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Managed Care August 2004 Martin Sipkoff	Bad Tiered Formulary Designs Yield Poor Outcomes, High Cost Now that tiered formularies rule the land, what many suspected is being demonstrated: Compliance is suffering and so, too, are patients.
Managed Care August 2001 Steve Perlstein	Four-Tier Approach Injects Consumerism Into Drug Benefit In tying copayments closely to the actual cost of medications, Humana takes a step toward promoting awareness of resource use...
Managed Care December 2003 Tony Berberabe	Why Do FEHBP and Big Unions Excel at Managing Drug Costs? Pharmacy benefit managers can do only so much to keep drug price increases in the single digits. Initiatives instituted by health plans can help in this effort.
Managed Care March 2007 Louis W. Hutchison	Unable to Carry Cost Burden, Payers Seek Other Remedies The pharmacy benefit landscape of today is all but unrecognizable from its predecessor of just a decade ago. Blending an approach that uses education, reward, and penalty can rein in runaway health care costs
Managed Care September 2005 John Carroll	Plans Struggle for Control of Specialty Pharma Costs Biotech drugs are a quickly growing component of health plan budgets. Here are the latest management techniques.
Managed Care January 2007 Martin Sipkoff	Employers Want Plans & PBMs To Push Hard for Generics Health insurers' aggressive stand on members' use of generic drugs can attract new clients, but does it interfere with the physician-patient relationship?
Managed Care July 2002 Thomas Kaye	Managing the Drug Benefit: One Company's Experience The pharmacy director of Blue Cross of Oklahoma shares his company's success with using three tiers and coinsurance to promote member responsibility.
Pharmaceutical Executive November 1, 2012 Lauri Mitchell	Who Pays for Specialty Medicines? Providers and patients fish for that delicate balance between access and abandonment.
Pharmaceutical Executive February 1, 2014 Jill Wechsler	Drug Coverage, Costs Under Scrutiny Benefits offered by insurance plans on health exchanges and through Medicare are raising concerns about patient access to needed therapies
Managed Care May 2006 John Carroll	Effective Ways To Increase Usage of Generics Generics is one of the few areas where insurance plans can economize effectively. BlueCross & BlueShield of North Carolina is one of many insurers that are changing members' and prescribers' behavior.
Managed Care November 2005	Plans Change Tactics As Costs Keep Rising For Specialty Drugs With specialty drug costs continually increasing, CuraScript expects to see a significant shift in the percentage of plans exclusively classifying specialty drugs under the medical benefit.
Managed Care March 2000	Three-tier drug copayments in; closed formularies on way out?
Managed Care March 2006 David Adler	Tiers Reach New Heights Under Part D Can commercial health plans learn from Medicare Advantage Prescription Drug Plans that have four or more formulary levels?
The Motley Fool August 10, 2004 Brian Gorman	Biotech Cost Control Will the high cost of therapies slow sales in the sector? Investors can avoid problems by paying close attention to companies' pipelines and reimbursement trends.
Pharmaceutical Executive January 1, 2012 Mason Tenaglia	Letting the Facts Get in the Way An empirical defense of coupons and copay offset programs.
Managed Care May 2001	Old Ideas About Formulary Structure Gone as Humana Tests 4-Tier Model Humana is phasing in a four-tier formulary that categorizes prescription drugs by costs, rather than generic or brand status. The higher the drug's acquisition cost -- regardless of whether it's a branded or generic product -- the higher the tier it lands in...
Managed Care October 2004 Martin Sipkoff	Not So Much of a Reach: Let Sick Pay Less for Drugs The idea is radical and simple: Those who need medication the most should pay the least. There is evidence that this is cost-effective.
Pharmaceutical Executive November 1, 2014 Jill Wechsler	Outrage Grows Over Drug Pricing Insurers, physicians attack high-cost therapies in anticipation of specialty drug surge.
Managed Care March 2006	The Formulary Files Four or more tiers that are common among PDPs and MA-PD plans.
Managed Care July 2004 Maureen Glabman	Wish List: 10 Things You Want From Your PBM One auditor estimates that 3 percent to 10 percent of pharmacy benefit manager (PBM) claims are processed incorrectly -- always in favor of the PBM.
Pharmaceutical Executive May 1, 2014 Jill Wechsler	Reimbursement Limits Threaten Drug Access High cost-sharing, narrow formularies create problems for pharma companies and patients.
Managed Care September 2003 Thomas Morrow	Managed Care Strategy: Create Competition In Expanding Biotech Field The biotech field is booming, and insurers are scrambling to find ways to deal with the high costs of new "biologic" treatments. One strategy is to try to create more competition among the producers of biotech drugs.
