Seize The Day & Reference Based Pricing

March 5th, 2019
One of many emails I get every week about Reference Based Pricing strategies. Seems there are more and more TPA’s entering that space in partnership with either ELAP, AMPS, Six Degrees or Payer Compass, the Big Four. Then there are all the others like HST and UCC making inroads too. Now we are seeing some of the BUCA’s entering into the Reference Based Pricing space via their wholly own TPA subsidiaries with the apparent mantra “If you can’t beat them, join them.”

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Specialty Drugs Are Killing Your Renewals!

March 5th, 2019

War On Drugs Continues……….

We specialize in helping self-funded employers dramatically reduce Rx spend while providing members a $0 Rx copay for many name brand and specialty meds.

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Insurer of Last Resort

March 5th, 2019

“No problem Joe, I’ll make a call for you”

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Glenn McLellan – Sales & Account Management at Centivo

March 4th, 2019

For 35 years I have worked closely with all constituents in the self-insurance industry to help our industry be the best that it can be. From my perspective, the development of Centivo is the culmination of every effort I have made for a TPA to be “world class” and represent the future.

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TPA Offers New Health Plan Model

March 3rd, 2019

Centivo offers an alternative to traditional insurance carriers or third-party administrators……..

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War On Drugs – The Indians Are Restless

March 3rd, 2019

Boston Tea Party

What’s the price of tea in China? How about insulin………….Insulin which was discovered in the 1920’s and whose patent sold for $1, has doubled in price between 2012 and 2016 while the price of insulin drug lantus increased 49% in 2014 alone. Why? In this war on drugs we should “Just Say No.”

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It’s Scary – House of Representatives or House of Horrors?

March 2nd, 2019

Rather than finding a way to provide for the small minority who still need health insurance, they want to overhaul the whole health system for everyone……………….

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Texas Addresses Balance Billing Issue

March 1st, 2019

A Texas Senate Bill was introduced a few days ago that addresses balance billing issues including credit reporting agencies……………….

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SOAP

February 28th, 2019

 

Our STRATEGIC OPEN ACCESS PLAN (SOAP) is designed to clean up your group medical program using common sense and traditional American business practices. Clients who adopt our strategies will realize plan savings of 20-40% while maintaining or even improving benefits at the same time.

 

 

“Cleaning up Your Employee Health Plan”

Field Rated Dental/Vision Plan

February 28th, 2019

Still quoting the same 100/80/50 Dental Plans that were popular 20 years ago? Let’s surprise your client with a new and innovative dental offering.

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Naysayers Bring Message of Impending Doom

February 28th, 2019

Maybe the problem with solving health care in this country centers around the apparent abundance of naysayers………………

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Jilted Lover Wants Back Billion Dollar Engagement Ring

February 28th, 2019

Judge, he’s a bully, manipulative, passive-aggressive and self-centered. I don’t love him anymore!

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SmartDecision Offered By HealthSmart

February 27th, 2019

A Reference Based Pricing solution called SmartDecision. It offers RBP, bundled pricing, cost and quality information, and a concierge service to help members navigate the entire healthcare episode. Please review our flyer to learn more about this truly unique program. Click here to download.

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Attention Health Insurance Brokers: You’re One Election Away From Extinction

February 27th, 2019

Medicare-for-all would move every American onto one government insurer in two years, while providing everyone with medical, vision, dental and long-term care at no cost………….

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February 27th, 2019

Anthem Antitrust Atty ‘Stunned’ At Cigna Balk On $54B Deal

A 25-year veteran antitrust lawyer for Anthem Inc. testified Tuesday he was stunned by Cigna Corp.’s sudden and allegedly fatal resistance to their now-abandoned, $54 billion tie-up, in the second day of a multibillion-dollar Delaware Chancery Court trial over the collapsed deal.

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February 26th, 2019

In Florida, Drug Re-Importation from Canada Finds New Champions, Old Snags

“Florida is joining the growing ranks of states that, squeezed by climbing drug prices, are eyeing the Canadian fix…. Legislation has been advanced this year in about a dozen states that would advance wholesale drug importation programs … While statehouses may be abuzz, in Washington, national politics impedes feasibility. And skeptics question how much relief these initiatives could actually provide.”
Kaiser Health News

Departments Ask for Advice from Health Plan Sponsors: Preserving ‘Grandfathered Status’ Under the ACA

“The specific questions include: [1] Do any of the requirements for maintaining grandfathered status create particular challenges, and how could these requirements be modified to reduce these challenges? [2] Why do plan sponsors choose to retain grandfathered status? [3] What are the costs and benefits that plan sponsors consider in deciding whether to retain grandfathered status? [4] Is preserving grandfathered status important to plan participants? [5] What changes in benefits typically trigger a loss of grandfathered status?” 
Segal Consulting

To RBP, or Not to RBP: That Is The Question

February 26th, 2019

Once upon a time, health benefits were just that – “benefits.”  Now, it’s assumed health insurance is included in an employment package, and what was once a benefit is now an entitlement…..

