Rx Management – CoPay Accumulator Programs
With Accumulator Programs the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum. Employers and health plans could potentially save big money because accumulators shift a majority of drug costs to patients and manufacturers. Normally, a manufacturer’s payments from a copay program count toward a patient’s deductible and annual out-of-pocket maximum. Once […]
IRS Guidelines – Indexed for 2018
FICA Social Security Tax is 6.2% on income up to $128,400 up from $ 127,200 Medicare Tax unlimited 1.45% to Unlimited High Deductible Health Plans Minimum Annual Deductible (Individual/Family) $1,350 / $2,700 Maximum Out-of-Pocket Limit (Individual/Family) $6,650 / $13,300 Health Savings Accounts Individual / Family $3,450 / $6,900 IRS announced change to $6,850 March 5, […]
Obamacare Driving New Wave of Hospital Bankruptcies
Health-care bankruptcy filings have more than tripled this year according to Bloomberg, and an index of Chapter 11 filings has reached record highs (industry companies with more than $1 million of assets). It’s expected that for 2018 the trend will increase; hospitals and other medical companies are likely to restructure their debt or file for […]
Pharmacogenetics
Pharmacogenetics allows prescribers and pharmacists to understand how medications react differently in the body based on an individual’s metabolism. Best Practice PBMs are able to apply the results of a fast and easy-to-administer pharmacogenetics test to enhance member safety, improve treatment outcomes and prevent wasteful drug spending. The science of pharmacogenetics utilizes precision medicine, which […]
Knock Out Blow? – Trump Ends Cost-Sharing Reduction Subsidies
The White House confirmed Thursday that it will stop making federal payments for cost-sharing reductions, payments to health insurers. The Department of Health and Human Services confirmed that the cutoff would be immediate. This action could throw the Marketplace into immediate turmoil as insurers start to evaluate their options for 2018. Many, certainly democrats, have […]
What is Reference Based Pricing?
With RBP plans are designed to negotiate treatments with high-quality providers at reduced costs and can work in different ways, depending on the insurance carrier or TPA. – Sound like a PPO or HMO? Not quite. RBP can have no network restriction, a network and use a network within a network. Call it Creative Networking […]
Power of THE Pen – Trump holds the key to Repeal!
Many have forgotten that our Congress (Senate and State Representatives) and public employees are not fully subject to Obamacare. President Trump can change that with a stroke of THE Pen. Congress was initially subject to the ACA. However, after a meeting with Senate Democrats in March 2013, Obama exempted Congress from section 1312(d)(3)(D). That section […]
Why are costs for prescriptions so much higher in the United States?
Specialty pharmacy will be 50% of a health plan’s drug spend by 2018. By 2020 pharmacy will be 50% of total healthcare spend. Pharmacy is the most utilized and least understood of healthcare costs. Why are costs for prescriptions so much higher in the United States than other countries? The easy answer is that Americans […]
Here’s why the CBO report on AHCA is wrong – BIG TIME!
Opponents of the American Health Care Act say 24 million more Americans will lose coverage. However, that number is based on faulty assumptions. The CBO report uses the ACA’s March 16 baseline projections for comparison. Projections that have already proven inaccurate. This leads to three flawed assumptions. 1) Premiums will not be more expensive than […]
Men are the problem!
Men don’t go to the doctor unless their arm or leg is falling off or they are dying. Consequently they are a major reason for the large preventable claims your company is incurring. So men, get a reality check, and become a smart patient. Human Resource Directors, read the following then think about this recommendation. […]