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These executive summaries were compiled from EMPLOYEE BENEFITS INFOSOURCE database, a source for information on employee benefits and human resources.
Drug Program Targets Costs.
Wojcik, Joanne; Business Insurance; v46 no11 p 6 Mar 12, 2012; journal article
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Abstract :
An innovative drug insurance product is attracting self-funded midsized employers. EBC Rx LLC is offering Rx 'n Go, a mail order program under which employers pay for 90-day prescriptions for generic drugs. Employers note the lower cost and easy refills improves compliance with chronic condition treatment plans, potentially cutting long-term health care costs. Billing statements for the program provide drug utilization data to the employer, third-party administrator and/or pharmacy benefits manager (PBM) at no extra cost. Obstacles come from the fact that most PBM contracts prohibit employers from such outside arrangements, and there is no integration between data for drug utilization and other medical services or metrics.
[0161854]
Misdiagnosis: The Clinical Integration Solution.
Falchuk, Evan; Employee Benefit Plan Review; v67 no3 pp 15-16 Mar 2012; journal article
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Abstract :
Research estimates the rate of misdiagnosis at 20 percent or higher. This is the result of lack of integrated clinical data, time pressure, inattention to detail and provider stress, and contributes to soaring health costs, and patient confusion and suffering. The solution is clinical integration, starting with a health plan sponsor's expectation that all vendors will coordinate efforts to support employees' disease management. Covering disability, specialty pharmacy, care providers, wellness programs and disease management, clinical integration aims to make the most efficient use of existing benefit offerings. It starts with the right diagnosis, which should be checked by a second opinion or more, considering personal and family medical history. Employers should insist that employees take active part in clinical integration, being educated about the true costs of care and being responsible health care recipients.
[0161874]
A Four-Part Prescription for Managing the Cost of Pharmacy Benefits.
Segal Company: Newsletter; 4 pp Feb 2012; journal article
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Abstract :
Containing the cost of prescription drugs, rising 7.2 percent for 2012, will take a range of strategies. Plan sponsors should start by considering trimming their retail pharmacy network, balancing deeper focused discounts against participant inconvenience. Generic pricing also demands reassessment in light of the growing numbers of competitive generic alternatives for any one condition. Many drug companies offer coupons directly to participants, undermining plan design goals and cost management. Plans can require participants to pay the price difference, impose higher-tier pricing or require generic use before brand name drugs. Closer contact between participants and pharmacists can boost therapy compliance but might need to be limited for higher-cost pharmacist-centered pharmacy benefit management services.
[0161652]
Cancer Care in Canada: Opportunities and Challenges.
Balch, Denise; Benefits and Pensions Monitor; v22 no3 p 44 Feb 2012; journal article
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In 2007 cancer was the most common cause of death for Canadians, striking four of every ten. A positive sign is the development of innovative treatments including oral therapies, those administered in a doctor's office and those taken at home. However, most insurers decline infusion therapy if not in a hospital, and alternative administration methods have complicated payment arrangements, often leaving employer drug plans or the patient's family to pick up the cost. The Cancer Advocacy Coalition of Canada documented that a significant number of provinces paid little or nothing for take home cancer drugs in 2007. It is time for plan sponsors, advocacy groups and provincial health ministries to tackle the challenge of reimbursement for cancer therapy and stop cost shifting to the private sector and uninsured.
[0161831]
Decision Time.
Bauer, Gabrielle; Benefits Canada; v36 no2 pp 26-28, 30-31 Feb 2012; journal article
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Abstract :
A December 2011 Drug Plan Management Forum brought together insurers, employers, pharmacists, physicians and pharmaceutical industry representatives to discuss how to make drug plans more efficient. Attendees heard Mercer survey findings that over 70 percent of employers pay at least 80 percent of drug costs, including over-the-counter drugs and rarely with out-of-pocket caps or cost pooling. Plan design changes involving tiering, copayments, dispensing fee caps, generics and biologic drugs were offered as effective strategies for cost management. Lifetime specialty drug therapy for chronic diseases may be unsustainable for plan sponsors without design changes and consumer education. Key lessons include prioritizing drugs based on outcomes, educating plan members about therapeutic effectiveness and cost sharing needs, requiring prior authorization and exploring cost pooling options for underwriting biologic drugs.
[0161735]