Healthcare benefits

Diabetes medications are multibillion-dollar drugs and the percentage of Americans diagnosed with the disease continues to grow, but there is evidence that major pharmaceuticals are causing pre-cancerous changes.

Express Scripts, however, says the decline was offset by an 18.4% rise in spending on specialty medications. The aggregate trend for 2012 was a bump of 2.7%, similar to that of 2011.

Opioid abuse and physician dispensing of repackaged drugs top the list of concerns for PBMs that handle workers’ compensation claims.

Two new FDA-approved weight loss drugs help patients lose weight but only in conjunction with diet and exercise.

Most pharmacy benefit managers don’t use warning systems to flag high use or potential abuse of narcotics. But you can, with a good eye and simple calculator.

Speed, convenience and the growing doctor shortage have patients flocking to ultra-convenient clinics, but not those at the world’s largest retailer: critics say Wal-Mart clinics are poorly promoted and too slow with prescriptions.

A new study indicates there could be treatment differences when a patient is seen in person versus an e-visit. While follow-up rates were comparable, physicians in e-visits did order different care.

The government said the rules announced last week would broaden the types of organizations eligible for an exemption from the birth-control mandate and make it easier for them to escape it.

Opioid painkiller abuse and physicians dispensing of repackaged drugs top the list of cost drivers in the 2012 Survey of Prescription Drug Management.

“Too few adults are taking advantage of protection from vaccines, leaving themselves and those around them at greater risk for vaccine-preventable diseases,” says one government health expert.

A small survey from the Midwest Group on Health indicates that, while further conversation is needed, awareness of the challenges surrounding specialty pharmacy is increasing.

The Centers for Disease Control and Prevention report that influenza is widespread in 47 states, but certain regions may soon start to see fewer cases.

Despite relatively flat prescription prices, drug cost remains a major concern for workers’ compensation pharmacy benefit managers. Their biggest trouble-maker: opioids.

Prescription medications for age-related conditions such as hair loss and mental alertness have been steadily increasing in cost, says benefit manager Express Scripts, surpassed only both those for diabetes and high cholesterol.

A report published this week claims there’s no such thing as resistance to aspirin, and that expensive prescription blood thinners may be overused.

Up to 20% of those who take currently available medication to lower bad cholesterol suffer from side effects, but new medicines may take unusual forms — engineered tomatoes and yogurt.

Customer satisfaction with mail-order pharmacies declined for the second year running, according to a survey from J.D. Power and Associates, and that could spell trouble for health plans that insist on their usage.

Health care plans that insist participants get their prescription medications by mail order could see backlash, unless they address concerns.

Consultants, industry groups question the transparency in PBM practices.

As CEO of United Benefit Advisors, I hear continually about the issues facing our 36,000 employer clients. Managing prescription drug costs continues to be paramount. The UBA 2012 Health Plan Survey shows that 64.2% of prescription drug plans utilize three co-pay tiers (generic, formulary brand, and non-formulary brand); 2.9% have a one-tier plan, 8.2% retain a two-tier plan; and 24.7% add a fourth tier (specialty). Consultants should watch these plan structures carefully as many brand-name drugs go off their patents and pricing is determined for the influx of generic drugs. On the other end of the spectrum, we're watching increases in specialty drugs, which are driving up costs significantly.