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  05:24:43 pm, by MedBen5   , 227 words,  
Categories: Prescription, Discounts, Health Plan Management

Breaking Down Drug Costs

Filling a Prescription

Just how do pharmaceutical companies price their products? As this article in the Employee Benefit News reveals, it doesn’t happen in a vacuum, and it involves quite a bit of number-crunching.

Multiple considerations go into the drug pricing process, from the manufacturer’s research and development costs to market demand and competition. Manufacturers also negotiate with pharmacy benefit managers (PBMs), who administer prescription plans and create networks with contracted pharmacies. In turn, the PBMs negotiate prescription prices with the pharmacies. On top of all that, generic drugs and mail order services factor into the total pricing equation.

Manufacturer discounts, rebates and other pricing concessions are common to larger PBMs. To quote from the article: “Successful PBMs are effective in leveraging their aggregated volumes and patient programs to achieve even deeper discounts.”

MedBen provides cost-effective retail prescription coverage to its clients through Pharmacy Data Management (PDM), a leader in pharmacy benefits management. The MedBen Prescription Plan passes 100% of paid formulary rebates onto the Health Plan through the PDM network. In addition, significant savings are generated by a cost pass-through approach to generic drugs.

Together, MedBen and PDM offer a level of transparency that equates to more plan savings for the employer. We have consistently beaten the odds by keeping annual Rx cost increases below the national average.

To learn more about MedBen pharmacy services, please visit the MedBen website.


  04:07:46 pm, by MedBen5   , 276 words,  
Categories: Wellness, Health Plan Management

A Healthy Internet Presence

Doctor on Computer Monitor

The Internet has become a virtual library of health information. Not to mention, a diagnostician, personal trainer, consumer watchdog and recordkeeper.

The Wall Street Journal highlights some of the more noteworthy sites available on the web. As you will see, there is a great deal of diversity out there, from a site that catalogs side effects of various medications to sites from Google and Microsoft that allow users to compile their medical records online, and share the information with physicians if they so choose.

MedBen has had a constant web presence since the launch of in 1997. In the ensuing decade, we have greatly expanded our content to provide clients with user-friendly, password-protected services featuring real-time data.

Our current websites include: MedBen Access, which offers 24/7 claims status and benefits information; MedBen Secure, which allows clients to receive reports with protected health information in a protected environment; and our MedBen FSA/HRA Online System gives participants an easy way to monitor plan activity. These and other customer service tools are available to MedBen clients anytime, anywhere.

Privacy concerns have been and will continue to be at the forefront of online health sites. That’s why MedBen makes client confidentiality its number one priority. On MedBen Secure, for example, your reports are downloaded over a secure line protected by Secured Socket Layering (SSL), the Internet standard for the transmission of secure data. This is on top of internal protection that double-checks the contact and content information in order to verify both are appropriate and accurate.

For more information about all of MedBen’s Internet services, visit our main website at and click on “Online Client Services".


  04:38:03 pm, by MedBen5   , 315 words,  
Categories: News, Wellness, Health Plan Management

CDHP and HDHP Participants Better Informed, Healthier

Mom & Daughter Making Salad

A survey by the Employee Benefit Research Institute finds that participants in a consumer-driven health plan (CDHPs), such as a flexible spending account (FSA) or a health reimbursement arrangement (HRA), or a high-deductible health plan (HDHP) make better informed health care decisions and are healthier in general. As reported in Employee Benefit News, nearly 10 million adults enrolled in such plans during 2008.

The survey showed that 3% of adults are enrolled in some type of CDHP, up from 2% in 2007. The number of adults enrolled in an HDHP held steady at 11%. Consumer satisfaction with the quality of care provided is similar in CDHPs to that of traditional plans, but lower for those participants only covered by an HDHP.

Of particular note is the survey finding that HDHP participants tend to be in better health than those with traditional coverage. On the one hand, it stands to reason that a plan with higher out-of-pocket costs would appeal more to those who stand less chance of incurring a major medical expense. But as the article points out, HDHPs also place a greater value on individual awareness of the cost of care, which in turn promotes a greater focus on personal wellness. So participants can benefit from HDHPs on a physical and emotional basis as well as a financial one.