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Single Mom Jailed Over Unpaid Medical Bill

February 25th, 2019

Mugshot photo of Melissa Welch-Latronica, 30, of LaPorte. (Porter County Sheriff’s Dept.)

Single mother goes from traffic stop to bench warrant to jail over unpaid medical bill: ‘It just isn’t right’

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Insulin Makers Face Drug Pricing Suit

February 22nd, 2019

Price of Drugs Is Too Damn High!

“This ruling blows the insulin racket wide open,’’ said Steve Berman, a plaintiffs’ lawyer who is one of the leaders of the potential class-action case. The ruling “clears the way for us to begin obtaining discovery from the manufacturers and PBMs so we can shine the light on exactly what has driven insulin prices sky-high,’’ he said.

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Primary Care – The Future of Employee Care?

February 22nd, 2019

“Direct primary care (DCP) — a fee-based model that gives individuals unlimited access to a primary care doctor for anywhere between $60 to $150 a month, without insurance being billed — is the “future of healthcare….”

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New MEWA in Texas Announced

February 21st, 2019

Last month, we received our license to sell Association Health Plans (AHPs) to medical groups in Texas through the Oklahoma State Medical Association (OSMA). They have a proven track record of providing significant savings to their members and offer a broad range of health plans.

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How You Can Save On Health Care in Texas

February 21st, 2019

Just like 4.3 million other Texans, they have zero health coverage. They simply cannot afford health insurance. “We don’t have health insurance because it’s just outrageous. We have to choose food or clothing over health insurance, and food and clothing are just going to come first,” Kevin Doetticher said.

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Jeanne Pinder On TED Talk

February 20th, 2019

My TED talk is up! 

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Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans

February 20th, 2019

 Industry wide, transparency is not the standard. ProPublica sent a list of questions to 10 of the largest broker agencies, some worth $1 billion or more, including Marsh & McLennan, Aon and Willis Towers Watson, asking if they took bonuses and commissions from insurance companies, and whether they disclosed them to their clients. Four firms declined to answer; the others never responded despite repeated requests.

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TO UNDERSTAND VALUE’S MARKET PROGRESS, WATCH PRIMARY CARE

February 19th, 2019

Brian Klepper

“Renegade PCPs long for independent practices where their patient care decisions are not so influenced by their employers’ interests……………….By recapturing control of care and cost, they also are re-establishing primary care’s primacy within health care……………..”

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Debunking The Stagnant Wage Myth

February 18th, 2019

“In 60 seconds, this CEO explains why healthcare has blocked many manufacturing jobs from coming back to the U.S.” – Dave Chase on Linkedin………………..

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How Dare You! 177% of Medicare Is Insulting!

February 17th, 2019

The state of North Carolina has adopted Reference Based Pricing for their state employee benefit program to become effective in 2020. The reference price will be pegged at 177% of Medicare. That has caused an uproar with the state’s hospitals and they are fighting back hard.

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McAllen ISD To Interview Top 3 Consultant Finalists

February 17th, 2019

By Molly Mulebriar

McAllen Independent School District in deep South Texas is set to interview the top three finalist for the district’s insurance consultant position this week. MISD employee benefit program is self-insured and administered by Blue Cross & Blue Shield.

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Texas Medical Association Highlights Reference Based Pricing

February 16th, 2019

“It’s an intriguing way to lower costs for both physicians and health plans, and it could reduce premiums for patients. It also could enable doctors to wrestle more contract-negotiating leverage out of the hands of the market’s dominant health plans ― and in some cases, contracting with them might not even be necessary.”

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American Health Care – The Economic Trojan Horse of Destruction

February 16th, 2019

“We are taking that wasted money and artificially inflating the cost of health care to the point that nobody can afford it without government continuing the death spiral of spending, monopolizing, and price inflation.”

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Reference Based Pricing

February 14th, 2019

In this video, Dr. Eric Bricker Explains Reference-Based Pricing.

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Reasons For Having A Primary Care Physician

February 14th, 2019

Dr. Eric Bricker Explains 3 Reasons for Having a PCP: 1) Screening, 2) Same-Day / Next-Day Appointments and 3) After-Hours Call-In Access.

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Why Aren’t More Employers Implementing Reference-Based Pricing Benefit Design?

February 12th, 2019

In contrast to deductibles, where the patient pays the “first dollar” of medical expenses, under RBP, the patient is responsible for the “last dollar.”

