Maximizing pharmacy benefits in self-funded plans

Typically Pharmacy Benefit Managers, or PBMs administer prescription benefit plans. PBM's job is to get discounted contracts with pharmacies and pharmaceutical companies, adjudicate claims from pharmacies, pay them for covered prescriptions and provide additional clinical & administrative support. Today, more than ever, prescription medicine represents a large portion of employer sponsored plan expenses, representing 15%-25% of the total…

Five steps to control escalating costs of speciality drugs

Speciality drugs are derived from living cells, often infused or injected and often require supervision. The prices for speciality drugs are much higher than branded or generic drugs. For example in employer sponsored plans, speciality drugs usage is about 2-5%, yet they make up over 30% of the overall cost. In comparison, the generics are typically…

Mind the gap in your stop-loss contract

The prevalence of high-cost claims have gone up drastically along with the dollar value of those claims. The conditions resulting in claims greater than $1 million are more prevalent today due to advances in medical technology and improvements in life-extending care. According to Sun Life, the 1,979 self-funded employers it counted as customers at the end of…