The survey also revealed that HDHP participants sometimes delay or avoid getting care because of cost concerns. But 42% of the 13.4 millions consumers with a high-deductible plan report that they do not have a health savings account (HSA), despite their availability. By encouraging the addition of an HSA or an employer-funded HRA from which the participant can pay their deductible costs, the employer can go a long way toward preventing this behavior.

MedBen offers full-service administration of FSA, HRA and turn-key HSA, along with the administration of both fully insured and self-funded HDHPs. For more information, contact MedBen Specialty Services at (800) 297-1829.


  10:15:45 am, by MedBen5   , 225 words,  
Categories: Prescription, Discounts, Health Plan Management

Battling Back Against Rising Rx Costs

Pill Bottles and Drugs

Rising prescription costs may be an unavoidable reality of our health care system, but that doesn’t mean that consumers have to take the high prices at face value. This Wall Street Journal article offers some good ideas on how to keep out-of-pocket Rx expenses in check.

Asking your physician about generic alternatives to brand medications is always a good first step. Never assume that the prescription you’re given represents your best value. And with more and more discount stores and pharmacy chains boasting $4 generics to draw in business, it’s definitely to your financial advantage to check out what’s available!

Another money-saving alternative, not mentioned in the article, is the growing number of previous prescription-only medications, such as Claritin and Prilosec, now available in over-the-counter versions. Employers are increasingly covering most, if not all, of the cost for these OTC drugs, so long as a physician prescribes them.

For MedBen clients who use PDM for prescription management, you can also gather a good deal of information from our RxEOB website. This handy online service provides a variety of useful features, such as reviewing your medication history, reading detailed drug information, and comparing prices of equivalent generic or lower cost alternative drugs. To visit RxEOB, simply go to and click on “Online Client Services”, select “MedBen Access”, log in and click on “My Rx”.


  08:49:07 am, by MedBen5   , 162 words,  
Categories: Announcements, News, Health Plan Management

MedBen Saves Clients an Additional $5.4 Million in Just 12 Months!

Magnifying Money

Since MedBen added AWAC® advanced surveillance software to its claims review process last year, clients have benefited in a big way! From October of 2007 through September of 2008, MedBen clients have saved an additional $5.4 million using this physician-powered approach to claims cost containment – savings that go beyond MedBen’s plan provisions, network discounts and other cost controls.

The cumulative savings average out to be $13.23 per employee per month over 12 months. In August and September alone, MedBen clients saved over $1.2 million in claim costs. Even greater savings are expected in 2009 with more employers using this advanced cost control methodology.

Access to this surveillance system is made possible through the AWAC® Alliance, a select network of third party administrators, which MedBen joined in September of 2007. At a meeting of Alliance members in Minneapolis, MN this week, MedBen President Doug Freeman learned of our year-end savings results.

To read more about how clients are receiving significant savings with MedBen’s cost containment services, download this report.


  12:58:43 pm, by MedBen5   , 292 words,  
Categories: Wellness

C'mon, Get Happy!

Happy Girl and Dog

We’ve all heard that a regimen of healthy food and daily workouts will improve our physical well-being. But what steps can we take to better our mental health?

Foresight, a British government scientific think-tank, says people can exercise their minds by performing a “five-a-day” program of simple social and personal activities, according to an article in Times Online. Doing things that you enjoy, that challenge your intellect and that make you feel better about yourself will boost mental well-being. And should your chosen activities also happen to benefit other people, so much the better!

The group states that there are five specific measures that lead to increased happiness:

Connect: Developing relationships with family, friends, colleagues and neighbors will enrich your life and bring you support.

Be active: Sports, hobbies such as gardening or dancing, or just a daily stroll will make you feel good and maintain mobility and fitness.

Be curious: Noting the beauty of everyday moments as well as the unusual and reflecting on them helps you to appreciate what matters to you.

Learn: Fixing a bike, learning an instrument, cooking – the challenge and satisfaction brings fun and confidence.

Give: Helping friends and strangers links your happiness to a wider community and is very rewarding.

