntary benefits to control health care costs |
| Feb 11, 2009 |
|
Senate, House debate COBRA subsidy |
| Feb 3, 2009 |
|
Dems optimistic on comprehensive health reform |
| Feb 1, 2009 |
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How's this for an incentive? You get to keep your health insurance |
| Jan 27, 2009 |
|
Medicare reimbursement shakes things up |
| Jan 20, 2009 |
|
Health benefit costs continue to rise, survey shows |
| Jan 13, 2009 |
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N.Y. proposes policy requiring employers to extend dependent coverage |
| Jan 1, 2009 |
|
Health care reform to take center stage this year |
| Dec 16, 2008 |
|
Employees cut back on health costs - for better or worse |
| Dec 1, 2008 |
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Moderating health care costs could signal trouble ahead |
| Nov 25, 2008 |
|
Tobacco addiction costs employers $167.5 billion a year |
| Nov 18, 2008 |
|
Benefits professionals favor drastically reworked employer-based systems in new administration |
| Nov 11, 2008 |
|
Employers urged to flex muscle on health care reform |
| Nov 4, 2008 |
|
Obesity epidemic remains a battle |
| Nov 1, 2008 |
|
Evidence shows positive outcomes from greater investment in primary care |
| Oct 21, 2008 |
|
Losing sight of wellness program goals |
| Oct 14, 2008 |
|
DOL seeks comments on how health plans use genetic data |
| Oct 1, 2008 |
|
More patients heading to the emergency room |
| Sep 23, 2008 |
|
BFE: Up your FMLA ante with these helpful tips |
| Sep 15, 2008 |
|
Companies combat high HMO premiums with aggressive strategies |
| Sep 8, 2008 |
|
Steady support for wellness and disease management |
| Sep 1, 2008 |
|
Chronic conditions afflict more than half of Americans |
| Aug 12, 2008 |
|
HHS wants wellness program advice |
| Aug 1, 2008 |
|
Attention all shoppers: How to be a smart PBM shopper |
| Jul 15, 2008 |
|
Parties stand far apart on health care reform |
| Jul 10, 2008 |
|
Benefits to protect— and add— during economic downturns |
| Jul 1, 2008 |
|
Seven Self-Insurance Myths |
| Jun 24, 2008 |
|
Growth of employer medical costs projected to accelerate |
| Jun 15, 2008 |
|
Pushing the envelope: Zero tolerance on tobacco use |
| Jun 1, 2008 |
|
A new direction for health care reform and HMOs |
| May 27, 2008 |
|
What's next for health care reform? |
| May 20, 2008 |
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Ohio, W.Va. and Pa. say no to CDHPs, survey reports |
| May 6, 2008 |
|
Health plan study shows performance varies region to region |
| May 1, 2008 |
|
Benefits finance: Is a self-insured health plan right for your company? |
| Apr 29, 2008 |
|
HHS Secretary Leavitt backs value-based health care |
| Apr 22, 2008 |
|
Obesity costs employers $45 billion a year |
| Apr 10, 2008 |
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Want to reduce sick days by an average of 41%? The solution is easy. Just walk. |
| Apr 1, 2008 |
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Robust incentives may improve retention rates in wellness programs |
| Mar 25, 2008 |
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Mercer Report: Employers focus on generic and specialty drugs to reduce Rx costs |
| Mar 11, 2008 |
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How to make your PBM more accountable |
| Mar 6, 2008 |
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Americans alarmed by gaps in quality health care delivery |
| Feb 21, 2008 |
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PBMI launches career center for drug benefit industry |
| Feb 12, 2008 |
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Business group wants to reduce health disparities among minorities |
| Feb 5, 2008 |
|
Using incentives for health risk appraisals |
| Jan 31, 2008 |
|
Mid-size employer turns to "hybrid" CDHP model |
| Jan 15, 2008 |
