Most pharmacy benefit managers dont use warning systems to flag high use or potential abuse of narcotics. But you can, with a good eye and simple calculator.
Opioid painkiller abuse and physicians dispensing of repackaged drugs top the list of cost drivers in the 2012 Survey of Prescription Drug Management.
As CEO of United Benefit Advisors, I hear continually about the issues facing our 36,000 employer clients. Managing prescription drug costs continues to be paramount. The UBA 2012 Health Plan Survey shows that 64.2% of prescription drug plans utilize three co-pay tiers (generic, formulary brand, and non-formulary brand); 2.9% have a one-tier plan, 8.2% retain a two-tier plan; and 24.7% add a fourth tier (specialty). Consultants should watch these plan structures carefully as many brand-name drugs go off their patents and pricing is determined for the influx of generic drugs. On the other end of the spectrum, we're watching increases in specialty drugs, which are driving up costs significantly.
Consultants, industry groups question the transparency in PBM practices.
Health care plans that insist participants get their prescription medications by mail order could see backlash, unless they address concerns.
Most population health management strategies do not contain a component to address behavioral health because of one main reason, says Sean Fogarty, senior vice president of sales and marketing at CuraLinc Healthcare. He explains also how an EAP can function as a proactive component of a population health management strategy.
Small and mid-sized companies are beginning to catch onto the onsite clinic trend. Listen as Joe Ellis, senior vice president at CBIZ, Inc., shares how he works with employers to design and install onsite clinics and explains their cost-cutting strategy.
For decades, health care consumers have been told once you have a problem, then you should go to the doctor. But now, as high-deductible health plans become ever more prevalent, employers are encouraging employees to go to the doctor first - before they get sick - and in turn the employer will often cover the visit at 100%.