Drug pricing can be a confusing business… and much of the confusion stems from a drug’s average wholesale price, or AWP. Simply defined, the AWP is the average price that a pharmacy or other retailer pays a wholesaler for a drug. But as straightforward… more »

Formulary updates for prescription plans administered by Ventegra and Pharmacy Data Management, Inc. (PDMI) are now available at MedBen.com – simply click on “Plan Sponsors” (for employers) or “Plan Members” (for insureds) and select “Prescription… more »

To improve medical cost transparency, the Centers for Medicare & Medicaid Services (CMS) has announced a new Medical pricing tool for surgical procedures that will also benefit certain reference-based pricing (RBP) plans. The Procedure Price Lookup… more »

As the prescribing of generic drugs has become more commonplace, most consumers have come to see that these medications work just as well as their pricier band-name equivalents. Indeed, when a generic alternative is available, MedBen clients see a 98%… more »

Drug pricing transparency is currently a hot government topic: On October 10, President Trump signed two bills designed to end the drug industry's "gag order" of pharmacists, which prevent them from discussing cheaper price options with consumers.… more »

Spread is a little-discussed aspect of prescription drug pricing, but its impact on pharmacy plan costs can be huge… and it’s why MedBen has responded with new pharmacy programs designed to remove spread from the cost equation altogether. Simply… more »

A strong economy and low unemployment contributed to an increase in employers offering health coverage in 2017, finds a new study by the Employee Benefit Research Institute. The increase halted a decade-long trend in which some companies dropped their… more »

Health care payers are continually looking for ways to reduce medical spending. One such concept that has gained traction in recent years is the bundled payment system, in which a provider is paid for a complete episode of care, rather than paid… more »

A Managed Healthcare Executive article spotlights "New Drug Pricing Tools Could Save Money" -- among them, a recently launched "real-time benefits tool" that shows out-of-pocket costs for medications based on a patient's plan benefits. Sound like a… more »

A recent wellness study confirms something that MedBen has known for a long time: If you want your workplace wellness program to succeed, the "physician first" approach is the way to go. According to BPS Research Digest, researchers tracked multiple… more »

There are plenty of benefits for employers who make the switch from fully-insured health care coverage to self-funding – and we’d be happy to share them all with you anytime – but perhaps the best reasons can be summed up quite simply: Savings,… more »

"Healthcare costs increasing at unsustainable pace" a recent Modern Healthcare headline reads. In a new study, PricewaterhouseCoopers predicts a 6% medical cost trend in 2019, as expensive new medical services and drugs and market consolidation make it… more »

During recent testimony to a Senate committee, Health and Human Services Secretary Alex Azar floated the idea of eliminating the rebates that drug companies and pharmacy benefit managers (PBMs) use in price negotiations. As noted on Bloomberg.com, "PBMs… more »

Plan language carve-outs don’t have to be limited to medical procedures or drug classes. If a provider charges above reasonable and customary prices, then an employer can amend their plan to direct that the provider’s claims should be processed using… more »

A recent Washington Post article highlights the machinations that drug companies will use to ensure that insurers and other private-sector sources pay for their products, rather than price-controlled public services like Medicare. One common… more »

At a recent MedBen University event, MedBen Vice President of Sales & Marketing Brian Fargus warned attendees against drug rebate guarantees that promise a lot but deliver little… and end up costing the employer more. “Some of the larger health… more »

Clinical reviews are an essential component of MedBen claim management, as our team of medical specialists ensures that your plan’s claims are paid accurately and in line with prevailing regional costs. At our recent MedBen University roundtables,… more »

Newly appointed Health and Human Services Secretary Alex Azar says he wants to see greater transparency in drug pricing. In an address to the Federation of American Hospitals last month, Azar noted that “in both healthcare services and pharmaceuticals,… more »

Among the speakers at several of this year's MedBen University sessions is pharmaceutical consultant Allan Zaenger, President of Pharmaceutical Horizons. In his presentations at recent roundtable events, he outlined plan design options employers should… more »

At two recent industry-specific MedBen University (MBU) roundtables, MedBen Vice President of Sales & Marketing Brian Fargus highlighted how the company's claims management solutions are keeping plan costs in check. From 2013 through 2017, the… more »