When you go to fill a prescription, do you present your health insurance card at the pharmacy and assume you’re getting the lowest price? You may be paying too much. The cash price for many prescription drugs — especially generics — is often less than insurance co-pays.

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GoodRx, a digital health startup that helps users track prescription drug prices, filed for an IPO on Friday. The company hasn’t yet priced its shares, but plans to be listed on Nasdaq as “GDRX.”

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Allen is Only Expert Chosen to Represent the Insurance Industry…………

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TSHBP offers Texas school districts a TRS ActiveCare alternative for 2020-2021 school year. A careful review of benefits and rating structures indicates smart risk management strategies to control health care costs for members.

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Drug prices keep going up, and up, and up with no end in sight. Isn’t it about time plan sponsors get away from open formularies and change the way they purchase drugs? Or do plan sponsors want to continue to spend and spend and spend,  more and more?

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Psst…GodFather, Carl’s At It Again!

We just received word that Florida Schuessler Stick (The Schuessler Stick™) sales have recently spiked straining manufacturing capacity at plants world wide. So staff set out to find out why. The following is their report…………….

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Common sense dictates that medical caregivers who accept Medicare pricing should have no problem accepting Reference Based Pricing plans that uses the same pricing.

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ANGRY HOSPITAL ADMINISTRATOR REACTS TO THE NEWS……………

“The goal of the rule is to reduce a disparity in Medicare payments where hospital-affiliated clinics get paid more than physician offices for the same services. Some critics have said the gap has helped fuel a race towards hospital-physician consolidation.”

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• Cash Pay Community Provider Network includes PCP office visits, Specialist Visits, Radiology, etc. Zero balance billing issues – Providers paid in full through electronic fund transfer at POS
• Centers of Excellence for Surgical Procedures. Zero balance billing issues
• Reference Based Pricing for all other services. Plan will attempt to resolve balance billing issues however there is no guarantee those efforts will always be successful

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Micro-Dot Image of Heretofore Secret Health Care Strategium 

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Court records allege Cigna uses four distinct schemes to embezzle and convert funds by defrauding patients, healthcare providers, and their own Self-Insured Health Plan clients …………………

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So guys, this is what my typical day looks like now………………………….

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“What medical school did Zuckerberg go to?”……………………………….

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Why price of Humira keeps rising despite FDA approval of generic competition

“Patent thicketing, and Humira is the poster child for this, builds a patent fortress around their product to protect their ability to continue their monopoly pricing.’’

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Here are some highlights from the podcast:

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ARTICLE REFERRED BY: Charles Luke

7/29 TDI Releases Preliminary Report on Balance Billing Dispute Changes 

The Texas Department of Insurance has released a preliminary report on the effects of recent balance billing dispute resolution procedures passed during the 86th Session in Senate Bill 1264. In the report, TDI examined 9,000 requests over the first six months of SB 1264 implementation.

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We know a thing or two when it comes to employee benefits. Actually we’re what you might call an “industry leader” in all aspects of online employee benefits communication, education, enrollment and administration.

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The Purple Cow is down in Raymondville, Texas, lonely as hell………………

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Whether you own a company it, run it, invest or influence it- WellNet refuses to play by the rules of the ‘health insurance company cartels’ that seem to only be interested in protecting their revenue streams.

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Hospitals are becoming increasingly proactive in updating their Charge Master’s and doing so on more than a quarterly or annual basis yet Hospitals Dismiss Significance Of Chargemaster Prices?

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Gerard, our in-house prognosticator who is never wrong announced this morning that the dreaded Chinese Flu (The Pandemic) chaos will end abruptly on November 4, 2020. That’s good news for exhausted Americans.

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At the stroke of midnight, August 31, 2020 as much as 5% of TRS ActiveCare membership may vanish……………

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There is a frenzy of activity among insurance brokers, consultants, third party administrators and others towards seizing what is perceived to be a new found opportunity in selling lucrative group medical plan alternatives to the TRS ActiveCare program.

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Texas school district to over TRS ActiveCare alternative health plan effective September 1, 2020

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First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools……………….

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TAKE COMMAND HEALTH touts cost saving alternative to TRS ActiveCare………………

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Mike, in a recent post, you said you’ve been to Tennessee and Georgia, giving speeches and filming for your new show. Before that, you were on the road shooting for Dirty Jobs. Is it really so important to film a television show in the midst of pandemic? Is it responsible of you to encourage this kind of behavior when infection rates are spiking? Don’t you watch the news? More and more cases every day – aren’t you concerned? – Darlene Gabon

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Reference Based Pricing vendors rejoiced when a jury sided with a patient over an egregious hospital bill (Jury-sides-with-patient-in-hospital-bill-lawsuit/) But plaintiff’s attorneys were singing It Ain’t Over Til It’s Over………..

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SOURCE: Greg Rudisill on Linkedin

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Fred Rusteberg wasn’t interested in the limelight, but he was always there to help the people of Brownsville, his beloved hometown, and he left an indelible mark in the process.

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A couple of weeks ago I was interviewed by someone in the U.K. for a podcast called The Jist. I spent about an hour trying to explain our crazy healthcare system to someone who’s had no firsthand experience with any of it. As you can imagine, most of what I told him sounded quite insane to him.

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What exactly is being peddled here?

