Tips and trends to unlock pharmacy and medical savings.
Lowering Diabetes Medication Costs with Alternative Strategies
One in ten people in the United States has diabetes. $1 in $4 of US healthcare costs is spent caring for people with diabetes, resulting in a 26% increase in the cost of diagnosed diabetes from $245...
Medical Pharmacy Affects Plan Spend
Pharmacy costs get all the press for rising prices; however, brokers and plan sponsors need to consider medical pharmacy if they want a complete picture of plan spend. Medical pharmacy is the...
RFP Questions You Should be Asking
When evaluating a PBM contract at renewal or mid-term market check, brokers and plan sponsors should be asking questions. Questions that lead to a thorough understanding of their current PBM...
Validating Pharmacy Savings Programs
Americans spent $328 billion on prescription drugs in 2020, eight percent of total healthcare spend. The rising cost of medications is motivating employers, especially those who are self-funded, to...
Navigating Gene Therapies
Research on gene-therapies began in 1960 with the hypothesis that introducing DNA sequences into patients' cells could cure genetic disorders. Decades of research have made these therapies a reality...
A Primer on J Codes
High-cost prescription drugs have been wreaking havoc on pharmacy plan budgets for over a decade. However, did you know that drugs costs also affect medical plan costs? Drugs are billed in either...
Trends to Follow in 2022
This year saw a post-pandemic return to preventive care, the introduction of several biosimilars, and legislation governing healthcare transparency. However, stakeholders are still working to...
Data and Vendor Fragmentation in Health Benefits
As payors and stakeholders move to more plan-centric health benefits models, fragmentation significantly impedes program efficacy. Point programs added to fill gaps in coverage, and bolt-on...
Artificial Intelligence in Pharmacy: Improving Patient Outcomes
Artificial Intelligence (AI) in pharmacy refers to automated algorithms that perform tasks traditionally completed by human intelligence. 62% of healthcare companies plan on investing in AI, with...
Covering Specialty Drugs: Medical vs. Pharmacy Channel
For self-insured plan sponsors, specialty drugs represent 33-50% of total pharmacy spend but only account for 1% of total prescription claims. These medications usually require special handling,...
Drug Rebates Affect Formulary Management
Formulary management is becoming increasingly important for plan sponsors. As drug prices, especially specialty costs, continue to rise, improving participant access to affordable medications is...
A Primer on Biosimilars
It has been 15 years since the widespread adoption of biosimilar medications in the European Union. Ten years later, in March 2015, the first biosimilar was approved by the FDA for use in the United...
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