Rebates have created pay-to-play dynamics. Employers facing high drug costs have “rebate addiction.” And the impressive “rebate guarantees” are hard to resist. But at least the process of how drugs get formulary placement is becoming clearer, and some PBMs have moved to charging administrative fees only.
Utilization management techniques for traditional medicines don’t translate to drugs covered by the medical benefit. Site-of-service programs show some promise, though.
After Ohio uncovered huge spreads, other states have taken a hard look at spread pricing in their Medicaid programs. U.S. senators and CMS are also getting into the act.
People with behavioral health problems have stretched emergency departments to their limit as the number of inpatient psychiatric beds has decreased. For many patients, the ED is the first place they go. Even people under the care of a mental health professional wind up in EDs because they’re in crisis and their provider’s office is often closed.
The insurer’s CEO explains the company’s approach to growth, how a team-based system nurtures better care, and why he thinks Medicare for all might not work.
