Medication Prices Often Lower Without Insurance

The cost of prescription drugs — in particular, generics — is increasingly lower when patients purchase the medications directly from online suppliers and leave their insurance cards out of the equation, according to a collaborative effort by the New York Times and ProPublica. The story, linked below, takes a closer look at the whys and implications.


Response: Call them what you want, but it is all just brand or generics.

by Dr. Franco Mueller
Partner/Medical Director, TFG Partners

We remain a bit skeptical of the studies mentioned in our previous post from KHN. Please look at the study dates, the data is from  between 2007 and 2013. Many Pharma companies have boosted the price in the last two years and we are just seeing costs continue to skyrocket. There are more problems facing employers then just orphan drugs in the industry pipeline. The issues go much deeper into the pharmaceutical industry and orphan drugs are just one part of the horizon.  more

Study Says Concerns About Orphan Drug Spending Are Unjustified

 | September 7

Rising concerns about spending on prescription drugs that treat rare diseases are not justified, according to a new analysis in the journal Health Affairs.

“We wanted to focus on the true impact of orphan drugs,” said Victoria Divino, a senior consultant at IMS Health and an author of the study. Researchers at IMS Health and drug maker Celgene analyzed U.S. pharmaceutical spending from 2007 to 2013 on more than 300 drugs that had orphan approval under the 1983 Orphan Drug Act. more

Point/Counterpoint – The Firestorm Over Drug Prices

by Ryan Jerico
Senior Consultant, TFG Partners
We all need to sit down together and talk this one out.

When it comes to the current media storm surrounding the EpiPen and other drugs with rising prices, their are two points of view when it comes to laying blame. In the media, we see fault being assigned to either the drug companies or the insurers. Here are two articles illustrating the opposing viewpoints.   more

REPORT: It Now Costs Over $8,600/ Covered Employee

The Society for Human Resource Management has released their Health Care Benchmarking Report and there are some pretty compelling insights.

  • The average cost of employee healthcare makes up 7.6% of a company’s annual operating budget.
  • The average cost per covered employee has increased by nearly $500 in the span of one year
  • Employers spent an average of $8,669 per covered employee in 2015, compared to $8,171 per employee in the previous fiscal year.“
  • Almost all employers (98%) now offer healthcare coverage for full-time employees.
  • Fewer organizations offer spousal coverage and more organizations have a spousal surcharge than in previous years, to help curb costs. As such, 92% of employers offer coverage for the spouses of employees, down from 96% in 2011.


Conspiracy Theory: A Secret Group Controls What Drugs You Can Take

This no conspiracy, it is completely true. As this article in the St.Louis Post-Dispatch explains,  A secretive board controls access to prescription drugs for millions of Americans. As an employer, you contract with a PBM to make these difficult decisions in the interest of balancing necessity, efficacy, and savings. Unfortunately, you’re employees may not always see it that way. more

Smaller Companies Move to Self-Funding

Many expected that the federal health law would push these employers in this direction. An analysis by the Employee Benefit Research Institute finds evidence that these predictions are coming to fruition.

Instead of buying a health insurance policy to cover their workers, a growing number of small and mid-sized companies are opting to pay their employees’ medical claims directly, a potentially riskier practice financially called self-insuring, a recent study found. more

Large Employers Expecting Moderate Care Cost Increase

Two surveys suggest these companies continue to try new ways to control the expense of employees’ coverage.

Big employers expect health costs to continue rising by about 6 percent in 2017, a moderate increase compared with historical trends that nevertheless far outpaces growth in the economy, two new surveys show. Employers are changing tactics to address the trend, slowing the shift to worker cost sharing and instead offering video or telephone links to doctors, scrutinizing specialty-drug costs and steering patients to hospitals with records of lower costs and better results. more