Care outside the hospital, like P&T committee responsibilities outside the hospital, is necessarily different. New processes and solutions, such as cloud computing, can help improve performance and transparency of benefit management for purchasers or users of health care services. The current role of PBMs includes concurrent improvement in health outcomes, so the take-home message is […]
Background on risk-sharing and insight into risk-sharing agreements from a payer’s and manufacturer’s perspective.
Provider Owned Commercial Health Plans. Provider-sponsored plans make up 15% or more of the health insurance market, and this percentage is growing, according to many of the projections by industry observers. Until recently, commercial health insurance products have, with only a few exceptions, been offered by health insurance companies. Now, health systems are increasingly assuming financial risk […]
Metro Areas Where Employers Influence Cancer Coverage Costs. Employers currently represent approximately 60% of the commercial insurance market dollars. The Employer commercial insurance market consists of more than 95,000 companies with self-insured plans, eighty percent of whom have less than 2,000 employees. Entering 2017, these employers face double-digit increases in the cost of prescription drugs […]
Employer Perspectives Specialty Drug Step-Therapy Program Evaluation American Health and Drug Benefits, September 2016 Vol 9, No 6 – Industry Trends Matthew Harman, PharmD, MPH, Director, Clinical Pharmacy Strategies Employers Health, Columbus, OH F. Randy Vogenberg, PhD, RPh, Strategic Advisor and Co–Project Leader, Midwest Business Group on Health National Employer Biologics & Specialty Drug Initiative […]
Impact of Commercial Insurance in 2017 – Considerable attention and planning has been focused on the Medicare market, but as we see from the chart below, Medicare represents approximately 13% of the total population. Employer 49% Medicaid 19% Medicare 13% Uninsured 10% Non-Group 6% Other Public 2% (Source: Kaiser Family Foundation) A recent Mercer […]
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 […]