Pharmacy Costs

Lots of Medicare Questions From Employers and Employees This Year

…Here are the ABC’s (and Part D)

For whatever reason – aging workforce, increasing costs, heightened awareness because of ACA – we’re getting lots and lots of questions from clients and their employees about Medicare this year. Way more than in years past. The vast majority of questions are about the basics.

And, it’s easy to get confused about what’s what. So thought it might be helpful to put together a cheat sheet of sorts about the basics. Here’s a quick summary of the ABC’s (and Part D’s)…

What’s the best combination of cost and care? Picking the right DOC still trumps all.

Last week I wrote about improving healthcare literacy. It’s an important and worthy goal. However, I always juxtapose this with something a highly respected physician colleague and friend said to me a few years back.  It really resonated with me back then and still does today.

He said that the push for improving the public’s health literacy and increased consumerism is good. The more knowledgeable people can become about their healthcare the better.  However, he also cautioned that the expectations of predicted great gains in cost savings and improved system efficiency from increased consumer knowledge were a bit unrealistic. They needed to be tempered.  Healthcare is so dynamic and so complex that as a physician he had to really work hard to stay on top of best practices, new developments in medicine, the cost and outcome implications of various types of treatment, etc. His point was that if he, as an experienced physician with years of training and treating patients had to work so hard to stay on top of the latest developments and trends, then it is unrealistic to expect that consumers with day jobs and no medical training at all could understand the complexities of our healthcare system.

woman handshaking with doctor after checkup

We know from years of analyzing data and our experience that the most experienced doctors with good teams around them deliver the best possible outcomes – clinical, functional and financial.

So I think the best bet – whether it’s you, your family members, or your employees – is still to do your homework and choose the best and most experienced doctors around.

Last week’s post in case you missed it…

 Health Insurance Literacy: Too Complex For Some?

Compromising on Contraceptives and Religion. Say what?

Recently the Obama Administration compromised to allow waivers for religious organizations to restrict paying for contraceptives on their health plans.

What does that mean for most religious groups that offer health benefits? Unless a group is self funded and writes their own plan, it will be difficult to change things. As we have discussed in earlier blogs posts, 98% of all employers purchase fully insured plans from insurance companies. Insurance companies file their plans and, for the most part, are abiding by the original requirements in ACA on what to cover. Therefore, if a group is fully insured, they cannot just change their plan.

WSJ-Apr222014-AdminOffersContraceptionCompromise

It is possible that the insurance carriers may roll out plans that give these types of groups a chance to change their plan. However, at this point that is not possible and we usually see insurance companies move slowly on these events.

The administration rolled this out to allow for waivers. The carriers will probably wait and see if there are a lot of requests and then decide if they will react.

To read more on this topic, please read Administration Offers Contraception Compromise for Religious Employers, an article that appeared on WSJ Online.

 

Big Pharma Companies Prescribe Higher Prices

An article about big pharma companies and their pricing policies show a trend toward sharply rising drug prices. It doesn’t seem likely that it will slow down any time soon. I warn you – there’s tons of details to consider when it comes to pharmaceutical drug costs. Here are some key takeaways:

  • Big Pharma is in a period of intense consolidation
  • The cost of brand-named drugs is soaring
  • Starting prices of new drugs are escalating
  • More concentration in a therapeutic area = higher prices
  • Generic drugs now make up 86% of all medicines used in the U.S. but that hasn’t reduced total spending on prescription drugs
  • The economics of prescription drugs are unique compared to other major markets
  • Turf wars between drug makers are driving costs higher
  • Rising prices of brand-named drugs is roughly equal to losses due to patent expirations

If you or your employees are concerned about the rising cost of drugs, stay tuned…you’ll see more about this hot topic from us.

To read the entire article, read Big Pharma’s Favorite Prescription: Higher Prices as seen on BusinessWeek.com

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