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Managed Care October 2004 Martin Sipkoff	Not So Much of a Reach: Let Sick Pay Less for Drugs The idea is radical and simple: Those who need medication the most should pay the least. There is evidence that this is cost-effective.
Managed Care July 2007 Martin Sipkoff	Lowering Copayments Can Improve Quality of Chronic Disease Care Employers and health plans are starting to see the advantage of what has been termed evidence-based benefit design.
Managed Care August 2004 Martin Sipkoff	Bad Tiered Formulary Designs Yield Poor Outcomes, High Cost Now that tiered formularies rule the land, what many suspected is being demonstrated: Compliance is suffering and so, too, are patients.
Managed Care January 2007 Martin Sipkoff	Employers Want Plans & PBMs To Push Hard for Generics Health insurers' aggressive stand on members' use of generic drugs can attract new clients, but does it interfere with the physician-patient relationship?
Pharmaceutical Executive December 1, 2011 William Looney	The Medicines Adherence Challenge Keeping skittish patients on their medicines ought to be a strategic priority for Big Pharma, but is it? An expert round table examines how best to make progress and agree on some practical steps for incorporation in the campaign agenda.
Managed Care October 2007 Martin Sipkoff	Asheville's Legacy: Pharmacy Moves From Dispensing to Clinical Management It is an idea whose time has finally come: Today's clinical pharmacists are involved in virtually all aspects of medical care.
Pharmaceutical Executive October 1, 2006	Sales and Marketing: Where the Buck Stops Pharma's ultimate customer is the employer - the guy who pays the health plan's bill. Here's what he wants to know about drugs.
Managed Care March 2007 Louis W. Hutchison	Unable to Carry Cost Burden, Payers Seek Other Remedies The pharmacy benefit landscape of today is all but unrecognizable from its predecessor of just a decade ago. Blending an approach that uses education, reward, and penalty can rein in runaway health care costs
Managed Care November 2006	Primed to Take on Challenges to PBM's This CMO of a pharmacy benefits manager wrestles with some of insurance's most taxing issues. Price, of course. And here come biologics!
BusinessWeek October 22, 2009 Arlene Weintraub	Tough Love, Lower Health Costs A UnitedHealthcare plan offers incentives to employees who strictly control their diabetes.
Pharmaceutical Executive April 1, 2006 Humphrey Taylor	Opinion: Unintended Outcomes for Consumer-Drive Insurance So-called "consumer-driven" health insurance is designed to help informed consumers make better decisions about their medical treatment. But the high deductibles associated with these plans are affecting the end goal.
CFO February 22, 2005 Martha E. Mangelsdorf	I Want a New Drug Plan Companies hoping to curb prescription-drug charges are looking at a host of new cost-control measures.
Managed Care June 2006 John Carroll	When New Drugs Are Costly, How High to Raise Copays? As some pretty costly, yet very useful, drugs are introduced, will new formulary designs deny access to needy patients?
Managed Care July 2006 Martin Sipkoff	Employers' Stock in Wellness Rises With No End in Sight Formerly, insurers used to devise new products and processes to attract purchasers. Now more and more employers are going to the plans and insisting on preventive care.
Pharmaceutical Executive August 1, 2011	Employers: Fighting Non-Adherence A Q and A with Andrew Webber, President and CEO of the National Business Coalition on Health
Managed Care April 2001	Employers easing prescription limitations? Some older medications once viewed by employers as "lifestyle" drugs when making benefit decisions are slowly gaining recognition as important components of primary care...
Managed Care October 2004 Arthur Lazarus	Formulary Restrictions Sometimes Harm Patients Much more research is needed to determine the full effect of drug benefit designs. Quality must be the foremost concern.
Managed Care May 2003 Wayne Miller	Higher Drug Copays Now Might Cause Problems Later The long-term impact of noncompliance must be considered before copayments are increased. This is especially true where chronic conditions are concerned.
Managed Care May 2007 Rachel M. Renshaw	Keys to Diabetes Control? Patience, Persistence, and Perseverance Careful attention to a comprehensive treatment plan could forestall or prevent the need to add drugs and costs to a patient's regimen.
Managed Care August 2007 Frank Diamond	Employers Roll Up Their Sleeves No longer passive, companies are working in a variety of ways to improve employees' care. Preventive programs cost money up front, but can cut overall treatment costs to insurers by 30 percent or more, yet few insurers pay for preventive care.
Managed Care December 2003 Tony Berberabe	Why Do FEHBP and Big Unions Excel at Managing Drug Costs? Pharmacy benefit managers can do only so much to keep drug price increases in the single digits. Initiatives instituted by health plans can help in this effort.
Managed Care November 2002 Frank Diamond	Companies Leaning on Workers in Battle Against Pharmacy Costs A new urgency means that tiered formularies and higher copayments will become even more widespread, a recent survey indicates.
BusinessWeek January 21, 2010 John Carey	Making Personalized Medicine Pay Medco and other pharmacy benefit managers say future profits depend on matching drugs to patients based on their genes.
Managed Care February 2001 T. Jeffrey White	Making Pharmacoeconomics In Formulary Development a Reality Despite what might be commonly believed, pharmacoeconomics is not a widely used tool for formulary development. Here's a model to follow...
Managed Care August 2001 Steve Perlstein	Four-Tier Approach Injects Consumerism Into Drug Benefit In tying copayments closely to the actual cost of medications, Humana takes a step toward promoting awareness of resource use...
