UPDATE: Federal law is beginning to move towards a solution to high prescription drug prices. The U.S. Supreme Court will soon take up a case on whether states can regulate certain aspects of prescription drug reimbursement, essentially taking on pharmacy benefit managers (PBMs) and protecting pharmacies from below-cost reimbursements. In addition, the “Lower Costs, More Cures Act” was introduced in December with the aim to lower out-of-pocket spending, protect access to new medicines, and strengthen transparency, accountability, and competition. This act has considerable bipartisan support, making it likely to pass.
Today's post is from our broker blog, AllWays Insider, which is exploring pharmacy cost trends in a series of posts.
Because many of the dollar amounts reported on cost increases are so staggering, health plans and pharmacy benefit managers (PBMs) are working together to address increasing drug costs. Here are four measures aimed to control premium and out-of-pocket insurance costs and help manage prescription drug costs.
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The Institute for Healthcare Improvement identified several pitfalls and promising practices drawn from the American healthcare sector's experimentation with quality-improvement methods and performance management:
Oliver Wyman released their annual consumer survey for health care, and the results may explain some inconsistencies in patient behavior.
Payment policies often seem different from payer to payer – which can add confusion to an already complex aspect of health care. However, the differences between the published payment policy and what a provider sees on an evidence of coverage often have nothing to do with the policy itself. The discrepancies are usually the result of variations in the member’s plan design, the provider’s contract, or both.