Category Archives: Prescription Coverage
Does Your Health Plan Really Cover Your Employees’ Medications?
I use generic drugs. I like generic drugs – they save me money and seem to do the trick. But not everyone feels the same way. Some people have allergies or side effects. Some doctors believe that the original is the only drug to use, so they prescribe the drug with “no substitutions” or “D.A.W.,” [...]
More Rx Trends in Health Plans
The Pharmacy Benefit Management Institute (PBMI) has identified intriguing pharmacy benefit trends. They began monitoring prescription costs and drug benefit plan designs in 1995 with an eye to identify trends over time. In their most recent report, there are some interesting health plan benefit design trends. General Trends A total of 93.1% of plans with [...]
Trends in Health Care Rx Costs
The Pharmacy Benefit Management Institute (PBMI) issues an annual report on health plan prescription costs and drug benefit plan designs. They began monitoring those items in 1995. The purpose is to identify trends over time. The most recent report does show some interesting trends: *The number of cost sharing tiers has increased to support more [...]
Partisan Ads from the Government??
Is the Obama administration trying to influence the elections using tax dollars? Is that an ethical violation? Answer to the first question: YES. The Obama administration has spent $3 million on TV advertisements during October to discuss the benefits of health reform. That’s “three times what was spent by pro-reform candidates and groups” according to [...]
Mass Health Plans Look Good by Comparison
In Massachusetts we have health insurance plans with deductibles and copays and coinsurance. For quickie review purposes, A deductible is money you personally pay before the insurance pays anything A copay is a fixed fee you pay each time an incident occurs — doctor visit, prescription, hospital visit, etc. Coinsurance is a percentage sharing between [...]
Value-Based Pharmaceutical Efforts Gain Traction
in an effort to maintain lower cost trends, employers are turning more toward prescription cost management. Although the rates of growth have shrunk from the 15% range of the late 90′s and early 2000′s, it’s an area ripe with promise. Today, national rates of generic dispensation have risen to about 70% and could climb to [...]
What's a Medical Expense? It Matters to Your FSA
If your firm has an FSA (and these same thoughts apply to HRA plans and HSA plans, too) you’d best be aware of whether or not to reimburse certain expenses. In particular, section 213d itemizes the kinds of medical expenses that can be paid for by FSA, HSA and HRA accounts and that are deductible [...]
HSA Plans and Preventive Care
A common presumption by opponents of HSA plans is that employees will skip necessary preventive care because the money will have to come from them. Wrong. Every HSA plan in Massachusetts and most in the US cover preventive care without debiting the employee’s HSA account. That is, the carrier provides preventive care coverage. So the [...]
Rx Program I SHOULD Have Known About
Kind of embarrassing… I’m supposed to keep track of this stuff and be a resource for my clients. But sometimes I fall down and let something slip. Well, at least I rush to make it up to them. What am I talking about? Walmart’s (and other drug stores’ ) generic drug program. Sure, you’ve heard [...]
Do Mail-Order Pharmacies Really Save You Money?
Here’s a policy development issue that’s in the news. In fact, the Boston Globe recently had some comments on the subject: Mail-Order Pharmacy. The question is whether or not Mail-Order can save Medicare (and you!) any money. PMBs (Pharmacy Benefit Managers) are telling the Obama admin that for each 1% of seniors with chronic conditions [...]