Prescription Drug Plans

Foundation Publication Search Results

These summaries were compiled from Foundation Publications Search, a database of articles, research reports and books published by the International Foundation and the International Society of Certified Employee Benefit Specialists.


National Pharmacare--Dead and Alive.
Bonnett, Chris; Plans & Trusts; v35 no6 pp 10-14 Nov-Dec 2017; journal article

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Abstract : Given the complexity and costs involved in a national drug insurance program, it is important for plan sponsors, advisors and insurers to be engaged on this topic and to be able to understand and communicate their needs and goals.
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Word on Benefits.
Abelson, Adam; Benefits Magazine; v54 no10 pp 74-75 Oct 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Discusses the Supreme Court ruling on the biologics drug case Sandoz Inc. v. Amgen Inc.
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Finding and Preventing Prescription Drug Fraud.
Hayes, Susan; Benefits Magazine; v54 no6 pp 18-23 Jun 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Prescription drug fraud can be a costly problem for health plans. The author describes common abuses and recommends steps plan sponsors can take to identify fraud and stop it from happening.
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Specialty Drugs: Four Options for Managing Costs.
Davies, Rory; Benefits Magazine; v54 no6 pp 30-35 Jun 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : With specialty drug costs growing at a double-digit pace and new drugs entering the market, plan sponsors struggle to keep up. The author describes challenges plan sponsors face with some particular high-cost drugs and offers four cost-control strategies.
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Can Pharmacogenetics (PGx) Help Your Members and Improve Plan Sustainability?
Litinski, Veronika; Dorfman, Ruslan; Plans & Trusts; v35 no3 pp 8-13 May-Jun 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : By enhancing the ability of doctors to select prescription drugs that better interact with an individual's inherited genetic variations, pharmacogenetics may hold a key to improving medical experiences for members and reducing plan costs.
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Redefining the Meaning of Lifestyle Drugs in Your Benefits Plan.
Polk, Gordon; Fong, Robert; Plans & Trusts; v35 no3 pp 22-26 May-Jun 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Plan administrators have to juggle the dual aims of improving member benefits and containing plan costs. Taking a broader view of health and lifestyle when it comes to drugs for smoking cessation and weight loss, among other categories, could help in achieving both goals.
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Attention Turns to Specialty Pharmacy.
Dross, David; Benefits Quarterly; v33 no2 pp 12-15 2nd Qtr 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Specialty biotech drugs represent 1-2 percent of prescriptions yet 35 percent or more of overall pharmacy costs--and are projected to reach 50 percent of costs over the next three years. In the United States, the cost of these drugs is multiples more than in other countries, and their use presents global competitiveness and philosophical challenges for plan sponsors. This article examines specialty drugs trends, discusses balancing access to them versus their impact and reviews the current state of specialty drug management. It provides plan sponsors with key considerations for the future. While specialty biotech management will remain an area of focus affecting benefits budgets for years to come, options are available to help manage their impact and improve outcomes.
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How Employers Are Looking at Specialty Pharmacy Today.
Morris, David; Palermo, Alex; Benefits Quarterly; v33 no2 pp 20-25 2nd Qtr 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The cost and complexity of specialty medications are keeping employers and plan administrators up at night. A 2016 survey found that large group employers (100+ full-time employees) struggle with specialty drug trend and cost management, using a variety of unconnected tools and techniques. This article outlines employer challenges and suggests a medical/pharmacy integration paradigm as a successful model for controlling costs and improving health outcomes.
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Managing Pharmacy Trend Rates.
Cassin, Nathan; Zeitel, Lisa; Patel, Hitesh; Benefits Quarterly; v33 no2 pp 8-11 2nd Qtr 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Although determining the driving forces behind double-digit price inflation trends for pharmaceutical costs has proven increasingly difficult, one thing is clear: Drug trend rates are unsustainable for plan sponsors and will continue to be a top challenge in the coming years. This article discusses emerging strategies for dealing with prescription drug cost trends, best-in-class contracting, changing and affecting drug mix, the changing reimbursement model and what's next in mitigating evolving pharmaceutical costs.
