Pharmacy Benefit Managers: A Brake on Rising Prescription Costs or a Cause of Them?

| posted in Blog

In 2015, spending on prescription drugs grew 9%, faster than any other category of health care spending, according to the U.S. Centers for Medicare and Medicaid Services. The report cited increased use of new medicines, price increases for existing ones, and more spending on generic drugs as the reasons for this growth. Increasingly, though, observers of the health care system point to one player – the pharmacy benefit manager. PBMs are intermediaries, acting as go-betweens for insurance companies, self-insured employers, drug manufacturers and pharmacies. They can handle prescription claims administration for insurers and employers, facilitate mail-order drug delivery, market drugs…
Read More

Prepare Now for Medicare Open Enrollment

| posted in Blog

Oct. 15 is the official start of open enrollment for Medicare and Medicare Advantage and you should take stock of your situation before signing up for your 2017 plan. Before you get started this year on either renewing your plan or opting for a new one, there are steps you can take to make sure that you get the plan that is best for you and that fits your budget and meets your expected medical needs for the year.   Understand the open enrollment period Open enrollment runs from October 15 to Dec. 7, 2015 for Medicare Advantage (Part C)…
Read More

Crackdown on Employers Who Shunt Employees onto Medicare

| posted in Blog

The Centers for Medicare and Medicaid Services (CMS) is stepping up efforts to root out employers who have improperly put workers who were eligible for the company’s group health plan into Medicare. Under the law, employers are prohibited from offering incentives of any kind to a Medicare-eligible individual to enroll in Medicare instead of the employer’s health plan. Companies with 20 or more employees may not encourage covered employees and/or dependents to make this change in coverage. The fine for encouraging an employee or dependent to take Medicare is $5,000 per situation, but that’s not the largest potential penalty. The…
Read More