On the one hand, you really don’t need the British government to tell you that productivity promotes positivity – heck, Dr. Phil figured that out years ago. But as the economic climate grows more uncertain, staying active and aware certainly can benefit your well-being. And there’s no heavy lifting involved in improving your mental health – unless, of course, heavy lifting makes you happy. In which case, enjoy but remember to bend with your knees, not with your back!

You can read the complete article


  04:56:43 pm, by MedBen5   , 262 words,  
Categories: News, Health Plan Management

Out of Balance

An illegal medical practice known as “balance billing” is costing consumers over $1 billion a year, according to an article in Business Week. When a health care provider believes that an insurer has not adequately compensated them for medical treatment, they may improperly bill the patient for the balance of the fee. Such overcharging has proven very profitable, as many patients either don’t know exactly how much of the bill they’re actually responsible for, fear alienation from the physician’s practice, or worry that their credit rating will suffer if the bill is not paid.

MedBen has multiple protection measures in place to guard against wrongful billing, including a physician-created electronic claims surveillance system. This proprietary software reviews every claim we receive against 80,000 financial and clinical algorithms, and flags those with questionable or potentially fraudulent charges. In its first year of use, MedBen surveillance software has saved clients an additional $4.7 million beyond standard plan provisions, network discounts and other cost controls.

Our claims system also analyzes claims for proper coding. In short, the system checks to ensure that the most appropriate American Medical Association codes were used in billing. When it finds errors, it adjusts the billing codes so plan members are charged appropriately.

Even with such safeguards, incidents of balance billing still do occur. And understandably, it can be difficult to sort out the fees you are responsible for on a physician bill from those being balance-billed. Should you ever have a question about any aspect of a provider invoice, talk to your group’s plan administrator or call MedBen Customer Service at (800) 686-8425.


  09:32:31 am, by MedBen5   , 177 words,  
Categories: News, Health Plan Management

Executive, Heal Thyself!

Executives looking to trim health care costs from the company budget may need to start with their own personal maintenance programs. According to an article on The Wall Street Journal Health Blog, some upper-level businessmen receive physicals that go well beyond the standard checkup – these exams cost thousands of dollars, include a battery of tests and often provide all of amenities of a luxury spa.

Dr. Brian Rank, writing for the New England Journal of Medicine, says executive physicals are of dubious usefulness, as CT scans and other costly tests are “rarely meaningful as a predictor of disease.” In fact, such unnecessary testing may do more harm than good, with prolonged exposure to radiation and false alarms being among the consequences.

But bigger than potential health risks is the message that expensive testing sends to employees. In an economic climate where across-the-board belt tightening should be the order of the day, executive physicals send an unmistakable message that the well-being of top management is far more important than that of the people who work under them.


  06:18:37 pm, by MedBen5   , 205 words,  
Categories: Wellness

Battling the Chronic Disease Epidemic


Pity the poor family physician. As obesity cases – and the chronic diseases that frequently attend them – continue to rise across all age groups, it’s all a doctor can do to stay on top of the mounting health crisis.

One physician has written about his efforts to help patients manage their health against increasingly difficult odds. Ben Brewer, a family doctor and contributor to The Wall Street Journal, says that the high volume of business required to maintain a successful practice makes it difficult to provide the level of care chronic disease sufferers need to better their condition. In one instance, Dr. Brewer monitored a patient’s blood sugar through regular e-mail updates for two weeks, uncompensated, until levels returned to normal. But even though his office has invested in a medical record tracking system to monitor chronic cases, it has done little to improve the overall situation.

The upshot of Dr. Brewer’s comments: Medical treatment and pharmaceuticals cannot, and should not, be the lone remedies to battling chronic disease. Instead, he advocates exploring “new approaches to wellness” and emphasizes self-management to better control health problems – or to keep them from occurring in the first place.

You can read Dr. Brewer’s article here.


  04:24:16 pm, by MedBen5   , 203 words,  
Categories: Announcements, News, Wellness

MedBen Recognized as a "Fit-Friendly" Company

MedBen is among an elite group of organizations that have been awarded Gold Fit-Friendly Company status by the American Heart Association (AHA). This honor recognizes ongoing companywide efforts to promote physical, nutritional and cultural wellness initiatives.