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Employees take advantage of wellness resources - when they're available |
| Jan 8, 2008 |
|
Consumers are in the dark on health insurance terminology |
| Jan 1, 2008 |
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Checking the label: Transparency, generics utilization key components to effective PBM relationship |
| Dec 18, 2007 |
|
Group counters belief that benefits sky is falling |
| Dec 4, 2007 |
|
Touting large-scale ideas for health reform |
| Nov 20, 2007 |
|
Health benefit costs still outpace the rate of inflation |
| Nov 8, 2007 |
|
Toolkit outlines best practices in health coverage for mothers, children and adolescents |
| Nov 1, 2007 |
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Communications, wellness prove challenging for HR |
| Oct 15, 2007 |
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HealthMarkets charged with misleading customers and denying required care |
| Oct 4, 2007 |
|
Is your company prepared for a pandemic? |
| Sep 25, 2007 |
|
Focus on health plan design paying off for employers |
| Sep 15, 2007 |
|
iPhone puts consumers' health records in the palm of hand |
| Aug 23, 2007 |
|
Health insurers are starting to focus on value-driven plans |
| Aug 9, 2007 |
|
California to produce first PPO report card |
| Aug 1, 2007 |
|
Chicago museum makes walking exhibit grounds cornerstone of successful, no-frills wellness program |
| Jul 24, 2007 |
|
Health care costs top employer concerns |
| Jul 12, 2007 |
|
Benefit professionals react to Moore's depiction of health care |
| Jul 1, 2007 |
|
Creating wellness incentives that resonate with workers |
| Jun 21, 2007 |
|
Health insurance inflation is slowing down |
| Jun 15, 2007 |
|
On the contrary: Employers not looking to shift costs |
| Jun 1, 2007 |
|
Can't we all just get along? Achieving successful benefits integration with multiple carriers |
| May 17, 2007 |
|
Employers shift focus to prevention |
| May 17, 2005 |
|
Employers shift focus to prevention |
| May 8, 2007 |
|
Fortune 500 firms push for health reform |
| May 2, 2007 |
|
Biotech drug costs skyrocket |
| Apr 26, 2007 |
|
Experts help small firms with health plans |
| Apr 18, 2007 |
|
Group says health premium jumps should be justified |
| Apr 5, 2007 |
|
HMOs more cost-effective in California |
| Mar 20, 2007 |
|
CVS buys Caremark |
| Mar 6, 2007 |
|
Americans value e-health services |
| Feb 22, 2007 |
|
Top-rated hospitals have lower mortality rates |
| Feb 5, 2007 |
|
Participation in wellness programs grows |
| Jan 25, 2007 |
|
Country reacts to Bush health care proposal |
| Jan 16, 2007 |
|
FMLA ruling protects subsidiaries |
| Jan 10, 2007 |
|
Latest CDH trend may be plan attrition |
| Jan 3, 2007 |
|
Tool helps employers keep up with the "Joneses" |
| Dec 20, 2006 |
|
Majority unaware of medical costs |
| Dec 13, 2006 |
|
Bill makes HSAs more flexible |
| Dec 5, 2006 |
|
Half of CDHP users would switch plans if possible |
| Dec 1, 2006 |
|
Health inflation lower, but worries grow over "fraying benefits" |
| Nov 30, 2006 |
|
NBGH launches free guide to preventive care |
| Nov 16, 2006 |
|
Medical costs may show double-digit increase in 2007 |
| Nov 7, 2006 |
|
Most workers do not use FSAs |
| Oct 25, 2006 |
|
PBMs keeping up with Wal-Mart |
| Oct 17, 2006 |
|
Consumers prefer generics to brand drugs |
| Oct 11, 2006 |
|
Workers worried about future of health benefits |
| Oct 1, 2006 |
|
Dental providers embark on new ways to offer benefits |
| Sep 20, 2006 |
|
Questions remain about provider quality programs |
| Sep 15, 2006 |
|
Cheaper Zocor throws generic market a curveball |
| Sep 6, 2006 |
|
HSA assets surge over past six months |
| Sep 1, 2006 |
|
Consumers get more tools to gauge medical costs, quality |
| Aug 31, 2006 |
|
Workers motivated by richer benefits |
| Aug 24, 2006 |
|
Bush compels price and quality transparency in health care |