Managed Care April 2007 MargaretAnn Cross	Do P&T Committees Have Enough Power? Plans and PBMs are divided about sharing drug prices with clinicians. Is it better to have an administrative committee determine the formulary?
Managed Care January 2004	Increasing drug copayments deter compliance Raising copayments in tiered prescription drug plans increases the likelihood that patients will stop taking prescribed medications, according to a recent study published in the New England Journal of Medicine.
Managed Care May 2006 Martin Sipkoff	Health Plans Are Ill-Prepared for Looming Diabetes Epidemic The problem is outpacing insurers' resources and perhaps even their commitment. Can the chronic care model help?
Managed Care November 2005	Plans Change Tactics As Costs Keep Rising For Specialty Drugs With specialty drug costs continually increasing, CuraScript expects to see a significant shift in the percentage of plans exclusively classifying specialty drugs under the medical benefit.
Managed Care April 2002 Rhonda Greenapple	HMOs Have Stake in Quelling Anger at Drug Store Counters Dissatisfied customers have a tendency to lash out and not be very discriminating about their targets. Prescription: Reduce the hassle...
Managed Care December 2003 MargaretAnn Cross	Will New Benefit Design Harm Some Patients? In the past, reducing demand for care by raising patients' costs has resulted in the loss of some needed care. Can we avoid the trap?
Pharmaceutical Executive June 1, 2014 Ben Comer	Take as Directed: From Force to Finesse in Promoting Adherence Healthcare players tout patient education and engagement as the keys to better drug adherence rates. Patients agree, as long as that translates to convenient and affordable access to therapy.
Pharmaceutical Executive November 1, 2006 Mike Mallett	Marketing to Professionals: Penetrate the Point of Purchase Leverage mystery shoppers, and improve patient compliance through local pharmacists.
Managed Care August 2006 Cross & Sipkoff	Although Employers Need Depression Programs, They May Not Know It Yet Research says the hidden cost of untreated depression far outweighs the cost of treatment. Plans need to get this information to purchasers.
Managed Care April 2005 MargaretAnn Cross	Don't Forget Productivity Gains When Rating Health Programs Disease management conference focuses on outcome measures that address issues such as presenteeism that concern most health care purchasers.
Managed Care September 2006 Martin Sipkoff	Specialty Pharmacy Grows As Cost-Control Option As the population ages, specialty pharmacy is becoming a unique, profitable, and invaluable delivery system. Plans are increasingly turning to specialty pharmacies to provide the expertise they lack.
Managed Care September 2005 Martin Sipkoff	Mail Order Pharmacy Saves Money, Says PCMA, but at What Cost? The savings to consumers and employers are apparent, but are health plans left holding the bag in mail-order pharmacy?
Pharmaceutical Executive November 1, 2013	Roundtable on Market Access Market Access is a window on what matters in the real world of soaring patient expectations and crimped payer budgets for innovation.
Managed Care April 2006 Martin Sipkoff	Blues Plan's Bold Move Brings Generics Savings Blue Cross & Blue Shield of North Carolina is waiving its copayments for generic drugs in a unique six-month pilot program.
Managed Care July 2005 Tony Berberabe	Change in Thinking For Pharmacy Benefits in CDHP The difference between the pharmacy benefit in a consumer-directed health plan and a traditional health plan is greater generic drug utilization.
Pharmaceutical Executive April 1, 2011	Off-Label But On Point? Use of off-label drugs is a balancing act for physicians, and poses even more problems for pharma. The FDA is moving slowly to help.
Managed Care July 2002 Thomas Kaye	Managing the Drug Benefit: One Company's Experience The pharmacy director of Blue Cross of Oklahoma shares his company's success with using three tiers and coinsurance to promote member responsibility.
Managed Care May 2004 Thomas G. Dolan	Pharmacist Care An Idea Whose Time Is Still Coming For more than a decade, it has seemed this idea would catch fire. But many insurers are still looking for evidence that it can reduce overall costs.
Managed Care June 2005 Martin Sipkoff	MMA Formulary Design Requires Health Plans To Control Costs Despite a mandate to adopt utilization management programs and make patients share costs, health plans are still lining up to participate in Medicare Part D.
HBS Working Knowledge November 29, 2004 Paul Hemp	If You're Sick---Stay Home! Sick employees who drag themselves to work every day cost their employers more in lost productivity than in what they contribute. Here are some ideas on how employers can cut "presenteeism."
Managed Care April 2005	Small HMO Takes Big Step: Decides To Launch PBM One small health insurer sees an opportunity in the recent woes that pharmacy benefits managers have experienced.
Pharmaceutical Executive August 1, 2011 Jennifer Ringler	The Adherence Fight: A TKO? Why does the match against medicines compliance always seem to end in an easy knockout?
Managed Care April 2004 MargaretAnn Cross	Medical Directors Find Themselves Working More Closely With Payers As large companies become more demanding of health plans, clinical executives are increasingly being relied on to provide advice and expertise.
The Motley Fool February 25, 2010 Brian Orelli	An Untouched Market Waiting to Be Captured Unfilled prescriptions are a potential boon to drug companies.
Managed Care August 2004 Alan Lotvin	Specialty Pharmacy Presents Unique Set of Challenges Only a small percent of a typical health plan's population takes medicine for conditions outside the generalist's scope. But it's a big portion of the drug bill.