Category: Pharmacy, PBMs, and Pharma costs

May
2

What’s not at RIMS

Posted by Joe Paduda on Wednesday, May 2nd, 2007 | Comments

Dozens of brand spanking new workers comp pharmacy benefit managers (PBMs). Last year at RIMS every aisle was packed with shiny new booths staffed by folks who, as swiftly became painfully obvious, were rather new to WC.
Either they didn’t want to come to New Orleans (they are definitely missing out) or they are out of business, or out of the comp business. Most likely they found their group health contracts, systems and processes, and cost management techniques just didn’t work in the highly-regulated, state-specific, first-dollar-every-dollar world of WC.
We’ll miss their enthusaism and humor-generating ability (“and how many members do you have? what kind of tiered copays are you using? let me tell you about our unique formulary that controls costs!”) and trinkets.
Sort of.

Apr
27

Direct to Doc marketing

Posted by Joe Paduda on Friday, April 27th, 2007 | Comments

Big pharma woos docs with free food, trips, and samples. Now that’s a “dog bites man” story. The reason for the ongoing marketing to docs is obvious – more contact, more drugs sold.
But the world is starting to look much more closely at the pharma-physician relationship, and that examination is likely to bring changes.

Continue reading Direct to Doc marketing

Apr
18

Working to increase your drug costs…

Posted by Joe Paduda on Wednesday, April 18th, 2007 | Comments

OK, another trip down Esoteric Lane, into the wierd world of WC drug management…
When states set high workers comp fee schedules for drugs, WC medical costs go up, and too many dollars are taken from employers and given to pharmacies and PBMs.
That’s exactly what an organization with the seemingly innocent title “Workers Comp Pharmacy Alliance” is working towards.

Continue reading Working to increase your drug costs…

Apr
10

those damn vendors

Posted by Joe Paduda on Tuesday, April 10th, 2007 | Comments

Insurance companies, employers, and TPAs rely on vendors to process bills, build and operate networks, manage prescriptions and PT, support litigation, and provide expert advice on problematic medical issues. In many instances the vendors are selected thru a competitive bidding process, wherein the lowest bidder gets the deal, or at the least has a much better chance of landing the business than their more costly competitors.
But in others, the selection process goes on seemingly without end.

Continue reading those damn vendors

Apr
9

Part D’s ugly beginnings

Posted by Joe Paduda on Monday, April 9th, 2007 | Comments

If watching the legislative process in DC is akin to watching sausage made, the passage of the Medicare Drug bill might be akin to the composting process. Roy Poses at Health Care Renewal reflects on “60 minutes'” recent piece on the making of Part D; Roy’s deep experience with big pharma adds a good bit of perspective.
Health care reform is coming; read Roy’s piece for a heads’ up on what the legislative process may look like.

Mar
27

the end of the third party biller auction?

Posted by Joe Paduda on Tuesday, March 27th, 2007 | Comments

Sources indicate Fiserv has terminated its efforts to sell third party biller Third Party Solutions thru Bank of America. This despite Fiserv’s interest in shedding non-core assets, begun under CEO Jeff Yabuki. While Fiserv may still entertain offers, it is unlikely any will approach the rumored goal of $275 million Fiserv was asking for TPS.
While more than a few private equity/venture firms assessed TPS, evidently no term sheets approached the desired valuation. Issues may have included concern about TPS’ “complicated” A/R situation.
Meanwhile, competitor WorkingRx is still for sale…
What does this mean for you?
A temporary continuation of the current awkward third party biller-pharmacy-PBM-payer struggle/business relationship.

Mar
23

Washington’s smart policy on opioids

Posted by Joe Paduda on Friday, March 23rd, 2007 | Comments

The state of Washington is a monopolistic workers comp state; unless an employer is large enough to be self-insured, it has to buy workers comp insurance from the state itself.
As a monopolistic state, the regulators have even more power than in the highly regulated but non-monopolistic states. One area of particular interest is how the state deals with the WC drug formulary, which specifically excludes Actiq and Lyrica.
Washington’s Health Dept. just released new guidelines on the use of narcotic opioids; the guidelines, their development process, and the impact of same should be watched carefully by regulators, insurers, managed care firms and most of all prescribing physicians.

Continue reading Washington’s smart policy on opioids

Feb
27

URAC’s foray into pharmacy benefit management

Posted by Joe Paduda on Tuesday, February 27th, 2007 | Comments

URAC, the accreditation body that seems to be into every aspect of managed care, is now looking to certify PBMs. In a presentation at the PBMI conference in Phoenix last week, a representative provided an overview of the process, modules, timing and certification levels contemplated by URAC.
While the process is only for health lines today, URAC is seriously looking into accrediting WC PBMs…
Brace yourselves.

Continue reading URAC’s foray into pharmacy benefit management