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Will Texas finally do something to fix health care for state employees and Texas educators? Fighting a $4.6 billion budget deficit can start with injecting common sense, reason and logic into how Texas funds health care………………….Or Is Texas still searching for their missing cajones? Hint: The little lady in Montana has them…………….

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Josh Butler is a West Texan who knows how to fix health care…………

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Shortly after posting the blog entry immediately preceding this post entry we received the following email message from Express Scripts:

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“It’s no secret that PBMs have been keeping secret their prescription pricing in order to evade public scrutiny and rake in revenue,” Mr. Yost said. “I intend to shed light on their business model………”

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“We knew that this was a time bomb because the percentage of obesity, hypertension, diabetes is so high,” said Dr. Adolfo Kaplan, a critical care physician who works with Dr. Brown at DHR Health in Edinburg, Texas. “

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Patient Centered Health Care vs Conveyor Belt Health Care

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UnitedHealth Group was the first major payer to release it second quarter earnings report, offering insight into how the coronavirus pandemic impacted the payer industry following the first quarter surge.

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“UnitedHealth Group treats all of the plans it administers as one huge piggybank, moving money around as it sees fit……………….”

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It was his dream job. He never thought he’d be bribing doctors and wearing a wire for the feds.

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Rather than basing Rx pricing by applying a discount off arbitrary sticker prices the strategy is to base pricing off what retail pharmacies pay for drugs. For example, if a pharmacy pays $10 for Drug A, the plan sponsor pays $10 plus a margin. This is Reference Based Pricing for Rx claims. But according to the following article this strategy does not save money. The American Rx pricing mystery continues…………….

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Lone Ranger Refuses To Wear Mask in Solidarity 

“I think it’s an insult to Texans to be required to do something they should have discretion for,” said Hugh Reed

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Texas expands elective surgery ban to more than 100 counties

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Big Medicine would love to trap your doctor in their job, even if it’s abusive.

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Look Kemosabe, Greg’s Pulling His Hair Out!

“The order is not a law, there is no requirement that any police officer enforce it, and it’s unenforceable. We can’t spend our time running from place to place for calls about mask we can really do nothing about.”

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SOURCE: Mike Reagan on Linkedin

“This West Texas doctor says he has a low cost cure for Covid-19 (Budesonide), we don’t need a vaccine and the “stay at home, shut down businesses mentality” is politically motivated. He further states that the way we are treating Covid is wrong.”

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Plan sponsors should determine whether they are a “covered entity” as newly defined under the final rule for nondiscrimination purposes. If not Katy-Bar-The-Door for out-of-the-box risk management strategies……..

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RiskManagers Interlocal Purchasing Cooperative is designed for Texas political subdivisions seeking alternatives to traditional managed care health insurance plans.

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“This first article in a three part series will focus on Pharmacy Benefit Managers – one of the three most influential opponents of price transparency.”

Twenty years ago Express Scripts was a $1 Billion revenue company, but now they have over $100 Billion in revenue per year.  No inventory to trouble with, no warehouses needed, no fleet of trucks to maintain………………the only thing needed are contracts of adhesion cleverly designed to screw third party beneficiaries……………………………..

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All the proper reserving in the world may not cure a severe case of lasers. The Great Laser Pandemic is running rampant, striking angst and fear among plan sponsors everywhere.

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Great news: We and our partners at CBS News won the 2019 Society of Professional Journalists – Sigma Delta Chi Public Service gold medal for network news for our health costs partnership, “Medical Price Roulette.”

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These are the tools of the trade a 72 year old industry dinosaur uses to underwrite group medical plans, projecting future costs, rate setting, reserve requirements, quantifying IBNR, etc.

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Xerox, Eastman Kodak And Cost Plus Insurance

“The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide.” – Bill Rusteberg

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Works on Brass But Not on Walnuts

When asked recently during a question and answer period at a symposium I attended, a member of the audience asked “What do you tell employers who voice concern about some of your strategies to reign in health care costs?”

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Pssst, God Father, Justin’s At It Again!

Cartels: “an association of manufacturers or suppliers with the purpose of maintaining prices at a high level and restricting competition………………

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Let the Sun Shine In…………………………………………………………

This will be the end of PPO networks and will turbocharge the explosive growth of Reference Based Pricing strategies…………………..

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Dr. Belk gives a talk to One Payer States, a group advocating for a single payer system…………

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Authorities said Hickman and the others recruited public-sector employees who were paid to get prescriptions they didn’t need and hadn’t been prescribed. Among the more than two dozen people who have pleaded guilty was John Gaffney, a Margate-based doctor who admitted signing prescriptions for patients he never saw………………..

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Tom, Dick and Harry on the way to a conference decided to stop along the way and get a hotel room. It was late at night, but they saw in the distance ahead a hotel with a neon sign that said “Vacancy.”

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In the eighth annual Disruptor 50 list, CNBC identifies private companies whose breakthroughs are influencing business and market competition at an accelerated pace. They are poised to emerge from the coronavirus pandemic with tech platforms that have the power to dominate.

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The El Paso Independent School District was the second public school district to challenge TRS ActiveCare in 2019 by offering employees a commercial health plan option in direct violation of TRS ActiveCare mandate prohibiting Texas school districts from doing so. So how has the commercial plan option fared financially so far?

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