| Aug 17, 2006 |
|
Workers uneasy about pay, health care |
| Aug 9, 2006 |
|
HMOs account for one quarter of insurance market |
| Aug 1, 2006 |
|
Generics influx drags prescription drug trend to seven-year low |
| Jul 25, 2006 |
|
Depression costs related to health care access |
| Jul 12, 2006 |
|
Research shows effects of quality ratings for surgeons |
| Jul 6, 2006 |
|
Employers portend scaling back retiree medical benefits |
| Jun 20, 2006 |
|
Tips for CDHP roll-outs |
| Jun 15, 2006 |
|
Ohioans recoup $6.5 million in health claims |
| Jun 8, 2006 |
|
Not-so-great expectations for health costs |
| Jun 1, 2006 |
|
Vermont latest state to pass health reform |
| May 30, 2006 |
|
Study gauges health data gap |
| May 17, 2006 |
|
Most employers do not offer DM, wellness, but they want to |
| May 10, 2006 |
|
Declining employer-sponsored health plans documented |
| Apr 27, 2006 |
|
Workers build muscle with incentives |
| Apr 25, 2006 |
|
Change coverage to lower pregnancy cost |
| Apr 20, 2006 |
|
Health experts face off on access vs. innovation |
| Apr 15, 2005 |
|
Target draws bead on consumer-driven health care |
| Apr 11, 2006 |
|
Female employers worry about skyrocketing health costs |
| Apr 5, 2006 |
|
Mental health benefits add value, not cost |
| Mar 27, 2006 |
|
Validate your health ROI to the CFO |
| Mar 21, 2006 |
|
Variety of strategies needed to curb health costs |
| Mar 9, 2006 |
|
Managers doubt CDH will make workers healthier |
| Mar 1, 2006 |
|
Health care to account for 20% of GDP by 2015 |
| Feb 23, 2006 |
|
Higher co-pay differentials increase generic fill rates |
| Feb 14, 2006 |
|
Consumer advocates worry about health data privacy |
| Feb 7, 2006 |
|
Cost and talent issues challenge benefit professionals |
| Jan 25, 2006 |
|
More than half of seniors stay away from Part D |
| Jan 15, 2006 |
|
Mind the Meds: Top 10 pharmacy benefits management strategies for 2006 |
| Jan 2, 2006 |
|
Put your health care eggs in many baskets |
| Dec 14, 2005 |
|
CDH participants dissatisfied but frugal |
| Dec 8, 2005 |
|
Health care banking gets the Blues |
| Dec 1, 2005 |
|
Generic drugs offer employers untapped savings |
| Nov 29, 2005 |
|
Care management, cost-shifting reduce health costs |
| Nov 17, 2005 |
|
Pay-for-performance generates quality improvements |
| Nov 15, 2005 |
|
Employers should examine full impact of obesity |
| Nov 3, 2005 |
|
US CEOs more health care cost conscious |
| Nov 1, 2005 |
|
Health cost relief takes center stage at BMF&E |
| Oct 25, 2005 |
|
Wal-Mart extends lower-cost health insurance |
| Oct 11, 2005 |
|
Large companies find lower health care hikes since 1999 |
| Sep 21, 2005 |
|
Cost-shift trend is also costing brokers |
| Sep 15, 2005 |
|
Financial incentives touted as health care cost fix |
| Sep 8, 2005 |
|
PBM mail-order pharmacies deliver cheaper drugs |
| Aug 31, 2005 |
|
A spoonful of compliance helps health costs go down |
| Aug 18, 2005 |
|
AutoNation claims UnitedHealthcare overpaid by $10 million |
| Aug 16, 2005 |
|
Consumers elevate HMOs over PPOs |
| Aug 9, 2005 |
|
Medical cost containment depends on changing habits |
| Aug 2, 2005 |
|
Employers could see relief in benefit costs |
| Jul 26, 2005 |
|
PBMs scoop up specialty pharmacies |
| Jul 15, 2005 |
|
Off and running: Self-funded employers may have head start in push for wellness |
| Jul 5, 2005 |
|
Walgreens says drug costs rose 7.2% in 2004 |
| Jun 28, 2005 |
|
More than half of employers concerned about wellness |
| Jan 21, 2005 |
|
Benefit managers offer best ways to ease health costs |
| Jun 14, 2005 |
|
UnitedHealth has a million in consumer-driven plans |
| Jun 9, 2005 |
|
Uninsured worsen medical inflation for workers |
| Jun 1, 2005 |
|
New study puts medical costs into focus |
| May 24, 2005 |
|
Disease management has become the norm |
| May 10, 2005 |
|
Unions found to have better access to health insurance |
