SmithRx’s Post

As prescription drug costs continue growing and pricey new pharmaceuticals add to health plans' cost burdens, some carriers are starting to reduce the number of medications they'll cover and are imposing new barriers to accessing the most expensive ones. A new report found that the statistics are likely worse for group health plans because they are not subject to the same regulations as Medicare plans are. Here's what's going on and how you can help your staff. https://bit.ly/4fTCAY8

As prescription drug costs continue growing and pricey new pharmaceuticals add to health plans' cost burdens, some carriers are starting to reduce the number of medications they'll cover and are imposing new barriers to accessing the most expensive ones. A new report found that the statistics are likely worse for group health plans because they are not subject to the same regulations as Medicare plans are. Here's what's going on and how you can help your staff. https://lnkd.in/eFiDrCWZ

What does this mean for your business? Higher costs may be inevitable, but strategies to manage them effectively are available. How Blue Horizon Benefits Can Help: We specialize in crafting customized strategies to keep your health plan affordable without sacrificing the quality of care your employees receive. Let's discuss how we can support your team in these challenging times. Reach out today to ensure your benefits strategy is as resilient as your workforce. #HealthcareCosts #EmployeeBenefits #GroupHealthPlans #BusinessSupport #HealthInsurance

When was the last time you really understood how your company’s prescription drug costs are affecting your health plan premiums? The more RX drugs your employees rely on, the greater the risk—leading to higher premiums year after year. But there are strategies to better manage this and keep costs under control. Let’s talk about how to protect your bottom line while ensuring your team gets the coverage they need!

New findings from @KFFHealthNews reveals that Americans now spend more than $1,000 annually on prescription drugs, with 30% reporting they’ve skipped medications due to costs. 🔗https://hubs.la/Q02W2kC70 💡 Key Insights: 1️⃣ Impact on Patients: Nearly 20% of large employer-sponsored health plans now utilize copay accumulators. For those managing chronic conditions, this can mean facing substantial out-of-pocket costs when they least expect it. 2️⃣ The Regulatory Landscape: While federal regulations are evolving, many states are taking proactive measures to protect consumers. 💬At Atlas, we’re committed to supporting patients in navigating these challenges. Our mission is to connect individuals with financial assistance programs that can help reduce the burden of medication costs. Together, we can drive change and ensure that every patient has access to the medications they need. #FinancialAssistance #PatientAdvocacy #AtlasHealth

As prescription drug costs continue growing and pricey new pharmaceuticals add to health plans' cost burdens, some insurers are starting to reduce the number of medications they'll cover and are imposing new barriers to accessing the most expensive ones. A new report found that the statistics are likely worse for individual health plans because they are not subject to the same regulations as Medicare plans are. Here's what's going on and how you can check if your needed medications will be covered next year. https://lnkd.in/gxCQdTFq

What does “step therapy” mean in Medicare drug coverage? Each Medicare Part D plan has a list of covered drugs that are called a formulary.  Within every formulary, there are a set of rules applied to the prescription drugs covered by the plan. One of those rules is called step-therapy.  If you get a prescription for a medication that has step-therapy rules, there is a process you will have to go through depending on the kind of drug you were prescribed (generic, preferred generic, brand name, etc.). There can be several drugs that are therapeutically equivalent, which means they essentially do the same thing but may have slightly different ingredients. Think of buying a generic brand of ibuprofen vs. buying Motrin ibuprofen over the counter at a drug store. There are the same variations for prescription drugs as well.  Step Therapy is a process that requires members to start with the most cost-effective drug (the first step) and only move on to other, more expensive, or risky medications (additional steps) if necessary. The exact number of steps and requirements can vary depending on the drug. Reach out to Alandra Mothorpe at Bridlewood Insurance for all your Medicare needs.

𝗦𝘁𝘂𝗱𝘆 𝗼𝗻 𝘁𝗵𝗲 𝗳𝘂𝗻𝗰𝘁𝗶𝗼𝗻𝗶𝗻𝗴 𝗼𝗳 𝘁𝗵𝗲 𝗧𝗿𝗮𝗻𝘀𝗽𝗮𝗿𝗲𝗻𝗰𝘆 𝗗𝗶𝗿𝗲𝗰𝘁𝗶𝘃𝗲 (𝟴𝟵/𝟭𝟬𝟱/𝗘𝗘𝗖) 𝗿𝗲𝗹𝗲𝗮𝘀𝗲𝗱 𝗯𝘆 𝗘𝘂𝗿𝗼𝗽𝗲𝗮𝗻 𝗖𝗼𝗺𝗺𝗶𝘀𝘀𝗶𝗼𝗻 As was announced in October 2023 in the European Commission Communication addressing medicine shortages in the EU, the Commission commissioned a study to gain insight into the functioning of Directive 89/105/EEC. This Directive relates to the transparency of measures adopted by the Member States regulating the prices of medicinal products for human use and their inclusion in the scope of national health insurance systems. The long-awaited report has now been released: https://lnkd.in/eG96aPAm The study i.a. discusses the benefits and challenges experienced by Member States, pharmaceutical companies and other stakeholders, and sets out some potential actions which could support the functioning of the Directive in its current form. According to the report, key challenges or limitations stakeholders encountered in relation to Directive 89/105/EEC mostly relate to the adherence to timelines by Member States, transparency of pricing and reimbursement decisions and criteria, transparency of prices, alignment with changes in the field of medicinal products and the introduction of new concepts in pricing and reimbursement negotiations (e.g., managed entry agreements), and alignment with the new HTA Regulation (2021/2282). Further, recent developments, such as the growing use of generic medicines, development of orphan medicinal products and advanced therapy medicinal products (ATMPs), as well as confidential pricing mechanisms, are perceived to reduce the impact of the Directive. Stakeholders also emphasise the need for technical guidance and tools to enhance its effectiveness and to help in interpreting the obligations of the Directive in a more uniform way. The Member State perspective highlights the practical challenges faced by Member States in implementing the Directive. Ways of accessing information on pricing and reimbursement procedures varies; this information is mostly found on official websites of national authorities. Complex HTAs, inflexible timelines, and reimbursement challenges are among the key concerns highlighted by Member States. Some Member State respondents also point to delays caused by pharmaceutical companies’ providing information very late. Furthermore, Member States indicate that the Directive needs to be interpreted in the context of a more complex pharmaceutical landscape, and in particular the new HTA Regulation. 

What does “step therapy” mean in Medicare drug coverage? Each Medicare Part D plan has a list of covered drugs that are called a formulary.  Within every formulary, there are a set of rules applied to the prescription drugs covered by the plan. One of those rules is called step-therapy.  If you get a prescription for a medication that has step-therapy rules, there is a process you will have to go through depending on the kind of drug you were prescribed (generic, preferred generic, brand name, etc.). There can be several drugs that are therapeutically equivalent, which means they essentially do the same thing but may have slightly different ingredients. Think of buying a generic brand of ibuprofen vs. buying Motrin ibuprofen over the counter at a drug store. There are the same variations for prescription drugs as well.  Step Therapy is a process that requires members to start with the most cost-effective drug (the first step) and only move on to other, more expensive, or risky medications (additional steps) if necessary. The exact number of steps and requirements can vary depending on the drug. Contact Amerigroup Financial, LLC / Bridlewood Insurance in Sioux Falls for all your Medicare needs.