Month: July 2022

You Don’t Want Me To Know Your Business Because It Won’t Be Good For You!

By Bill Rusteberg

Recently I was referred to a large medical group that was interested in learning more about how we help plan sponsors manage their employee health care needs. They were fully-insured with a BUCA and tired of double-digit rate increases year after year.

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Build Your Own RX Plan – Bypass Predatory Business Models (PBMs)

“Don’t bother doing something unless your radically different from the competition”– Richard Branson

By Bill Rusteberg

Building a Rx benefit plan without a PBM (Predatory Business Model) is beginning to make sense for plan sponsors whose Rx costs are as high as 50% of total plan spend. They no longer view their plan as a health plan but as a Rx plan with health benefits attached.

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PBM Shell Game – Hiding Fees Through Middlemen

Are PBM’s Adding Another Middleman To Avoid Transparency?

Are PBM’s creating another intermediary in the supply chain to prepare for transparency requirements? They stand to lose a lot if they get regulated on rebates. By creating another organization that’s offshore, they can protect their interests…………….

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Law Firm Manages & Reduces Risk For RBP Plans

Protecting patients,
health plans and insurers
across the U.S.

“We engaged Koehler-Fitzgerald in 2015 to represent covered employees of health plans we provide administration to that have adopted reference based pricing. They have been very responsive to the needs and questions presented by plan sponsors, plan members, and our staff. Their success rate with balance billing issues presented to them has been in excess of 99% by any standard of measurement. Knowing that every participant has legal representation from a high quality, experienced law firm provides our client plans and employers confidence that their employees will be properly protected from the many aggressive balance billing practices that a small portion of hospitals and other medical providers attempt to employ. They have been shown to be the most effective solution to the only real impediment to adopting reference based pricing.” – Jim Farley, J.P. Farley Corporation

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Specialty Drugs Are Bankrupting Health Plans

Specialty Drugs Have Consequences 

During the interview process Joe Sixpack learns the position pays $35,000 plus benefits. Little does the employer or Joe know the true cost was going to end up being $650,000…..the equivalent of 18 jobs………..so to keep from bankruptcy the employer must reduce his workforce by 18 (hopefully non-essential) employees and freeze wages for everyone else ………….or move his manufacturing business to China and his $685,000 per year employee to unemployment.

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Elected Official Mad As Hell – Hospital Cartel Crushing Middle Class

“Some things are worth getting mad about. The hospital cartel is using taxpayer dollars to help crush the middle class and rob lower-income families of upward mobility…………Wealthy hospitals took billions of taxpayer dollars meant to protect struggling hospitals — and then some billed poor families or even sued patients.” – State Treasurer Dale R. Folwell, CPA

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Dr. Banting Patented Insulin Over 100 Years Ago For $1. What Happened?

4 Out Of 5 Americans With Diabetes Went Into Debt To Pay For Insulin, New Survey Shows

By Deb Gordon

Amidst rising inflation, Americans are feeling the squeeze of higher prices on everything from gas to groceries. But when inflation bumps into the already rising cost of drugs such as insulin, the impact can be serious and the stakes are high.

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More Plan Sponsors Eye The Canadian Connection

“What! I thought It was The French Connection!”

A county government in New York has been accessing Canadian prescription drugs through their self-funded health plan since 2004 with savings in the millions of dollars. Now we see more employers considering the same by moving away from traditional Predatory Business Models (PBM’s) as drug prices reach unaffordable levels in this country.

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Predatory Business Model (PBM) – The Case of The Missing 40%

Holms & Watson Remain Stumped

SOURCE: Vitori Health

A report by the PBM Accountability Project reveals the details of PBMs’ “evolving business models and revenue.” Despite the available financial data, the authors could not identify “the source of nearly 40% of PBMs’ total gross profit.”

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