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

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

We Call Them ‘Zero Balance Claims’

by Ryan Jerico
Senior Consultant, TFG Partners

With my Prescription Benefit, I pay a $20 copay for all generic medications. So when I go to the doctor for my yearly sinus infection each spring, things are pretty routine. She writes me a prescription for Amoxicillin.  I walk across the street into a large chain grocery store who advertises $4 for a 30 day supply of 40 different generic drugs. more

Filling A Prescription? You Might Be Better Off Paying Cash

By Julie Appleby for Kaiser Health News  | 

Some consumers who use health insurance copays to buy prescription drugs are paying far more than they should be and would be better off paying with cash, especially for generics.

The added cost runs as high as $30 or more per prescription, say pharmacists, and the money is largely being pocketed by middlemen who collect the added profit from local pharmacies.

Cash prices started to dip below copays a decade ago when several big box stores started offering dozens of generics for as little as $4 per prescription. But as copays have risen and high-deductible insurance plans become more common, more consumers are now affected.

The phenomenon illustrates the complexity of how drugs are priced in the U.S. and has led to finger-pointing about who is benefiting or who’s to blame. more

Increasing Drug Costs – What Should We Believe?

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

According to a recent article in the New York Times by Katie Thomas on April 27, 2016, drug costs rose about 12% in 2016. However, according to research firm IMS Health, net prices — what insurers and employers actually paid — grew only about 2.8%, the lowest rate in years. The article points out that insurers and others say that lower figure obscures the larger price increases in specific areas like cancer treatment, medications-257333_640where less competition exists and it is more difficult to pit manufacturers against one another. Indeed, drug makers do profit from raising their list prices because rebates and discounts are often based on a percentage of those prices. The article then quotes Steve Miller, chief medical officer of Express Scripts “That’s where the real angst in the marketplace is.”

Chief financial officers, responsible for budgeting and paying for employee drug benefits, and human resource managers, responsible for designing the benefits, will ask: “How this difference between 12% and 2.8% is possible? How are these price increases measured?” When looking at total drug benefit costs companies are paying for employees, the 2015 increase is certainly greater than 2014’s 10% even when factoring in rebates. more