In 15 minutes you will know more about Cash Pay Health Plan strategies than most Plan Sponsors.
Continue reading The Rise of Cash Pay Health PlansThe Rise of Cash Pay Health Plans
Day: March 18, 2025
The Fiduciary Obligation to Avoid 56,000% Markups on Rx
Lessons from the Latest ERISA Fiduciary Suit vs. JPMorgan
Imagine going to the pharmacy, filling your prescription, and trusting that your employer-sponsored health plan has negotiated a fair price for you. What if, instead, that same prescription was costing you hundreds—or even thousands—of times more than it should?
Continue reading The Fiduciary Obligation to Avoid 56,000% Markups on RxWhat Pharmacy Benefit Managers Do, and How They Contribute to Drug Spending
Role of a Pharmacy Benefit Manager in Providing Services and Flow of Funds for Prescription Drugs
* Includes establishing formulary and patient adherence programs and implementing utilization management tools – such as prior authorization, step therapy, and tiering — to steer patients toward certain drugs on formulary.
Data: Adapted from Congressional Budget Office, “Prescription Drug Pricing in the Private Sector” (CBO, Jan. 2007).Source: Kristi Martin, “What Pharmacy Benefit Managers Do, and How They Contribute to Drug Spending” (explainer), Commonwealth Fund, Mar. 17, 2025. https://doi.org/10.26099/fsgq-y980
Continue reading What Pharmacy Benefit Managers Do, and How They Contribute to Drug SpendingHealth Insurance Is Not Really Insurance Anymore
By Molly Mulebriar
Health insurance in the United States is no longer insurance in the traditional sense. It’s become an entitlement welfare scheme that’s fast becoming a heavily regulated government utility.
Continue reading Health Insurance Is Not Really Insurance AnymoreCalamity
Medical Cost Comparison Shopping At The Click of A Button
The Power of Artificial Intelligence In Health Care Financing
AI is changing the world as we know it. For us we’re using it to lift the codes and prices from the medical bills and repricing it. This is much cheaper than owning/leasing claim adjudication programs and the human capital needed to operate these organizations (TPAs). AI allows you to take a picture of your bill and be done with it. The same transformation happened with buggy whip makers over 100 years ago. The automobile (ai) replaced how things used to work. That moment is now in the benefits industry. Next year or two it will be a lot smaller, cheaper, and less complicated” – Leon Wisniewski
Continue reading Medical Cost Comparison Shopping At The Click of A Button