Healthcare benefits

For decades, health care consumers have been told once you have a problem, then you should go to the doctor. But now, as high-deductible health plans become ever more prevalent, employers are encouraging employees to go to the doctor first - before they get sick - and in turn the employer will often cover the visit at 100%.

A battle is brewing to influence public opinion over the drivers of rising prescription drug benefit costs, cost-containment strategies and the path to meaningful health care reforms.

Patients who don't take their medication as prescribed is a billion-dollar problem, reports pharmacy benefit manager Express Scripts in its 2011 Drug Trend Report. Nonadherence to prescription medication cost the U.S. health care system $317.4 billion in 2011. And that's just for treating medical complications - not the cost of lost productivity - that could have been avoided if patients had taken their medication as prescribed. The report shows that for many therapy classes, less than 50% of patients take their medication as prescribed.

The preliminary results of a pilot project involving a large, self-funded employer and a new mobile application, myDrugCosts, show that 42% of employees who used the voluntary benefit reported saving money on their prescription drug costs.

Employers want to step up programs to encourage healthier behavior among their workers and to control spending on expensive injected specialty medicines, according to a survey by pharmacy benefit manager Express Scripts Holding Co.

CVS Caremark Corp raised its full-year forecast on Wednesday after reporting a sharp rise in first-quarter sales as the drugstore operator and pharmacy benefits manager continued to win over former patrons of Walgreen stores.

A new study comparing utilization rates of patients filling 90-day prescription medications using community and mail order pharmacies found that when copays are similar, patients preferred the community pharmacy channel by a ratio of four to one.

Lawmakers are investigating three pharmacies in Maryland and North Carolina for diverting critical but scarce drugs from patients to wholesalers, who are then able to resell the medicine at sometimes big markups.

A federal judge declared last Wednesday that a Washington state rule requiring pharmacists to dispense emergency contraceptives against their religious beliefs is unconstitutional.

Objections to Express Scripts' $29 billion plan to buy rival pharmacy benefits manager Medco Health Solutions are accumulating as U.S. antitrust regulators weigh whether they have enough evidence to stop the megamerger.

Walgreens is being hit by its withdrawal from the Express Scripts Inc pharmacy network and by a much-weaker-than-expected flu season, leading it to temper its expectations for the number of prescriptions it will fill this year.

Can you imagine a world where the “new norm” required insurers and providers to disclose what they charge upfront? Read as Mark Gaunya, president of the Massachusetts Association of Health Underwriters, shares two specific messages he took to the Hill at the Cap Conference and the outcome.

[IMGCAP(1)] NEW YORK | Mon Jan 23, 2012 9:42am EST (Reuters) - When your health insurance provider denies an experimental treatment or a high-cost drug, how much are you willing to pay for the care you believe you need? Barby Ingle, a former cheerleading and dance coach at Washington University who now lives in a Phoenix suburb, has been forced to face this question. …

Express Scripts’ clients, including employers, have seen minimal disruption since Walgreens left its network earlier this month, says Brian Henry, ESI’s senior director of public affairs. In this Q&A, he sits down with EBN to discuss what efforts the company has made to make the transition easier since Walgreens announced last June it would be leaving.

Pharmacy benefits manager CVS Caremark has agreed to pay $5 million to settle an investigation by the Federal Trade Commission that it overcharged seniors and taxpayers in the Medicare prescription drug program. The FTC also announced it has concluded its investigation of the company.

Walgreens is on the offensive this month, informing both employers and employees that it’s no longer part of the Express Scripts network. Kermit Crawford, president of Walgreens’ pharmacy, health and wellness business, recently sat down with EBN to discuss how the company plans to move ahead.

Walgreens is going through "the worst" part of not being in Express Scripts Inc.'s network and, while the transition is difficult now, the drugstore should rebound as the year progresses, its top pharmacy executive said on Monday.

Walgreens said last Friday it will increase staffing at its call centers and offer discounts as it tries to hang onto customers once it stops filling prescriptions for Express Scripts Inc. members.

ts Inc. on Jan. 1, 2012, and its stance suggests that the odds of the drugstore making up with the pharmacy benefits manager before the end of the year are remote.

After decades in relative obscurity, a legal doctrine that holds corporate officers liable for company wrongdoing is finding its way back into some high-profile health care prosecutions.