| May 4, 2005 |
|
Employers don't lie down for higher premiums |
| Apr 28, 2005 |
|
Mandatory health insurance rejected in California |
| Apr 21, 2005 |
|
GM says health costs partly to blame for first-quarter losses |
| Apr 12, 2005 |
|
Group launches program to buy health insurance in bulk |
| Apr 7, 2005 |
|
Maryland considers bill that mandates benefits spending |
| Mar 25, 2005 |
|
Many would sacrifice choice for lower health costs |
| Mar 15, 2005 |
|
State health mandates scrutinized |
| Feb 9, 2005 |
|
Scandals may prompt more online insurance bidding |
| Jan 19, 2005 |
|
Employers should investigate disease management math crimes |
| Jan 12, 2005 |
|
Clients tackle medical inflation roots |
| Jan 8, 2005 |
|
Employees prefer work-based insurance |
| Dec 21, 2004 |
|
Automated Systems For Drugs Examined |
| Dec 14, 2004 |
|
Companies Rapidly Cutting Health Benefits |
| Dec 2, 2004 |
|
40 Percent in U.S. Use Prescription Drugs |
| Nov 1, 2004 |
|
Your New Health Plan |
| Sep 27, 2004 |
|
Health costs rising faster than incomes, study says |
| Sep 13, 2004 |
|
Employers slow shift of health care cost burden to workers |
| Aug 10, 2004 |
|
Health care costs employers more than paid leave |
| Jul 15, 2004 |
|
Health insurers lost $85 billion to fraud last year |
| Jul 22, 2004 |
|
Health and productivity management intrigues firms |
| Jun 4, 2004 |
|
Rising benefit costs hurt small businesses' financial health |
| Feb 28, 2004 |
|
Strike-weary grocery workers eye new offer |
| Feb 28, 2004 |
|
Experts ponder limitations of cost-sharing |
|
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Checking the label: Transparency, generics utilization key components to effective PBM relationship
As employers look even more closely at managing health care costs, keeping close tabs on prescription drug costs is front of mind among benefit managers. In particular, companies are looking to partnerships with pharmacy benefit managers to keeping drug cost increases in the single digits.
Accordingly, some benefits analysts and executives advise employers to not only push for explicit contractual language on pass-through pricing, but also to support drug benefit designs that focus on multi-tiered formularies, innovative cost sharing and generic drug utilization.
"Dealing with a PBM is not really about being a good or bad thing, but about clearly defining what the deal is in a way that you can communicate to the stakeholders in your organization," said John R. Adler, national practice leader at Wisconsin-based TRICAST, Inc, a firm that manages pharmacy benefit risks.
Seeking administrative and drug transparency
For Adler, drug pricing transparency means "I am going to tell you I am making money, while pass-through pricing says I am going to give you whatever I am buying the drugs for and you will receive the same pricing,'" he explained at a session on selecting a PBM during the International Foundation of Employee Benefit Plans' annual conference.
He acknowledged there are some fully transparent PBMs who provide clients with the precise pricing of drug costs for retail, mail-order and manufacturer revenue. Adler warned employers that there are variations of pass-through pricing.
For example, some PBMs might withhold mail-order and price that traditionally, "while retail and manufacturer revenue, otherwise known as rebates, will be included in the pass-through pricing," he added.
Granted, much attention has been paid to drug pricing transparency, but transparency with administrative fees and services is equally important, experts remind.
For instance, before employers sign on the dotted line, they should "know how many other clients the PBM pharmacist is working with," Susan E. Larkin, senior vice president at Brokerage Professionals, a subsidiary of Pennsylvania-based consulting firm Gallagher Benefits Services, Inc., told IFEBP attendees.
