Benefits Insights

The U.S. Department of Health & Human Services requested comment on a proposed rule that removes the current safe harbor protections for rebates involving prescription pharmaceuticals from the Federal anti-kickback statute and creates two new safe harbor protections for certain point-of-sale discounts and certain PBM servi... read more

The pharmacy benefit management marketplace is facing more public scrutiny than ever. Over the past several months, the news media exploded with stories concerning the business practices of pharmacy benefit managers (PBMs). Some stories focus on the rebates PBMs receive from drug manufacturers or the unexplained spikes in the ... read more

It seems on a weekly basis that publications introduce us to some new term that describes an unruly practice within the pharmacy benefit landscape. Clawbacks, spread, gag clauses and others dominate the headlines, with advocates for the many stakeholders in the pharmacy supply chain lining up to either launch an assault or def... read more

There are quite a few PBM pricing “illusions” that require purchasers and their consultants to look “beyond the spreadsheet.” These subtle caveats are aimed at providing the illusion of more aggressive pricing through higher discounts and rebates on the consultant’s spreadsheet while reducing or changing the number o... read more

Edited 10/12/18 With prescription drug prices rising, the spotlight is shining brightly on the health care industry. Consumers and politicians alike have questioned how best to curtail rising prices. Consolidation is a central strategy of managed care organizations, pharmacy benefits managers, pharmacies, wholesalers and insur... read more

Benefits Accelerator® is a value-based strategy that harnesses a robust technology platform, preferred vendors with proven concepts and results that emphasize heightened health status and well-being. This collaborative approach can accelerate a plan sponsor’s objectives to control health care costs, improve health outcomes ... read more

Most plan sponsors evaluate the pricing competitiveness of their pharmacy program the same way – by going out to bid for a new pharmacy benefits manager (PBM). But, running a bid process can be expensive and difficult to manage. Therefore, plan sponsors tend to avoid the process all together. PBMs use this to their advantage... read more

The “Cadillac Tax” is a 40 percent excise tax on the cost of employer-sponsored health coverage that exceeded certain cost thresholds. As originally enacted by the Affordable Care Act (“ACA”), the Cadillac Tax was non-deductible and scheduled to begin in 2018. Although the tax was intended to only impact “high-cost�... read more

Over the past 10 years, employer expenditures for employee health care were perceived as a “necessary evil,” as employers used health benefits as part of their attraction and retention strategies. With health care costs rising faster than the general inflation rate, employers and plan sponsors have been faced with the chal... read more