Three conditions — hepatitis C, diabetes, and cancer — show how budgets can be busted (and patients harmed) if providers and payers don’t astutely manage the use of costly new drugs

Health plan clinical administrators can take much better advantage of the low prices of pharmaceuticals that become untethered to a brand name

When drug manufacturer coupons make members’ costs for brand drugs equal to generics — or less — health plans, employers, PBMs, and members pay a price
Pass-through pricing is a good way for a payer to realize the benefit of increased prescribing of generic drugs
When a health plan contracts with a PBM, it should insist on strict definitions of brand drug and generic drug, an experienced negotiator advises
Unfortunately, most contracts practically invite the companies that health plans deal with to manipulate prices
Transparency in contracting is a great thing, but it takes vigilance to keep it from clouding over
References to maximum allowable prices in contracts between plans and PBMs need to be scrutinized, since things are not always what they seem
An experienced negotiator and lawyer describes in detail how health plans that contract with PBMs can get a better deal