Cutting Costs by Carving Out the Pharmacy Benefit
Healthcare is now more advanced than at any other time in history, and it keeps moving forward. However, effective medical treatments come at a high price, and there’s no escaping the rising cost of prescription drugs. As this trend continues, employers and health plan sponsors are turning to pharmacy carve-out plans to manage expenses more […]
The PBM’s Role in Effective Specialty Pharmacy Management
Specialty medications are life-saving treatments for complex conditions like cancer, rheumatoid arthritis, multiple sclerosis, and more – but they come with a steep price tag. Although specialty drugs are used by less than 2 percent of the U.S. population, they represent more than 50 percent of total pharmacy spend. The financial impact on plan sponsors […]
5 Essential Steps for PBM Account Teams to Prepare for a Successful Contract Renewal
Contract renewals are critical junctures for pharmacy benefit manager (PBM) Account teams, offering both a challenge and an opportunity to solidify client relationships and showcase value. While preventing a client from going out to bid is ideal, certain clients may be required to explore other options. In these cases, proactive preparation is key to ensuring […]
The Importance of Medical and Pharmacy Claims Integration
The United States spends significantly more on healthcare than other nations, but that doesn’t mean it enjoys better healthcare outcomes. A 2023 Peter G. Peterson Foundation study shows that U.S. healthcare expenses have increased drastically over the past few decades. With costs continuing to soar year over year, health plans and Pharmacy Benefit Managers (PBMs) […]
The Building Blocks of a Sustainable Corporate Weight Loss Program
Obesity is one of the most pressing public health challenges of our time, with nearly 74 percent of U.S. adults classified as overweight or obese. The implications for employers are significant: skyrocketing healthcare costs, declining productivity, and the erosion of overall employee well-being. While many employers recognize the importance of covering weight loss medications like […]
Set the Stage for Success: Year-End Prep for PBM Account Teams
As the current plan year draws to a close, PBM Account teams face a critical window of opportunity to ensure their clients are well-prepared for the year ahead. This period is not just about tying up loose ends; it’s about setting the stage for a successful and seamless transition into the new plan year. Being […]
Reining in Healthcare Costs: Real-Time Solutions for High-Cost Claims
High drug costs are an ongoing thorn in the side of the U.S. healthcare system. New reports show that in 2023, the country spent $722 billion on prescription drugs. That’s a 14 percent increase from the previous year. The main reason for this high expenditure is the growth in spending per prescription as the cost […]
GLP-1 Medications: Direct and Indirect Costs and How to Manage Them
The landscape of healthcare is continuously evolving, and employers are increasingly faced with decisions that impact both their bottom line and the well-being of their employees. One important decision is the coverage of GLP-1 medications, which are primarily used for managing diabetes and, more recently, for addressing excess weight and obesity. As these medications gain […]
Redefining Obesity Treatment with Medication and Lifestyle Changes
The epidemic of overweight and obesity continues to surge in the United States, posing significant health risks and increasing healthcare costs for employers and employees. Achieving and maintaining weight loss is critical to improving health outcomes and lowering healthcare costs. While there are numerous approaches to achieving a healthy weight, the most effective and sustainable […]
The Role of Digital Therapeutics
Technological advancements are transforming almost every sector and business, and healthcare is no exception. Now, healthcare companies must confront these changes, which bring significant advantages but also cause disruption and unpredictability. Digital therapeutics (DTx), for example, is a cutting-edge approach to healthcare, leveraging software and digital platforms to deliver evidence-based treatments to patients. These tools […]
