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10/31/07

  12:00:01 pm, by MedBen5   , 182 words,  
Categories: Announcements

MedBen Access: New Look, New Features and More Convenience!

MedBen Access has changed for the better! If you’re a frequent visitor of our 24/7 claims and benefits information website, you’ll notice some important differences on your next visit designed to make your online experience even more user-friendly, including a personalized information page and convenient drop-down menus. And if you’re a newcomer, we think you’ll find MedBen Access to be an easy way to manage your health care plan!

For those who have yet to check out MedBen Access, the site allows you to perform a variety of customer service functions, such as checking real-time status of current pending claims, tracking your plan year contributions, and reviewing your plan’s benefit summary – and that’s just for starters!

There’s a lot you can do on MedBen Access, so we invite you to go to www.medben.com and take a look for yourself! To create a User Name and Password, follow the simple instructions on this MedBen Basics flyer. And if you have questions about MedBen Acess, please contact our Customer Service Department at (800) 686-8425 or medben@medben.com.

10/15/07

  08:12:58 am, by MedBen1   , 235 words,  
Categories: Announcements, Prescription, Health Plan Management

Pharmacy Pricing - what is AWP, how will it change and what can you do?

Segal Co. offers a good overview of the effect of the class action lawsuit related to drug pricing. You can get the summary from Segal’s website here.

As Segal notes, the calculation for Average Wholesale Pricing, or AWP, was determined to inflate the price of approximately 8,500 drugs by 4%. Pharmacy pricing for groups is usually expressed in terms of AWP minus some percentage.

The survey also reviews some of the alternative pricing structures, such as wholesale acquisition cost (WAC).

In addition to the pricing structure, MedBen recommends the following to its clients when looking at drug pricing:

Transparency - demand full disclosure of discounts and rebates received by the pharmacy benefit manager. Many managers offer what appears to be a stronger discount on brand name drugs, only to withhold a bigger portion of the generic discount available. The same thing holds true for rebates. Pharmacy Benefit Managers “guarantee” a per drug rebate, keeping dollars above that rebate. Generally, you want all the discounts available – even if it means no guarantee – and all the rebates paid.

Full Fee Disclosure - make sure to get a statement of all fees being paid from your pharmacy program.

Measure Performance - utilization, member copayment (in dollars and percentage of drug ingredient cost), generic substitution rate, drug ingredient costs and amount paid per member per month will offer a good benchmark to measure the effectiveness of your drug plan.

10/08/07

  08:06:36 am, by MedBen1   , 139 words,  
Categories: Announcements

Beware of overused tests

Consumer Reports has a top 10 of overused medical procedures and the associated hazards in their November issue. A summary can be found on their web site.

Among the top 10 are back surgeries (90% of of back pain goes away within six weeks), heartburn surgery, prostate treatments, implanted defibrillators (according to Consumer Reports, over 30 percent of defibrillators placed are not needed), coronary stents, cesarean sections, whole body screens (the editors warn of false positives), high-tech angiography, high-tech mammogram and the virtual colonoscopy (if something questionable is found on the virtual colonoscopy, in goes the tube and up go the charges).

As the headline warns, “Insured? You’re money in the bank to the health-care system.”

What can consumers do? Be cautious around the top ten, lead a healthier lifestyle and work with your physician. Ask questions and devise a treatment plan together.

10/03/07

  09:26:50 am, by MedBen1   , 182 words,  
Categories: Wellness, Discounts, Health Plan Management, Incentives

Lower health plan costs tied to health focus, plan management over discounts

Employers with the lowest comparable health costs focus on strong clinical programs and solid plan management over proclaimed discounts, according to the 2007 SHPS Health Practices Study (you can download the study here). According to SHPS’s CEO Rishabh Mehtrotra:

“We discovered a troubling pattern whereby employers use financial models and network procurement strategies to manage health costs instead of addressing the underlying clinical risks driving the demand for health care.”

Five key findings in the report, according to Employee Benefit News are:

1) Employers that focus on targeted conditions in their programs experience costs averaging 18.2% lower that norms.

2) Incentives for participation in desirable health behaviors led to costs averaging 15.1% lower than norms.

3) Companies using strong benefit managers with centralized recordkeeping and solid eligibility procedures experienced costs on average 12.7% below norms.

4) Wellness promotion and education helped costs by 16.9%.

5) Practices that increased costs included over-reliance on proclaimed network discounts, multiple plan design options used to control costs, use of deductibles and copays in isolation to control costs, and using the health care benefits as a tool to become an “employer of choice” or to lower turnover.

10/01/07

  01:25:29 pm, by MedBen1   , 137 words,  
Categories: Announcements, Prescription

Generic profit margins (or lack thereof) begin to take effect

Walgreen’s third quarter earnings were a good reflection of the general trend of tighter prescription drug margins. According to a posting on The Wall Street Journal’s Health Blog, “Despite higher revenues, Walgreen’s net income for the quarter was down 3.8% from last year.”

The blog also notes that the major pharmacy benefit managers, from Express Scripts to Medco, saw similar results.

As more drugs become available generically, it is tougher for these companies to make money on the spread between brand and generic drugs. Bad news for the middlemen, who have traditionally keep part of the margin as profit. Good news for smart benefit plan buyers who demand fully transparent plans and complete pass-through of discounts instead of savings and rebate guarantees that give the impression of savings while allowing valuable margin to be left on the table.

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