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The Great Free Standing ER Scam Continues…………………

February 12th, 2019

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Catholic Diocese Insured Against Child Sexual Abuse Claims

February 11th, 2019

Liberty Mutual has agreed to pay the Diocese of Duluth US$6.5 million under a recent settlement agreement over litigation of insurance coverage for child sexual abuse damages………..

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Greenlight Re invests in Texas-based TPA

February 10th, 2019

Greenlight Re Innovations, part of specialist property and casualty insurer Greenlight Capital Re, has announced an investment in Sana Benefits, a Texas-based third-party administrator (TPA) focused on the self-insured health market……………...

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$1,000,000,000.00 Insurance Scam

February 10th, 2019

Four men and seven companies have been charged in connection with a $1 billion healthcare scam, according to the Department of Justice………………….

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AccuRisk Solutions LLC

February 10th, 2019

AccuRisk Solutions LLC is a Chicago-based Managing General Underwriter focused on providing its producers with innovative insurance products and outstanding customer service.

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Mexican Drug Run

February 10th, 2019

“It’s cheaper for us to pay for the drug down there, send them down there and then give them $500….”

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Japan Post Eyes $2.6 Billion Investment in AFLAC

February 10th, 2019

Japan Post would like to expand Aflac’s cancer insurance products sold at post office counters…..

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Kratom Anyone?

February 8th, 2019

Kratom is a miracle cure for everything from opioid addiction to anxiety……..

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Nataline Could Have Been 28 Today If Not For A Health Insurance Decision

February 8th, 2019

I’ve been asked many times if there was one thing, one moment, that led me to leave my job at a big health insurance corporation. Yes, there was, and it occurred five days before Christmas in 2007. That was when a beautiful 17-year-old girl named Nataline Sarkisyan passed away, days after the company I worked for refused to pay for a liver transplant that her doctors believed would save her life. A few days after Nataline’s death, I turned in my notice.

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Climate Change & Employee Benefits – Are You Kidding Me!

February 8th, 2019

If your’re in HR and believe in climate change this article is for you. You may want to consider offering your employees energy-free light bulbs and mandate car pooling………….

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Insurance Denials Can Be Death Sentences

February 8th, 2019

                  Molly Fetzer

Self-funded school district overrides TPA’s (Anthem) decision to deny coverage and authorizes doctor ordered treatment plan for stage 4 cancer member………………….

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Patient Sentenced To Death?

February 7th, 2019

Putting dollars in front of saving lives……………………..?

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Sheryl Bonner 1963-2019

February 6th, 2019

Respected industry leader passes………………………

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Why Employers Should Work With Older Folks

February 6th, 2019

“I’m 67, so I could give a shit,” she says. “What are they going to do, fire me? I’m packin’ a Medicare card.” – Marilyn Bartlett

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USA Rx Revolt Looks To Canada For Help

February 5th, 2019

Colorado on Thursday joined a growing number of states that want to cut certain prescription drug prices by importing licensed drugs from Canada………………..

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Gotta Love Bernie!

February 5th, 2019

Bernie Discovers Self At Early Age

Senator Sanders asks why drug, once free, now costs $375,000,000.00…………..

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HRA’s To The Rescue!

February 5th, 2019

The HRA’s Are Coming!

Expands the use of HRAs to allow for the purchase of individual health insurance coverage…..

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Centenarians Rejoice

February 4th, 2019

Hawaii considers ban on cigarette sales except for centenarians…………………..

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Cigna’s $54 Billion Problem

February 3rd, 2019

Health insurer’s purchase of Express Scripts is looking like even more of a blunder……..

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The Prevalence of Self-Funded Health & Welfare Plans

February 3rd, 2019

With steady growth in the last four decades, self-funded plans are now the most common type of health plan that workers are enrolled in across the United States. Various sources put this number at nearly 70% and climbing. Nearly all self-funded employee benefit plans are managed through a third party administrator (TPA) firm, an independent organization that assists with overall plan operations, benefit coordination and claims processing.

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Nonprofit Dental Insurer Under Scrutiny For ‘Flagrant’ Spending

January 31st, 2019

Dental insurance giant Delta Dental of California is facing mounting criticism for paying its CEO exorbitantly, flying board members and their companions to Barbados for a meeting……

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January 30th, 2019

Man Robs Bank, Demands To Be Sent To Prison

January 30th, 2019

“I’ve never heard anyone rob a bank so they can get to prison so they could get health care,” James Griffin, the assistant district attorney prosecuting Gallagher……………..

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Solution To High Health Costs: Abolish Health Insurance!

January 30th, 2019

Health Insurance Agent Reacts to News

Raging Left Coast Democrat vows to eliminate all private health care insurance for approximately 150 million Americans………………………………….

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A Cure For Cancer?

January 29th, 2019

A small team of Israeli scientists think they might have found the first complete cure for cancer…….