MedBen has taken numerous measures to improve its fitness during the past year that were critical factors in reaching Gold status, like offering employee health club discounts, participating in charity walks and adding heart-healthy options to our vending machines. Our BeneFitness program, introduced in 2005, brings a variety of individual and team wellness challenges to employees.

MedBen President & CEO Doug Freeman believes that encouraging healthier employee lifestyles is just one part of its responsibility as a health benefits administrator. “I think that wellness is the next frontier of health care cost control, and if we’re going to promote that as a company to our clients, we’d better be walking the walk,” Freeman said.

MedBen was one of just four Central Ohio companies publicly recognized at the 2008 AHA Start! Heart Walk on August 23, sharing the stage with fellow Fit-Friendly companies OhioHealth, AEP and Nationwide. A MedBen team also participated in the 3-mile charity walk, which raises money to fund heart disease and stroke research and education.


  07:06:57 pm, by MedBen5   , 125 words,  
Categories: News, Wellness, Health Plan Management

More Employers Offering CDHPs

Consumer-driven health plans (CDHPs) now account for nearly 13 percent of all plans offered by employers, according to a survey conducted by United Benefits Advisors. From 2007 to 2008, the number of health plans offering a CDHP increased by 43 percent, and plan participation nearly doubled in the same period.

The survey of 12,860 U.S. employers also found that 10 percent of respondents have implemented a wellness program as an additional measure to reduce cost increases.

MedBen has been on the cutting edge of the CDHP movement for nearly a decade, and was among the fist to administer health reimbursment arrangements (HRAs). 1 out of every 2 MedBen TPA clients currently offer at least one CDHP.

You can read more about the CDHP survey, as reported in the Houston Business Journal, here.


  07:59:16 pm, by MedBen5   , 257 words,  
Categories: News, Prescription

Dog Days of Summer for Drug Makers

It’s turning out to be a less-than-sunny summer for members of the pharmaceutical industry. On the heels of their voluntary ban on promotional items for doctors, prescription drug companies are dealing with extra-strength headaches both external and internal, according to two recent reports in The Wall Street Journal Health Blog.

In something of an equal time initiative to presentations given by pharmacy reps, bills have been introduced in both houses of Congress proposing an “academic detailing” program. Under the plan, government-funded experts would speak to doctors about the “safety, effectiveness and cost of prescription drugs,” serving as a counterbalance to drug company messages. Selected healthcare professionals would be trained to present to physicians and pharmacists, and educational materials would be developed by nonprofit medical societies and schools. There’s no mention in the bills of how much such a program would cost.

Of course, such government oversight is necessary only when there is a steady supply of drugs on which to opine. But new medications are being introduced at a relatively slow rate nowadays, particularly when one takes into consideration the mounting costs of research and development. The problem, it would appear, is that while technology and design have made the process more efficient, drug companies are still limited by our collective understanding of what causes disease and the best ways to combat it. Simply put, there is still a high degree of luck when it comes to creating a useful (and profitable) drug – a reality that even the pharmaceutical giants (or government intervention) cannot easily overcome.


  10:40:13 am, by MedBen5   , 191 words,  
Categories: Prescription, Discounts, Health Plan Management

Generics and the "Pass-through" Principle

Pill Bottles and Drugs

The Wall Street Journal Health Blog reports on the practice of pharmacy benefit managers (PBMs) marking up the prices of generic drugs. The PBMs negotiate discounts with pharmacies, but rather than passing the full value of the discounts onto clients, they charge an inflated price to health insurance companies. The insurers, in turn, make up the difference in higher premiums to the patients.

MedBen doesn’t subscribe to the “big discount/bigger premium” pharmacy concept – in fact, we take the exact opposite approach. Our prescription plan is unique in offering “pass-through” benefits – we pass through 100% of any paid formulary rebates directly to our clients. That means no unnecessary mark-ups on generic drugs, resulting in significant savings to employer and employee alike!

