GLG News by Mr. Michael Berman, Assistant Vice President
Analyses are solely the work of the authors and have not been edited or endorsed by GLG.
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Medical Tourism Has Price Transparency - The United States Has Opaque Pricing
September 7, 2007
American's Gamble for Bargain Surgery Abroad | www.medpagetoday.com
The United States has very limited price transparency for medical providers and facilities. The lack of price transparency artificially raises costs in the United States because there is very little price competition for services. This is true even in areas where there is excess capacity.
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Transparency to the Client is Paramount
July 24, 2007
Insurance brokers reconsider taking insurer commissions | www.marketwatch.com
Contingent commissions, if not disclosed, can result in brokerage clients not knowing how much they are paying for the services they receive from their risk brokers. A commission should be viewed as just an alternative to fee-based consulting. In theory the amount of commissions received should equal fees a client is willing to pay as commissions are built into insurance premiums.
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You Need to Consider Drug Mix and Plan Design
May 29, 2007
Comparison of Mail Order with community Pharmacy Cost | www.amcp.org
It is universal that the mail order distribution channel has lower generic utilization than the retail channel. PBM pricing is always better for mail order scripts versus retail. In addition, plan design is a major component of net claim costs.
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Quality and Service Will Suffer With Outsourcing
May 28, 2007
Insurance Outsourcing Focuses on India | www.insurancejournal.com
Outsourcing won't work well until the Indian outsourcing firms develop the core competencies of key insurance operations.
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Is PBM Transparency a Good Thing?
December 4, 2006
PBM transparency: More than meets the eye | www.benefitnews.com
This article discusses transparency in the context of retail pharmacies; however, PBMs are most profitable in the mail order distribution channel.
Transparent PBM deals have more guarantees than implied by this article. -
November 24, 2006
Pay-for-Performance Plans Now Common Among HMOs | www.nlm.nih.gov
One product the major healthplans are starting to sell are benefit plans (HMO's/PPO's) that utilize a high performance network (HPN). The HPN is a more limited network of doctors who have shown that they are providing quality service and good value from a cost standpoint.
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Walmart Program Beneficial to Consumers
November 24, 2006
Wal-Mart Expands Generic Drug Program | www.newsinferno.com
Many people with health insurance have pharmacy plans with generic copays with flat dollar minimums of at least $5.
Walmart may gradually expand the program or add additional pricing tiers. -
November 24, 2006
Trend: Consumers dumping HMO plans | www.fiercehealthcare.com
HMO Plans have become very similar to PPO without an out-of-network benefit.
Member cost sharing is typically lower than PPO plans making them more expensive. -
September 25, 2006
Wal-Mart Stores offers $4 generic drugs in Florida | ca.today.reuters.com
The breadth of the drugs Wal-Mart will be selling at this price level is reported to be low.
We need to wait and see if Wal-Mart adds additional drugs to their "formulary" -
Don't Forget Benefit Buydowns When Analyzing Premium Increases
August 29, 2006
Some Factors Fueling Rising Healthcare Costs in 2006 | www.pwc.com
Its important to consider benefit buydowns when analyzing year over year premium increases as they can mask the underlying medical trend.
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Disease Management ROI Difficult To Quantify
August 21, 2006
Guidelines For Gauging ROI In Health Programs | www.benefitnews.com
Disease management programs are becoming much more common; however, its very difficult to quantify the return on investment that employers can expect from these programs.
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Medco Agrees to a More Transparent Business Model
August 21, 2006
Medco Agrees to More Financial Transparency | www.northjersey.com
Medco is starting to embrace the concept of transparency by agreeing to voluntary Health Care Policy Association (HRPA) certification
Express Scripts is now the only "Big 3" PBM to not be certified by HRPA. -
Part D Not Perfect But Better Than No Drug Plan
August 18, 2006
U.S. Seniors Navigating New Medicare Prescription Drug Plan: Some Beneficiaries Encounter Problems | www.medscape.com
Medicare Part D is far from perfect but it has provided a real benefit to millions of Medicare recipients who previously had no drug coverage.
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August 18, 2006
Aetna Shares Drop on Medical Costs, Enrollment Cut | www.medscape.com
CIGNA was perceived to have a much better quarter than Aetna despite having a much higher medical loss ratio (MLR).
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CDH: Lower Costs Through Higher Generic Dispensing Rates
August 15, 2006
Consumer-Directed Health Plans Boost Demand for Drug Price Comparisons | www.aishealth.com
Price Transparency is critical for the success of CDH
Drugs have the most transparency of all medical cost components -
CDHP not Replacement of HMO/PPO
July 31, 2006
CDHP's and the market trend in NJ, NY & PA | www.hctproject.com
CDHP plans are not really competing with traditional HMO and PPO plans. In the large employer market, they are generally offered alongside another plan design.
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Pharmacy Copay Trends in Employer Benefit Plans
July 12, 2006
When New Drugs Are Costly, How High to Raise Copays? | www.managedcaremag.com
This article deals with the meaningful question of the level that benefit managers will set pharmacy copays.
The author correctly notes that lowering utilization of high cost drugs does not always lower overall plan costs.
PBM's do not set plan copays. -
CDHP and Large Employer Market
June 26, 2006
CDHP Phenomenon | hr.blr.com
Large employers are commonly offering a CDHP option in their employee benefit plans; however, very few are moving to CDHP on a full replacement basis.
CDHP plans generally have poor price transparency, which is in conflict with the concept of consumerism.
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