Out-Of-Pocket Costs Based on List Prices

Today's blog features a Benefits Pro article that delves into the issue of patients paying out-of-pocket for brand name medicines on the full list price as well as cost sharing on nearly one out of five brand-name prescriptions. This is according to Amundsen Consulting, which went on to find in spite of “robust negotiations between biopharmaceutical companies and payers,” health plans don’t pass along the savings achieved via rebates and discounts on the price of medicines, but instead still require patients with high deductibles or coinsurance to pay up based on the medications’ full list price.

The article continues to tackle important issues in the healthcare industry including the role of PBMs and Medicare sufferers. Read more by clicking HERE for the full article. 

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/     

CMS Audit Success: Compliance Matters

In the recent Express Scripts article titled, "CMS Audit Success: Compliance Matters", ESI highlights that strong compliance is a direct indication of high quality, excellent service and optimal health outcomes for members. 

ESI states, "Non-compliance is not an option for Medicare Part D plans. And the monetary penalties can add up for those plans who do not meet The Centers for Medicare and Medicaid Services performance standards."

The results ESI has seen from the Medicare Part D compliance are worth it. These results include low audit scores, fewer compliance actions, higher-than-average star ratings, satisfied beneficiaries, and overall success in this competitive marketplace.

Read the full article HERE!

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/     

House Approves Drug Price-Gouging Bill

Erin Cox of the Baltimore Sun recently reported that Maryland's attorney general could sue drug companies for price gouging according to a new bill approved by the House of Delegates on Monday.

Cox explains, "Under the legislation a drug price increase by more than 50 percent would trigger a report to the attorney general, who would have power to demand an explanation for the increase."

There's much more on this topic. For more information, please read the full article HERE! 

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/     

Study Finds ACA Replacement Plan Could Harm Dual-Eligibles

Today's blog highlights the recent Modern Healthcare article that continues to keep us updated on the most up-to-date happenings regarding the Affordable Care Act. The plan to completely modify Medicaid as part of this new bill could affect more than 11 million beneficiaries who were also covered by Medicare.

Steven Ross Johnson writes, "The population, commonly known as dual-eligibles, make up about 15% of the entire Medicaid population but account for 36% of Medicaid spending. Most dual-eligibles are 65 years or older but more than 4 million are younger adults living with severe disabilities." 

Be sure to read the article in its entirety HERE!

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/     

Patients Before Politics

Kevin O'Reilly of the American Medical Association recently reported on a new website launch that will make it easier for patients and physicians to understand the new healthcare bill along with tools to be able to take part in the effort to protect healthcare coverage for millions.

O'Reilly states, "The site, Patientsbeforepolitics.org, colorfully delineates the nine objectives that will guide the AMA in its discussions regarding ongoing efforts to improve the nation’s health system. The objectives were included in the letter that AMA CEO and Executive Vice President James L. Madara, MD, wrote to Congressional leaders in January. They grow out of the AMA’s comprehensive vision for health-system reform."

Learn more about this website and how to make your voice heard by reading the full article HERE!

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/     

Should Specialty Drugs Be Shifted From Medical To Pharmacy Benefit?

Today's blog features a piece courtesy of Transparent that asks the question, should specialty drugs be shifted from medical to pharmacy benefit? Peter Wherwein carefully outlines the four advantages of making this shift throughout the article. Very important read! Check it out HERE!

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/     

13 Things You Need to Know About the ACA Replacement Bill

At HORIZON Health Ventures we're staying on top of all the headlines pertaining to the ACA Replacement Bill. Modern Healthcare just released another article on the topic that breaks down the American Healthcare Act into 13 key points that you need to know. Be sure to read the full article HERE!

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/     

A Peek Down the Pipeline

Yesterday Magellan Rx sent out their recent information sheet about their upcoming Hepatitis C Agents in 2017. 

Steve Cutts writes, "The horizon of hepatitis C management continues to unfold in anticipation of a new round of FDA approvals. With these complex and expensive treatment options, our industry is facing great challenges in helping to improve patient health while effectively managing costs." 

Visit www.magellanrx.com for more information!

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/     

Hemophilia Management Solutions

Magellan Rx Management recently sent out an informative PDF highlighting Hemophilia Management Solutions. Hemophilia is a rare, inherited bleeding disorder in which the blood does not clot normally due to missing or low levels of protein known as clotting factors. This disease affects an estimated 20,000 males in the United States. Although rare, hemophilia is one of the most expensive chronic conditions facing healthcare payers today. 

Magellan Rx has a solution! 

Visit www.magellanrx.com for more information!

HORIZON Health Ventures is a healthcare cost management solutions company used by insurance brokers, employee benefit consultants, third-party administrators, insurance companies, and associations, to bring proven thought leadership and strategy to the management of their clients healthcare costs. To learn more about HHV and their services, please visit http://horizonhealthventures.com/