Rising Drug Costs Lead to PBM Scrutiny

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If prices rise more than an agreed upon rate, excess increases may be offset by additional rebates. For some employers this means the PBM is pocketing some or all of the rebate money, driving record profits. In these cases there is absolutely no incentive on the part of the PBM to lower Rx costs. Rather, they earn more kickbacks as drug costs escalate. This revenue sharing between the PBMs and manufacturers at the expense of consumers continues to fuel spiraling Rx costs.

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MEC Plans – A Tax Dodge Whose Time Has Come & Gone?

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By Molly Mulebriar

Minimal Essential Coverage (MEC) plans are simply a tax dodge utilized by employers seeking to minimize the Affordable Care Act’s punishing mandates. By offering a MEC plan with essentially no benefits other than coverage for preventative care an employer can avoid the $2000 per year fine for every full time employee (minus the first 30).

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Moving Away From PPO’s Can Be Legally Challenging – Contracts Really Do Mean Something

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By Molly Mulebriar

Tired to seeing your claim costs escalating, year after year despite representations from managed care intermediaries that cost saving “discounts” are ever increasing and have never been higher? And, you should thank PPO’s for saving you 50% or more off health care costs.

But, RiskManagers.us has now proven to your satisfaction the real truth behind ever increasing health care costs. You are finally ready to jump off the cliff into what you perceive as shark infested waters with the assurance you will (1) survive, (2) the sharks are more afraid of you than you are of them and (3) the cleansing currents will take you to an island paradise where health care costs are fair, reasonable, predictable and essentially static. Umbrella drinks abound.

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Health Care Watch Dog Continues Search For Truth

belk David Belk

Hello Again Everyone! You might remember that, last Summer, I wrote a blog that questioned United Health’s claim that they lost hundreds of millions of dollars on the ACA exchanges last year. In short, I used their own financial statements to show that their profits, revenues and madical loss ratios didn’t square with their claims very well.

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Mexican Dogs Get Better Deals

mexicandogA friend  runs a hunting lease in deep South Texas. I asked if rattlesnakes pose a danger to hunters. “Yes, could be, but not that prevalent. What you may find interesting is antivenom for my hunting dog who had an unfortunate up close experience with one was $700 but the same antivenom needed by one of my hunters was $20,000. Same drug. You ought to put that on your blog.”

That’s interesting, I thought, but Mexican dogs get it much cheaper, around $200. Savvy ones, who have been around the block a few times and know how to negotiate, get it slightly north of $14…………..It’s those Mexican dogs that can teach Trump a thing or too about the “Art of the Deal.” 

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Veterans Day Weekend in Houston Heights

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While in the Houston Heights over Veterans Day weekend, I took my daily walk through the Heights. As I turned to go down Courtlandt Street, I noticed a “garage sale” ahead with a small crowd around a table. As I got closer, I saw this was something extraordinary. It was not a garage sale, but something very different. And, it turned out, something very special.

Curious, I joined the small crowd of on-lookers as a young man explained the history of various WWII artifacts on display. “This is A WWI helmet, still has the insides all intact, worn by British soldiers in the trenches of France. This is a WWII helmet, used by Americans although this on has a German flag symbol on the side of it. ….”

Standing next to me was a 94 year old veteran and his daughter. He was clutching a photograph. I asked him if he was a veteran. “Indeed, here is a picture of me with my crew. I was the pilot, the one standing on the far left here.” How old were you back then I asked. “I was 21.”

I could tell this was a special gathering of spectators. The atmosphere was thick as the young man gave his most interesting “tour” of his mini-museum. He overheard my conversation with the old man, and asked if he could see the picture too. After a brief discussion, he asked “Sir, my I have your signature please. “Yes” he chuckled, “As long as it’s not on a check!”

The old man continued, “I have quite a few things I have kept since the war that I want you to have. I think this will be a good home for them…………………….

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State of Texas Employees Lose 3.8 Lbs Each In Bold Weight Reduction Program

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We Collectively lost 15.2 Lbs!

“Since April, 15,000 current and former state employees—90 percent of whom are at risk for diabetes, cardiovascular disease or other related conditions—have lost more than 57,000 pounds through Real Appeal.” 

57,000 lbs / 15,000 employees = 3.8 lbs each

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Hidalgo County Voters To Decide Financial Health Care Scam Today

scam“Hospitals agreed to assess a fee on themselves for every outpatient served and put that money into a fund that is then sent to the federal government to be multiplied.” TRANSLATION: Hospitals inflate medical charges to consumers, put these additional inflated dollars into a fund that Uncle Sam will match with money taken from working men and women through forced taxation.  Consumers are charged twice, once in the form of onerous taxation and second when they seek medical care.

“Many opponents believe the district would mostly benefit the shareholders at Doctors Hospital at Renaissance. The physician-owned hospital is one of the biggest supporters of Proposition 1.” TRANSLATION: Hospital can’t lose. They fund through overcharging patients which Uncle Sam matches, then these funds which are now double return back to the hospitals in the form of patient revenue.

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CVS Warns of Coming Retail-Prescription Tumult

cvs“Very-recent pharmacy-network changes in the marketplace are expected to cause some retail prescriptions to begin migrating out of our pharmacies this quarter.”

Editor’s Note: We have found PBM pricing at CVS to be some of the highest, along with Wallgreen’s pricing. Some of our clients have excluded both pharmacy chains from their network and have achieved plan cost reductions.

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The Truth About Managed Care Contracts

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“Paying protection money for the promise of no balance billing against egregious, arbitrary sticker pricing that has no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices”  – Molly Mulebriar

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Wikileaks: Mulebriar Exposes PPO Kickback Scheme

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Health care consumer reacts to shocking revelation

Wikileaks has released a purloined email today in response to Mulebriar’s interview with Julian Assange earlier this week (Wikileaks Releases Mulebriar Transcripts – Part One). In an email dated 2011 to RiskManagers.us, Mulebriar expresses shock and amazement that PPO contracts may not always pass on the full “discount” to consumers. She asks, “Are 100% of PPO discounts passed on to the consumer? In this case, the answer is no.”

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