This level of transparency also is notable for stemming the tide of rising Rx plan costs. Employers using the MedBen Prescription Plan – offered through our Rx partner, Pharmacy Data Management (PDM) – actually saw a 2.2% decrease in the amount they paid per member in 2007. And, all Rx clients have free access to a pharmacy consultant who will review your current prescription plan design and offer additional cost savings strategies.


  10:39:29 am, by MedBen5   , 158 words,  
Categories: Wellness, Incentives

Lose Big, Win Bigger!

Woman Weighing Herself on Scale

Competition and camaraderie are fueling employer efforts to help their employees lose weight, according to an article in The Wall Street Journal. And as workers drop the pounds, employers are enjoying some sizable benefits.

Wesley Willows, an Illinois-based employer spotlighted in the article, responded to an increasingly overweight workforce by implementing a companywide wellness contest. Through competitive challenges and financial incentives – $3 for every 1% of body weight lost – the 290-person staff lost a cumulative 750 pounds in just a little over a year. Equally impressive, the program coincided with a 19% reduction in the company’s health insurance claims from 2006 to 2007.

Participants in the Wesley Willows weight-loss program can choose to be part of a team or participate individually, and can track results through a customized website. One unexpected benefit from the program: Employee turnover dropped 30% from 2007 to 2008, a trend the employer credits to “a more collegial environment.”

You can read more about Wesley Willows and other employer wellness programs here.


  04:48:18 pm, by MedBen5   , 292 words,  
Categories: Discounts, Health Plan Management, Incentives

The “Guaranteed Discount” Myth

Businessman Holding Money

MedBen recently came across a “guaranteed discount” from a competitor that so defied belief, we thought we should share some of the details, as a public service.

First, the competitor offered a “targeted” 43% discount guarantee – that is, the averaged in-network discount would meet or exceed 43%. One small catch: There was a “no penalty corridor” between 39% and 43%. So the 43% guarantee target really didn’t exist.

Next, the discount average did not include claims above $100,000 and Children’s Hospitals claims – additions that would drive down the average down significantly. It did, however, treat denied claims as having a discount of 100%!

So what happened if the 39% target was not still met? The competitor guaranteed a payout schedule that maxed out at $15,000. Sounds like a generous sum – except when one observes that the competitor’s fixed costs were $20,000 higher than ours to begin with!

And, one more not-insignificant point: The client was already achieving a discount of 42.7% through MedBen!

Here’s the reality about guaranteed discounts: A penalty paid for lower-than-expected discounts rarely, if ever, comes from the carrier – it comes directly from the employer’s pocket! A carrier will always protect its risk by covering the potential penalty cost with an increase in a client’s service fees – either upfront or after the penalty is paid.

MedBen doesn’t offer so-called “guaranteed discounts”. Rather, we work with high-performance networks that can offer similar average discounts. And we examine every claim, regardless of type or dollar amount, for additional cost savings potential.

MedBen has developed a series of MedBen Solutions to inform clients and partners about a variety of market practices. You can get a copy of our MedBen Solutions for Guaranteed Discounts by e-mailing or by contacting your Regional Sales Director.

  10:43:13 am, by MedBen1   , 26 words,  
Categories: News, Prescription

End of an era

The Wall Street Journal Health Blog reports that a new code of conduct among drugmakers may bring an end to free pens, pads and coffee mugs.


  12:48:24 pm, by MedBen5   , 167 words,  
Categories: Wellness, Incentives

Employer Wellness Incentives on the Rise

Mom & Daughter Making Salad

More employers are using financial incentives as a way to promote wellness in the workplace, according to a survey of 225 major U.S. companies conducted by the ERISA Industry Committee (ERIC), the National Association of Manufacturers (NAM) and IncentOne, Inc.

From 2007 to 2008, the percentage of employers surveyed who offered inducements with their worksite wellness programs rose from 62 to 71%. Such monetary rewards were typically tied to participation in the program, rather than achieving benchmark goals like losing a certain amount weight or quitting smoking.

While financial incentives can range from as little to $5 to upwards of $600, the overall average is $192. Most financial incentives came in the form of gift cards, followed by reduced employee premiums and cash payments.

The survey also examined the return on investment (ROI) compared to employer expectations. Of those employers who have measured ROI, 83% say their wellness program has exceeded the break-even point.

