The 2003 WilsonRx Survey reports that patients have identified Medco Health Solutions as the top pharmacy benefit manager for the third year in a row. Reported satisfaction was less for AdvancePCS, Aetna, Anthem, Caremark, Eckerd Health Services, Express Scripts, Prescription Solutions, RxPrime, Walgreens Health Initiatives, United Healthcare, and WellPoint Pharmacy Management. Wilson Health Information researches pharmacy, pharmacy benefit, insurance, and treatment issues.

"Members ranked the ability to get the prescribed medication they expected, out-of-pocket costs for prescription drugs, and the ease and ability of filling and refilling prescriptions as most important," said Jim Wilson, president of Wilson Health Information. In addition, Medco Health Solutions was highest in the categories of mail and home delivery services, as well as the ability of its customer service representatives to answer questions and solve problems for members.

The survey also asked how likely each member would be to re-enroll in his pharmacy benefit plan. Researchers used the relative difference between the highest-rated and lowest-rated PBMs to determine the difference in re-enrollment intention. The difference in re-enrollment intention was 13,450 per 100,000 members — a difference of 13.5 percent.

"Satisfaction with the prescription drug benefit is ... crucial to retaining health insurance members," said Wilson. Compared to members who were simply "satisfied," members who were "highly satisfied" with their PBM were more than twice as likely to intend to re-enroll in their health plan and more than three times as likely to recommend their pharmacy benefit plan to a friend or relative.


Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.