"If the pharmacist has numerous clients, then you are probably not going to get the individual attention you want," Larkin explained. Benefit executives need to be sure they are comfortable with the pharmacist's workload.
Moreover, when negotiating with PBMs, she urged employers to find out whether they have to pay separately for concurrent and retrospective drug utilization reviews, identification cards, member packets and disease management programs.
PBMs and employers will agree that at the end of the day it's about lower drug costs and customer satisfaction.
Last November, the Pharmacy Benefit Management Institute issued a report showing a strong correlation between transparency and employer satisfaction. In it, employers who are "extremely satisfied" with the financial transparency of their PBM relationship gave their PBMs an average overall service and performance rating of 8.8 on a 10-point scale, with 10 being the highest rating.
Conversely, employers who are "somewhat satisfied" with financial transparency scored their PBMs an average performance rating of 7.9, whereas respondents who are "somewhat dissatisfied" or "extremely dissatisfied" with financial transparency rated their PBM's performance at 7.5 and 5.9 respectively, reports PBMI, an Arizona-based educational group focusing on PBM issues.
The survey questioned more than 440 employers representing 15.4 million beneficiaries. The findings "reinforce that the way PBMs conduct business does impact employer satisfaction with their services," says Dana H. Felthouse, president of PBMI. The institute reports employers saw on average a 6.9% increase in drug costs, a 0.6% drop from 2006.
Promoting generic drugs
Virginia-based Landmark Communications recently teamed up with Cigna Pharmacy Management to redesign the prescription drug benefit. Under the new 2006 design, the company witnessed a generic utilization rate of 57%, and that number is estimated to reach 63% by the end of 2007.
In 2004, the privately held media outfit had a 12% drug trend increase; a year later, it jumped to 14%. Landmark also had annual drug spending of $4.5-to-$6 million. Back then, its generic utilization percentage was 48% in 2004 and 51% in 2005.
Kathleen Thomas, director of benefits at the company, told attendees at EBN's 20th annual Benefits Management Forum & Expo that the organization wanted to implement a new prescription drug benefit with minimal employee disruption that would not negatively influence the company culture.
In 2006, Virginia-based Landmark Communications reduced copayments from $10 to $5 for retail generic drugs and from $25 to $10 for mail-order drugs. In addition, the company increased coinsurance from 20% to 25% for preferred brand drugs and from 40% to 50% for non-preferred brand drugs.
"We knew we had to use several different avenues to communicate changes to our employees during the transition. Naturally, we promoted the more positive aspect of the change, which included lower co-payments on generic drugs," she said.
Overall, the company saved $500,000 and reduced double-digit pharmacy trends to 3.7%. Part of the savings included $15,000 from an early-refill management program and $18,000 from a generic conversion program. Design changes also included clinical management programs and Web-based drug comparison and pricing tools.
"We knew that every member was not going to choose a generic drug, so we included brand-name drugs where the patents were about to expire," said Erik Fiedler, vice president of account management at Cigna Pharmacy Management. "It's a great success story of reducing prescription drug costs without putting on tight management controls to the members. It was achieved simply by plan design and communication."
Chandra Matthews, director of benefits at Tennessee-based Dollar General Corp., a national retailing chain, said, "We wanted people to really think about their pharmacy decisions as being separate from their medical decisions."
The company hired Buck Consultants to help it revise its prescription drug offering. In 2003, Dollar General had a 26% drug trend. Between 2004 and 2005, the company introduced a deductible for brand-name prescriptions only, moved to a mandatory generic program and replaced copayments with coinsurance.
Further, Dollar General carved out its prescription drug benefit and hired a pharmacy benefit manager, EHS/PharmaCare, which provided robust clinical resources and actively managed the pharmacy program. The PBM provided detailed and timely reporting information and offered transparent pricing, including disclosure of rebates.
In 2004, Dollar General had a generic utilization rate of 52.1%; the number was projected to reach 66.6% by the end of 2007.
By Lydell C. Bridgeford |
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