Act Now – Block Lyrica CR

17 Nov, 2017 0.

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

It’s Time To Limit Your Coverage of Restasis 

05 Oct, 2017 0.

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

New Rx Drugs: The “Latest” Is Not Necessarily The “Greatest” When It Comes To Drugs 

09 Aug, 2017 0.

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

Fix Your Claims Data Errors – Or Lose Money & Eviscerate the Meaning of Your PBM Contract’s Financial Guarantees

09 Aug, 2017 0.

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

New Hep C Realities: December 2014-January 2015

09 Aug, 2017 0.

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

It’s Time To Determine How Much Your PBM Is Depriving Your Plan Of Rebates:  File An “Accounting” Procedure  

10 Jul, 2017 0.

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

Express Scripts Lawsuit Should Raise Everyone’s Eyebrows 

31 May, 2017 0.

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"

Lessons from Horizon Pharma: Stop Covering Vimovo, Duexis and Pennsaid and Stop Relying on Your PBM’s “Standard” Formulary

15 May, 2017 0.

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

Striking Savings Are Possible (But Your Plan Has To Act To Get Them)

30 Apr, 2017 0.

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

Bloomberg Article on PBMs – quotes Cahn

17 Mar, 2017 0.

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

Manufacturers Are Using “Switch Operators” To Undermine Your Plan’s Cost Saving Efforts

11 Jan, 2017 0.

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

Don’t Be Fooled By Eli Lilly’s & Express Scripts’ New Insulin Program

21 Dec, 2016 0.

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

Don’t Be Duped By Manufacturers’ New “Single Digit Price Increase Pledges”

16 Dec, 2016 0.

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

Message from Mylan: It’s Time For Every Health Plan To Address Rebate Issues

17 Nov, 2016 0.

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

Take Action To Decrease Your Plan’s Crestor Costs

13 Nov, 2016 0.

  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

Pay Attention to Your Metformin HCL ER Diabetes Costs 

30 Oct, 2016 0.

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

MORE REASONS to Protect Your Beneficiaries Against New Drugs’ Dangers

09 Oct, 2016 0.

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

The FDA’s Latest Hep C Drug Warning Makes Clear Why You Should Protect Your Beneficiaries From New Drugs’ Dangers

06 Oct, 2016 0.

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,

End Your PBM’s Refill Pill Mill

27 Sep, 2016 0.

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

Hep C Drugs: Is Your Plan Really Benefiting From Your PBM’s “Deal”?

27 Sep, 2016 0.

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

Controlling New Specialty Drug Costs: Lessons from Farydak & Kalydeco

27 Sep, 2016 0.

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

Protect Your Health Plan Against Astronomical Drug Price Increases

26 Sep, 2016 0.

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

Control Testosterone Use – For Health & Cost Reasons

26 Sep, 2016 0.

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

Stop Covering Rx Drugs That Are Available Over-the-Counter

26 Sep, 2016 0.

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

When Drugs Lose Their Patent Protection, Change Your Coverage and Save!

26 Sep, 2016 0.

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

Stop Paying For Drugs The FDA Has Never Even Approved

26 Sep, 2016 0.

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

Protect Your Plan: Address Extreme Price Increases   

25 Sep, 2016 0.

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.

It’s Time To Exclude High-Cost Pharmacies From Your Retail Pharmacy Network

25 Sep, 2016 0.

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