Occupational Health & Safety magazine highlights additional findings from the wellness survey on their website. You can read their article here.


  04:48:55 pm, by MedBen5   , 208 words,  
Categories: Wellness, Incentives

Hit the Road, Tobacco!

No Smoking Symbol

Anytime is the right time for an employer to offer smoking cessation assistance as a wellness initiative, but several existing factors make such a program particularly attractive to employees nowadays – call it tobacco’s “perfect storm”:

  • Current economic conditions, including the rising cost of cigarettes and other tobacco products;
  • The increased social stigma of public smoking; and
  • The widespread knowledge of tobacco’s risks coupled with the upwards trend toward adapting healthier lifestyles.

Employers have an additional incentive to put a cessation program in place: Since smoking is a primary contributor to heart disease, a successful cessation program will provide benefits in the short term (reducing heart disease risk and its related medical costs) as well as the long term (a healthier and more productive workplace).

An article in the June issue of Managed Care explores how smoking cessation programs have found greater acceptance with employers. Through telephone coaching, nicotine replacement therapy, and a supportive doctor-patient relationship, tobacco users stand a much better chance of kicking the habit for good.

Smoking cessation is one of many services offered through MedBen’s Worksite Wellness program. Each program participant is assigned a nurse coach who will help to establish realistic goals, and create a practical plan to reach those goals.


  02:40:57 pm, by MedBen3   , 198 words,  
Categories: Prescription

ETHEX Corporation Voluntary Drug Recall

The ETHEX Corporation has announced that it is voluntarily recalling several lots of its 30mg and 60mg morphine sulfate extended-release tablets. The recalled lots were distributed to pharmacies between June, 2006 and May, 2008. The recall is due to the possibility that oversized tablets, some with as much as twice the labeled amount of morphine sulfate, were distributed. The extra dosage in the abnormal tablets could lead to overdose, which can have life threatening consequences such as respiratory depression (difficulty or lack of breathing) and low blood pressure.

If MedBen manages your prescription drug benefit, those individuals who are currently taking an ETHEX Corporation morphine sulfate in the doses listed above were notified directly regarding the recall.

If you are using ETHEX Corporation morphine sulfate extended-release 30mg or 60mg tablets, we encourage you to call your doctor, pharmacist or healthcare provider.

Questions regarding the recall can be directed to ETHEX Corporation Customer Service at 800-321-1705 Monday through Friday, 8:00 a.m. to 5:00 p.m. CST. Additional information can be found on the Food & Drug Administration’s MedWatch website: You can also call the Food & Drug Administration at 888-INFO-FDA (automated) or 301-827-4570.


  05:02:49 pm, by MedBen5   , 258 words,  
Categories: News, Health Plan Management

Protecting Against Auto-adjudication Fraud

Processing claims electronically with auto-adjudication software is a common practice in the insurance industry, but without sufficient safeguards in place such systems is vulnerable to fraud – a lesson recently learned the hard way by Medicare, which uses auto-adjudication to pay the vast majority of its claims. As detailed in a Washington Post article, it took one person, armed with just a laptop computer, to bilk $105 million from the government health program over a four-year period.

MedBen’s auto-adjudication system, which contains more than 300 checks to ensure key claims data is properly recorded, is an important tool in turning around claims quickly and accurately. But much more critical to minimizing fraud is the human element that complements the technology. All MedBen claims examiners are required to meet daily performance standards and have current accuracy rates of 99.6% procedural and 99.8% financial accuracy.

MedBen is unique in that it audits 5% of every examiner’s claims daily to verify claims data has been interpreted and coded correctly.

Most recently, MedBen took a significant step to protect against fraud by adding a proactive, physician-to-physician claims cost management system. Every day, proprietary surveillance software scours your claims prior to payment, using over 60,000 physician-produced algorithms. Potentially fraudulent claims are flagged for physician review to confirm or dispute the legitimacy of the claim.

The MedBen Claims Department also works closely with an internal Anti-Fraud Unit. This dedicated team reviews questionable claims, and other related information, to protect client assets. The Anti-Fraud Unit is also a member of multiple associations formed to share information regarding possible deceptive activities.

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