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Brownsville ISD Seeks Insurance Consultant

January 29th, 2019

The Brownsville Independent School District (BISD) in deep South Texas is seeking an insurance consultant in a competitive request for proposal process.

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Medical Industrial Complex Fights Back

January 29th, 2019

A new group wants to raise $2.5 million to fight State Treasurer Dale Folwell’s plan to reduce health care spending for about 720,000 state employees and retirees…………….

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School Superintendent Accused of Insurance Fraud

January 29th, 2019

Superintendent used her own health insurance to seek medical treatment for a sick student…….

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Spectrum Equity Leads Majority Recapitalization of Payer Compass

January 27th, 2019

Investment positions Payer Compass to continue its rapid growth………to date the company has grown to serve over 125 payer customers, representing nearly 1,000 employer groups and over two million covered lives………………….

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On Fire!

January 25th, 2019

We were excited to be featured on the CBS Evening News and CBS This Morning earlier this week!

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Health Insurers Support Single Payer System?

January 24th, 2019

As the support for a single-payer, “Medicare-for-All” health care system in U.S. grows, so do the contributions from the health insurance industry………………

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Americans Mad As Hell About Cost of Health Care

January 23rd, 2019

Poll: 56 percent of public supports ‘Medicare for all’

BY PETER SULLIVAN – 01/23/19

A majority of the public supports a single-payer health insurance system, often called “Medicare for all,” as the idea gains steam among Democrats, according to a new poll.

The poll from the Kaiser Family Foundation finds that 56 percent of the public supports a single-payer plan, compared to 42 percent who oppose the idea.

Progressives are pushing the new Democratic House majority to move forward on the idea, and many Democratic presidential hopefuls have signed on to the idea as well. More centrist Democratic lawmakers remain opposed to the proposal, however.

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What’s Your RBP Sweet Spot?

January 21st, 2019

The State of North Carolina’s Reference Based Pricing sweet spot is 177% of Medicare. “The new rates for various categories of services will average out to 177% of Medicare’s fees, down from a current (PPO) average of 213%, North Carolina Treasurer Dale Folwell (R) told The Wall Street Journal. …………………………”

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Another Vendor Enters Reference Based Pricing Marketplace

January 20th, 2019

Another vendor, touting a NEW strategy to reduce health care costs, enters the Reference Based Pricing arena. They, along with the rest of their competitors are 35 years late in identifying the concept. Back in the early 1980’s J Patrick Rooney (1927 – 2008) contended that authoritative research showed that Medicare plus 25 percent is the reasonable amount for hospitals to charge. Then, of course, there is J.P.Farley (www.jpfarley.com)who has actually been implementing Reference Based Pricing plans since the 1990’s……………………….

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The Only Way to Pay Less for Health Care Is to Pay Less for Health Care

January 18th, 2019

This 35 minute podcast is well worth the time………….Listen to the Master, David Contorno…..

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Wellness Programs Expected To Hit New Highs

January 18th, 2019

Wellness Consultants Cheech & Chong

Attention HR Directors! Take your Wellness Program to a high & reap the rewards of a happy and mellow workforce! 

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Health Insurance Brokers Identify Key Cost Drivers?

January 17th, 2019

“Brokers are also seeing high demand for benefits communication, employee engagement and transparency as a way to address the rising cost of healthcare…..” REALLY? How in the world will this reduce health care costs?

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Are Rising Drug Cost Destroying Group Health Plans?

January 17th, 2019

“The primary villain in the multi-year erosion of the value of the employer-provided health benefit, and private insurance generally, has been drug costs.”

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Court Case Addresses Cross-Plan Offsetting

January 17th, 2019

“The court strongly hinted that the practice violated ERISA’s fiduciary duty rules, including the requirement that plan assets of one plan be used for the ‘exclusive purpose’ of benefiting individuals covered by that plan.”

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Texas Teachers Giveth Raises – Health Insurance Taketh Away…………

January 17th, 2019

A RETIRED TEXAS SUPERINTENDENT ON WHY TEACHERS ARE QUITTING IN DROVES: “UPS starts people with no experience (HS diploma or GED) at $13 per hour plus full benefits. Within a couple of years you can graduate to a route where drivers make six figures after five years. In 7 years you can make over $100k delivering packages. In contrast, my wife is in her 25th year as a teacher with a Masters degree. She makes $57k and has some of the worst insurance in the country”

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What Can We Do About The Cost Of Health Care?

January 16th, 2019

Answer: Pay Less For Health Care………………………………..

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RBP Vendor Fees In An Evolving Competitive Market

January 16th, 2019

As Reference Based Pricing (RBP) strategies take hold in the market, with more vendors entering the fray for market share, the inevitability of increasing competition becomes evident. That is good news for plan sponsors……………………

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