Day: February 26, 2010

Amfels, the second largest employer in South Texas located in Brownsville, Texas, has moved their self-funded health plan administration to Group & Pension Administrators Inc. (GPA). The move is signficant since GPA is known in the industry as one of the most progressive and agressive health plan administrators in the country, achieving significant savings for their clients by utilizing unique risk management techniques.

Another large Brownsville, Texas based employer contracted with GPA last year, moving from a local HMO plan. A recent claim study shows that claim costs on a PEPM have been cut in half.

Observers speculate that the Brownsville Independent School District will take note and apply similar strategies to reduce their +$40,000,000 employee health plan expenses.

Editor’s Note: GPA has received national publicity in the past year on their success in reigning in health care costs for their clients. The Dallas Morning News ran a front page article on GPA –  Forbes picked up the story as well as other national news sources.

In an Employee Benefit News, February 2010 issue, front page article, “Report Calls PBM Merger Into Question”, critics acuse CVS Caremark of driving up costs for health plans and lowering quality for patients, reducing transparency and hampering oversight for health plans, and compromising the privacy of health plan participants.

“CVS Caremark is currently the only major PBM that is owned by a retail pharmacy chain, and this combined business model has an inherent conflict of interest. As a retailer, CVS Pharmacy has an incentive to drive customers into its stores, fill as many prescriptions as possible, particularly those with high markup, and has little interest in saving health plans money.”

“Of particular interest to health plans and sponsors is the report’s contention that CVS Caremark promotes the use of more expensive brand name drugs over cheaper generics. ”

The article also advises plan sponsors on how to negotiate with their PBM, listing four major points to consider.

Editor’s Note: If you wish to recieve a copy of this article, email Riskmanager@sbcglobal.net