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Pharmacy Benefit Integration: A Connected Approach to Total Medical Cost Savings.
Vancura, Michelle; Benefits Quarterly; v33 no2 pp 16-19 2nd Qtr 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Pharmacy and medical benefit integration's most meaningful value lies in obtaining a comprehensive understanding of someone's health journey. An effective way to control health care costs for all stakeholders and improve overall wellness is to understand and manage health conditions in their entirety, not just the prescriptions. This article highlights (1) how pharmacy and medical benefit integration provides a more holistic view of health, (2) how individuals inquiring about their pharmacy benefits can be successfully engaged to participate in health coaching and other programs available through their medical benefits, (3) how integrated data provides real-world insights for evaluating the value that drugs and health management programs deliver and (4) what plan sponsors might attain in cost savings through the use of integrated benefits.
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Pharmacogenetic Testing May Improve Drug Treatments and Shorten Disability Leaves.
Lefaivre, Antoine; Litinski, Veronika; Vandenhurk, Maria; Benefits Quarterly; v33 no1 pp 43-49 1st Qtr 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : This article describes how methods of personalized medicine—specifically, pharmacogenetic (PGx) testing—can benefit private health plans, benefits managers, care providers and consumers alike. The authors cover pharmacogenomics as a science and also introduce an innovative way to optimize drug treatments. The article touches on some important clinical outcomes drawn from a study in community pharmacy and reviews the application and return on investment of PGx testing in disability and medication management.
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Drug Plan Sustanability and Current Trends--What You Need to Know.
Bergstrom, Kathy; NewsBriefs; v35 pp 16-18 1st Qtr 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Although much attention has been focused on the role of biologics and specialty drugs in increased private drug plan costs, plan sponsors should also consider how to manage the other 77 percent of drug costs and 99.5 percent of claims. Based on the author's presentation at the 2016 Sympoisum.
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Prescription Coverage Savings: Easy to Find if You Just Look For Them.
Cahn, Linda; Benefits Magazine; v54 no1 pp 20-27 Jan 2017; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : A health plan sponsor can dramatically reduce its prescription costs if it excludes--or disfavors--high-cost drugs, pays attention to and changes its PBM contract terms and guarantees, excludes high-cost pharmacies from its retail pharmacy network and takes advantage of manufacturer coupons.
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Benefit Trends: Health Care Cost Controls.
Held, Justin; Benefits Magazine; v53 no9 pp 8-9 Sep 2016; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The International Foundation’s fifth Employee Benefits Survey reveals benchmarking data from 577 organizations representing nearly 20 industries and ranging in size from fewer than 50 to more than 10,000 employees. This data examines employers’ moves beyond traditional cost-sharing schemes to examine several cost-containment techniques, including administration and data analysis initiatives, plan design and program initiatives, purchasing and provider initiatives, and utilization control initiatives, and utilization control initiatives.
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Quick Look: Unwrapping Benefits Packages.
Benefits Magazine; v53 no7 p 45 Jul 2016; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : It’s no stretch to say benefits are an important part of many organizations’ strategies for attracting and retaining the best employees. The Foundation’s fifth Employee Benefit Survey collected benchmarking data from 577 organizations. Respondents from nearly 20 industries, from organizations of fewer than 50 to more than 10,000 employees, answered questions about a wide variety of retirement, health care and leave benefits along with life-style perks—think coffee service and allowing babies at work—and everything in between.
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Pharmacies Denied Injunction Against Pharmacy Benefit Manager.
Benefits Quarterly; v32 no2 pp 58-59 2nd Qtr 2016; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Pharmacies suing pharmacy benefit manager for failure to follow ERISA notification rules when it cut medication coverage were not entitled to preliminary injunction.
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Mail-Order Drugs for Canadian Plan Sponsors: Ready to Help or Still Under Construction?
Petruniak, Jane; NewsBriefs; v34 pp13-16 1st Qtr 2016; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Canadian plan sponsors may want to explore mail-order pharmacy as a cost-control tactic for dealing with prescription drug costs.
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Employee Benefits Survey: 2016 Results
Held, Justin; Mrkvicka, Neil; Stich, Julie; 70 pp 2016; survey

