2015 Generic Prescription Drug Launch Forecast [UPDATED]
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How to Determine if Your Company [or Client] is Overpaying |
Step #2: In addition, request an electronic copy of all your prescription transactions (claims) for the billing cycle which coincides with the date of your price list.
Step #3: Compare approximately 10 to 20 prescription claims against the price list to confirm contract agreement. It’s impractical to verify all claims, but 10 is a sample size large enough to extract some good assumptions.
Step #4: Now take it one step further. Check what your organization has paid, for prescription drugs, against our pharmacy cost then determine if a problem exists. When there is a 5% or more price differential (paid versus actual cost) we consider this a problem.
What’s more, because insurers put certain pricey prescription drugs in specialty tiers that require members to pay more for them, which may discourage consumers with pre-existing conditions from enrolling in their plans, advocacy groups call for measures to recognize possible discrimination, the report notes.
How to Determine if Your Company [or Client] is Overpaying |
Step #2: In addition, request an electronic copy of all your prescription transactions (claims) for the billing cycle which coincides with the date of your price list.
Step #3: Compare approximately 10 to 20 prescription claims against the price list to confirm contract agreement. It’s impractical to verify all claims, but 10 is a sample size large enough to extract some good assumptions.
Step #4: Now take it one step further. Check what your organization has paid, for prescription drugs, against our pharmacy cost then determine if a problem exists. When there is a 5% or more price differential (paid versus actual cost) we consider this a problem.
How to Determine if Your Company [or Client] is Overpaying |
Step #2: In addition, request an electronic copy of all your prescription transactions (claims) for the billing cycle which coincides with the date of your price list.
Step #3: Compare approximately 10 to 20 prescription claims against the price list to confirm contract agreement. It’s impractical to verify all claims, but 10 is a sample size large enough to extract some good assumptions.
Step #4: Now take it one step further. Check what your organization has paid, for prescription drugs, against our pharmacy cost then determine if a problem exists. When there is a 5% or more price differential (paid versus actual cost) we consider this a problem.
Click here to register for: “How To Slash the Cost of Your PBM Service, up to 50%, Without Changing Providers or Employee Benefit Levels.”
Avalere Study Did Not Include Medicare Part D Drug Plans; May Impact Costs
The analysis by Avalere Health found that the vast majority of plans in the Health Insurance Exchanges require relatively high cost sharing for all medicines in at least one class. The study did not include Medicare Part D plans but did include Medicaid managed care plans.
But, can increase costs in Medicare, says the Campaign for Sustainable Rx Pricing:
“The issue of higher cost drugs, especially “specialty drugs”, is only going to become more critical to deal with in the coming years. One estimate notes that by 2020, spending on specialty drugs will quadruple from $87 billion to more than $400 billion. This continued growth in spending will put significant upward pressure on premiums in the private marketplace as well as in public programs like Medicare.”
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How to Determine if Your Company [or Client] is Overpaying |
Step #2: In addition, request an electronic copy of all your prescription transactions (claims) for the billing cycle which coincides with the date of your price list.
Step #3: Compare approximately 10 to 20 prescription claims against the price list to confirm contract agreement. It’s impractical to verify all claims, but 10 is a sample size large enough to extract some good assumptions.
Step #4: Now take it one step further. Check what your organization has paid, for prescription drugs, against our pharmacy cost then determine if a problem exists. When there is a 5% or more price differential (paid versus actual cost) we consider this a problem.
Click here to register for: “How To Slash the Cost of Your PBM Service, up to 50%, Without Changing Providers or Employee Benefit Levels.”
Druggists and industry experts told MNI that traditional brand-name and generic drugs prices are also firming. Right alongside that, healthcare cost-sharing for prescription drugs continues to shift toward employees and others insured, by way of deductibles, co-payments, drug coverage exclusions and percentage coverage, also known as co-insurance.
The moderating impact on costs in recent years from a wave of blockbuster brand-name drugs going generic, from Lipitor to Lexapro, has faded, they said. A pharmacy benefit management company forecasted accelerating prescription-drug cost increases in 2014 for both consumers and insurers.
“It’s growing substantially this year because of the introduction of the new products in the hepatitis-C market. It’s very exciting but extremely dynamic in terms of its impact on cost this year on many of our plans,” said Peter Wickersham, senior vice president of integrated care and specialty at Prime Therapeutics, a PBM that helps control costs for 23 Blue Cross Blue Shield companies and other insurers that cover a combined 25 million members.
Total prescription drug costs, borne by consumers and Prime Therapeutics’ insurers, rose an average of 3.3% in 2013 from 2012, compared to 2.1% inflation the year before, in part due to increased utilization, Wickersham said.
“That’s about to change greatly,” Wickersham told MNI, and added that aggregate drug cost inflation should come in “north of 10%” this year, thanks in great part to Solvaldi, the hepatitis-C medication.
Specialty drugs cost insured consumers an average of $142 per prescription per month in 2013, up 15% from 2012, Wickersham said. The average specialty drug itself cost insurers $3,150 per month in 2013. Sovaldi comes in at a whopping $85,000 for a 12-week course, or about $1,000 per pill, he said.
Specialty drugs, Wickersham said, treat a relatively narrow population and comprise just 1% of total prescriptions filled. Yet by 2018, they could account for 50% of total drug costs, he said. And they aren’t the only medicine outlays on the rise.
“Starting toward the end of last year, we saw some price inflation on generic products, as well,” Wickersham said. While most generic prices are by and large stable, some “individual products are taking large price increases,” he said.
Read more here: https://mninews.marketnews.com/index.php/reality-check-us-consumer-drug-costs-climb-ever-higher?q=content/reality-check-us-consumer-drug-costs-climb-ever-higher
How to Determine if Your Company [or Client] is Overpaying |
Step #2: In addition, request an electronic copy of all your prescription transactions (claims) for the billing cycle which coincides with the date of your price list.
Step #3: Compare approximately 10 to 20 prescription claims against the price list to confirm contract agreement. It’s impractical to verify all claims, but 10 is a sample size large enough to extract some good assumptions.
Step #4: Now take it one step further. Check what your organization has paid, for prescription drugs, against our pharmacy cost then determine if a problem exists. When there is a 5% or more price differential (paid versus actual cost) we consider this a problem.
Click here to register for: “How To Slash the Cost of Your PBM Service, up to 50%, Without Changing Providers or Employee Benefit Levels.”