Category: Industry Articles

Published on October 29, 2019

Contract Games If you are presented with a standard contract from a PBM, it should be reviewed for your protection. Below are just a few of the areas to give extra scrutiny. All italicized content below is from actual contract language. Names have been changed to protect the guilty! Formulary Manipulation The following clause allows […]

Published on October 22, 2019

Perpetual Mail order Do you ever wonder why plan designs offer two months for the price of three for mail order? PBMs absolutely love these standing orders once they are established. One of the reasons is the recurring revenue stream, as most own the pharmacy. Stopping the order is quite a feat in most cases. […]

Published on October 15, 2019

In a relatively short period of time, PBMs went from transactional business to managing all aspects of the plan’s pharmacy component. With three major PBMs, Express Scripts, OptumRx and CVS, dominating almost 80% of the market, there is obvious concern about the correlation between the profitability of these companies and the rapidly increasing costs for consumers […]

Published on April 9, 2018

Someone on LinkedIn recently wrote the word Coopetition in a post. It was clearly a typo, but it perfectly describes what a limited number of advisors and consultants are doing to disrupt the broken health care model. I recently attended the Ascend Conference in Nashville and Q4Live in Tampa and was pleasantly surprised to find […]

Published on March 25, 2018

HB37 was sign into law on Friday, March 23rd, by Governor Rick Scott. Previously, the Senate voted unanimously for approval and the House by a 97-10 vote. The bill essentially clarifies that DPC membership does not constitute health insurance and is therefore not subject to oversight by the Florida Office of Insurance Regulation. It’s no […]

Published on January 30, 2018

On January 30, industry giants, Amazon, Berkshire Hathaway and JPMorgan Chase announced a planned collaboration on a health care solution for their employees. According to their statement, the newly formed company will be “free from profit-making incentives and constraints.” “The ballooning costs of health care act as a hungry tapeworm on the American economy,” Warren […]