Specialty Drug Wave Hitting Medical and Pharmacy Plans Harder: Trends versus reliable benefit strategy to handle the impact through 2020?

Specialty Drug Wave Hitting Medical and Pharmacy Plans Harder: Trends versus reliable benefit strategy to handle the impact through 2020?The U.S. now has two different markets resulting from implementation of the Affordable Care Act (ACA) and resultant trends. Related to specialty or biological drugs, public sector CMS’s forecast of drug spending is somewhat counterintuitive, given […]

Buy and Bill Trend: Are there Contradictions to Vendor or Pharma’s Reported Data

Buy and Bill Trend:  Are there Contradictions to Vendor or Pharma’s Reported Data Distribution based sales of specialty pharmaceuticals raises critical issues for manufacturers and providers as plan year 2016 decisions have been made and 2017 preparations begin by purchasers. For pharmaceutical manufacturers, the dilemma arises when (1) reimbursement is limited or eliminated under benefit […]

The Anthem Cigna merger: 10 things to Know

The Anthem Cigna merger: 10 things to Know – Published July 24, 2015 By Tracey Walker, Managed Healthcare Executive Anthem’s acquisition of Cigna is being called the first “merger of titans” by industry watchers. The forces of consolidation are well under way and the merger was not totally unexpected—all of insurance is going through similar […]

Blues Plans Can Use Various Tactics to Mitigate Generic Drug Price Inflation

Blues Plans Can Use Various Tactics to Mitigate Generic Drug Price Inflation, Published in The AIS Report on Blue Cross Blue Shield Plans, V14, Number 7 July 2015         Randy Vogenberg, Ph.D., Partner, Access Market Intelligence notes that the FDA has cited “quality and manufacturing issues” as “a major reason for drug shortages. Most […]

Why CVS Recent Deals Change the Specialty Landscape

Why CVS Recent Deals Change the Specialty Landscape – Following a similar path as in the late 1990’s with long term care pharmacy, specialty pharmacy has matured enough to undergo consolidation and roll-up into larger healthcare entities. Specialty represents a small distribution volume in the retail pharmacy space but also results in the greatest profit […]

Employers Medical Stop Loss for Specialty Rxs

Employers Medical Stop Loss for Specialty Rxs – Employers will continue to experience escalating specialty Rx costs.  Effective but expensive non-substitutable products emerging from pharmaceutical manufacturers’ development pipelines will quickly and sharply drive both pharmacy and medical benefit year-over-year spending increases. Traditional risk management tools, like stop loss insurance policies are designed to mitigate risk […]

CVS Health Acquires Omnicare

CVS Health Acquires Omnicare – Well, the guessing game is over as CVS Health acquires Omnicare. The Pharmacy in Long-Term Care market has a new industry leader as CVS Health will see if their business model translates to the long-term care pharmacy market. The LTC market is a different business and CVS is moving from their traditional “core competency”. It […]

A Call to Action to Address Burden of Unintended Pregnancies in Plans’ Benefit Design

Benefit Design – A Call to Action to Address Burden of Unintended Pregnancies in Plans’ Benefit Design F. Randy Vogenberg, PhD, RPh Partner, Access Market Intelligence, Greenville, SC Adjunct Professor of Pharmacy Administration, Presbyterian College School of Pharmacy, Clinton, SC Adjunct Instructor, Outcomes and Health Policy, University of Illinois at Chicago College of Pharmacy Originally […]