Availability : International Foundation of Employee Benefit Plans
Abstract : Results of the fifth comprehensive benchmarking survey conducted by the International Foundation. Includes data on pension and retirement plans, health care benefits and other benefits, such as life insurance, work/life benefits and time off, for three distinct sectors in the U.S.—corporations (including professional service firms), public employers and multiemployer benefit plans. Responses were gathered from members of the Foundation and the International Society of Certified Employee Benefit Specialists during 2016.
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Don't Fall Asleep Monitoring Rx Coverage: You May Wake Up to a Nightmare.
Cahn, Linda; Benefits Magazine; v52 no12 pp 34-41 Dec 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Health plans are increasingly trying to find ways to lower prescription coverage costs, which presents insurees with six marketplace challenges they must face. Drug prices are increasing and the FDA is approving scores of new high-cost specialty drugs for the market. Patients and their doctors often resort to convenient combination drugs, many of which combine two or more lower-cost drugs into a single, often far more expensive product. Specialty pharmacies have popped up that promote high-cost products, some of which aren't approved by the FDA. Over-the-counter drugs have become lower cost legitimate alternatives to higher cost prescriptions and when brand drugs lose their patents, with generics available at a much lower cost, but pharmacy benefit managers (PBMs) are often slow about encouraging changes to plans that take advantage of these lower costs.
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Quick Look: Specialty Pharmacy Management.
Benefits Magazine; v52 no8 p 10 Aug 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : For its detailed "2015 Speciality Drug Benefit Report," Pharmacy Benefit Management Institute (PBMI) surveyed 366 employers covering about 23.5 million enrollees about their concerns about and strategies for managing specialty drug cost trends.
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ERISA Statute of Limitations Provision Tolled in Cases of Fraud or Concealment.
Benefits Magazine; v52 no6 pp 55-56 Jun 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Tenth Circuit Court of Appeals reversed the lower court's ruling regarding statute of limitations in Fulghum et al. v. Embarq Corporation et al. The plaintiffs were retirees whose former employer amended the employee benefit welfare plans for those eligible for Medicare, cutting drug and life insurance coverage, which the plaintiffs claimed were vested for life. The court reviewed 30 summary plan descriptions (SPDs) and granted summary judgment for the defendants. The plaintiffs argued those not covered by those specific SPDs should not be included in the judgment, and the Tenth Circuit agreed. The plaintiffs also claimed misrepresentation and concealment of facts about their benefits, a point dismissed by the lower court as untimely but allowed by the circuit court because of the exception for fraud or concealment under ERISA Section 413. The court allowed the defendants' justification for cutting benefits, agreed the presented SPDs did not promise lifetime vesting and found no age discrimination but reversed the lower court's dismissal of breach of fiduciary claims affected by fraud and claims.
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The More Things Change: Benchmarking Collectively Bargained Private Sector Benefits.
St. Jacques, Riley; Petruniak, Jane; Plans & Trusts; v33 no3 pp 14-19 May-Jun 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : A PBI Actuarial Consultants survey of 41 Canadian public and private sector multiemployer plans reveals commonalities and differences useful for benchmarking. Plan designs have changed little since the 1980s, but accelerating technological change challenges the status quo. The PBI survey found most private sector multiemployer plans offered long-term disability to age 65, though some limit benefits to five years. All provide some vision and hearing benefits, though benefit levels are falling, while corporate plans tend toward choice through flexible health spending accounts. Only one in 20 private multiemployer plans have prescription drug dispensing fee limits, in contrast to the majority of corporate and public sector plans. Virtually all private multiemployer plans cover massage, a benefit for about half the other plans. No private sector multiemployer plan surveyed offered a health and wellness spending account, but nearly half of public sector plans did.
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Say "Yes" to Programs to Control Drug Use.
Cahn, Linda; Benefits Magazine; v52 no1 pp 22-29 Jan 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Unlimited access to pharmaceuticals is not in the best interest of drug plan participants or the plan itself. The Centers for Disease Control state prescription painkiller overdoses caused nearly 17,000 deaths in 2013. Opioids are intended for short-term use, and overuse leads to drug tolerance and dependence. Excessive use of painkillers can be controlled by limiting quantities, instituting step therapy and requiring prior authorization. There are abundant signs of overuse or misuse of other types of pharmaceuticals such as proton pump inhibitors, specialty drugs, antipsychotic drugs and erectile dysfunction drugs, often leading to serious risks and side effects. Plan sponsors should review pharmacy benefit manager (PBM) authorization data and ensure their PBM updates benefits to reflect current drug recommendations and appropriate usage.
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Are Your Pharmacy Benefits Being Adjudicated Properly?
Anderson, Brian N.; Benefits Magazine; v51 no5 pp 22-27 May 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : A pharmacy benefit claim audit has considerable potential value, typically uncovering problems in three to five percent of paid claim costs. Audits deliver the opportunity to recover overpayments and reveal system errors, providing a typical six- to ten-fold return on investment. They should be written into pharmacy benefit management contracts. The goal of an audit is primarily to assure that claim payments are accurate and comply with plan terms and contractual agreements. It can also spot errors, propose solutions, evaluate administrative practices and consider the chances for monetary recovery. It focuses on plan design, financial aspects, eligibility, rebates and performance assurances and should be performed at least every two years.
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Court Considers Changes to Retiree Medical Benefits.
Benefits Magazine; v51 no4 pp 72, 74 Apr 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The New York State Court of Appeals came to no conclusion in Kolbe v. Tibbetts, in which the plaintiffs sought continuation of health benefits without change during retirement, prompting the court to remand the case for further consideration. The plaintiffs were retired school district employees who were told the former two-tier prescription drug classification would be changed to three tiers, resulting in higher costs to the employees. They alleged this violated terms of the collective bargaining agreements (CBAs) in force when they retired. One state court ruled for the plaintiffs, finding the plan language granted the same benefits as at the time of retirement, despite expired CBAs. The appellate court reversed, stating rights should vest on retirement, not end with CBA expiration. Yet the court found the CBA ambiguous as to whether same coverage meant coverage equivalent to that offered currently, considering changes to cope with rising costs, or coverage equivalent to that offered at the time of retirement. The court remanded the case for the purpose of resolving this ambiguity.
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