Study Group: Group Life & Health Insurance Experts: Actuarial Consultants(?)

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.

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...

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.

Outsourcing won't work well until the Indian outsourcing firms develop the core competencies of key insurance operations.  

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.