How does Medicare paying physicians less than commercial insurance affect the commercial health insurance market?
According to a report from Omniscient Health, a healthcare data science, research and consulting firm, physicians are paid 33.6% less for treating Medicare patients than a decade ago thanks to reimbursement cuts coupled by rising practice expenses When Medicare pays healthcare providers less than commercial insurance does for the same services, it creates several ripple […]
Industry Trends
Large U.S. employers expect median health care costs to rise 10% in 2026. Small employers can typically expect larger increases. The projected increase is attributed to a variety of factors, with specialty drugs and catastrophic claims the biggest contributors. The top four factors Specialty drugs Catastrophic claims Utilization due to chronic conditions Medical provider costs […]
“One Big Beautiful Bill”
The President has signed the “One Big Beautiful Bill”. The health-related provisions are as follows: The bill: Did not take away the employer tax exclusion, a big win in maintaining the ability of employers to offer employee benefits. Did not renew the enhanced premium tax credits, which means they will revert to the original Affordable […]
Pharmacy Benefit Management – Part 3 – Case Study
How can your company reduce pharmacy costs while providing the best care and service to employees? Our PBM model consistently delivers high value and significant savings to clients. While each element of our program produces savings for clients, the savings are maximized when all programs are implemented. As each pathway targets different savings opportunities. In […]
Pharmacy Benefit Management – Part 2
Do you know how specialty medications are impacting your company’s health insurance costs? While specialty medications offer promising treatment options for complex conditions, their high cost can pose challenges for affordability and access, impacting both patients and healthcare systems. Specialties not only cause significant increases to the overall plan, but can impose financial hardships on […]
Pharmacy Benefit Management – Part 1
When medication costs go up, insurance costs follow suit because insurance companies have to cover those expenses. So, rising pharmaceutical medication prices can lead to higher health insurance premiums for consumers. If you are self-funded and using a Pharmacy Benefit Manager you need to understand how your PBM is managing the cost of pharmaceuticals. Employee […]
Florida PBM Reform is Here
Effective July 1, 2023 the Florida legislation reshapes the PBM landscape, requiring that PBMs pass through 100% of all manufacturer rebates to plan sponsors, while prohibiting spread pricing, clawbacks, mail order mandates, affiliate-only networks, and other practices that have long been status quo for many in the pharmacy industry. Florida SB 1550 requires that entities […]
Fat People Are Costing Your Company
Several years ago, I blogged, Fat People Have Issues, with the disclaimer of posting the politically incorrect title in hopes of getting more people to read. Not being one to suddenly bow to the woke politically crowd I have posted another potentially insensitive title, again, in hopes of getting more people to read. As I […]
Overpaying for Prescriptions? – Try this
If you are fortunate enough to have health insurance with a low deductible or low-cost prescription co-pays, the high cost of drugs is driving up the premiums that you or your employer pay, making getting health insurance expensive and challenging. Every American should have access to safe, affordable medicines. If you don’t have insurance or […]
Many Patients Billed for Preventive Care That Should Be Free
People are being charged for preventive health care, health care that should be at no cost to them. That’s the headline from an article in the US News & World Report by Robert Preidt, HealthDay Reporter. The article stated, “Out-of-pocket charges for preventive care that should be free under the Affordable Care Act can discourage patients […]