Managed Care March 2001	Single-source drugs get formulary preference Managed care organizations often place costly new drugs on a formulary's priciest tier, but products for which substitutes do not exist often are made available at lower copayment levels...
Managed Care January 2008	Copayment Rates Outpace Inflation Workers are definitely paying more for health benefits today than they were in 2000, especially for prescription drug copayments.
Managed Care September 2003 Tony Berberabe	Pharmacy Benefit Starts To Reflect Push for Consumer-Directed Care Health insurance plans looking for a low-risk way to experiment with new benefit designs might start with the pharmacy benefit.
Managed Care February 2005	Biggest increases in specialty drug costs seen in rheumatologic, cancer, and hemophilia agents Medco reports that of the top seven contributors to specialty drug costs, agents for rheumatologic conditions (80.6 percent), cancer (33.2 percent), and hemophilia (28.4 percent) demonstrated the greatest percent change in cost from 2002 to 2003.
The Motley Fool March 22, 2010 Brian Orelli	Health-Care Reform Passes! Here's Where to Invest Now Some healthy suggestions for your portfolio.
Managed Care August 2007	Managed Care Outlook Specialty drugs increasingly used to treat chronic conditions.
Managed Care August 2004 Alan Lotvin	Specialty Pharmacy Presents Unique Set of Challenges Only a small percent of a typical health plan's population takes medicine for conditions outside the generalist's scope. But it's a big portion of the drug bill.
The Motley Fool June 12, 2006 Brian Gorman	Biogeneric Payoff? A new report indicates that spending on specialty drugs increased 17.5% in 2005. This growth bodes well for makers of biotech drugs, which make up a large portion of the specialty drug category. Investors, take note.
Managed Care August 2004 MargaretAnn Cross	Employers Take the Lead In Drug Benefit Design Companies test new approaches to funding the pharmacy benefit with the goal of saving money overall.
Managed Care September 2006 Martin Sipkoff	Specialty Pharmacy Grows As Cost-Control Option As the population ages, specialty pharmacy is becoming a unique, profitable, and invaluable delivery system. Plans are increasingly turning to specialty pharmacies to provide the expertise they lack.
Managed Care May 2002 John Carroll	Hospital Copayments: At What Cost? High daily copayments for high-priced hospitals are coming into fashion. It's all about shifting costs, but what about quality of care?
Pharmaceutical Executive May 1, 2011 Mason Tenaglia	Out of Control The pharmaceutical industry needs to use new and better data to accurately measure how much it is willing to invest in avoiding plan control.
CFO February 22, 2005 Martha E. Mangelsdorf	I Want a New Drug Plan Companies hoping to curb prescription-drug charges are looking at a host of new cost-control measures.
Managed Care April 2002 Paula Sirois	HMOs Should Prepare Now To Get Handle on Injectables With more than 360 biotech products in the pipeline, high-cost injectable drugs are about to flood the market. How will we control the expenditure?
Managed Care April 2006 Martin Sipkoff	Blues Plan's Bold Move Brings Generics Savings Blue Cross & Blue Shield of North Carolina is waiving its copayments for generic drugs in a unique six-month pilot program.
Pharmaceutical Executive June 1, 2013 Jill Wechsler	Washington Report: Innovation, Coverage, and Costs The backlash against high prices for new medicines will impact research, patent exclusivity, and drug benefits.
Pharmaceutical Executive June 1, 2014 O'Connor et al.	Challenges to the Specialty Business Model New constraints require new solutions. Innovative, value-based pricing models will be critical to securing reimbursement and continued market access of high-price drugs.
Pharmaceutical Executive June 9, 2014 Kleinrock & Noor	Pharm Exec's Pharma 50 2014 For those companies in this year's Pharm Exec Top 50, meeting the accelerating market demand for specialty products has become an acute strategic imperative.
BusinessWeek January 21, 2010 John Carey	Making Personalized Medicine Pay Medco and other pharmacy benefit managers say future profits depend on matching drugs to patients based on their genes.
The Motley Fool April 19, 2011 Bryan White	Rising Star Buy: Medco Health Medco has a much brighter future than its current stock price implies.
Managed Care September 2002 John Carroll	When Success Sours: PBMs Under Scrutiny Pharmacy benefit managers are under fire from many corners. What will the push for transparency mean for the industry?
Managed Care March 2008	Specialty Drug Spending to Double by 2010 Additional indications for existing products, rather than new products, account for the bulk of increased specialty drug use.
Managed Care March 2008	Drug Caps Lower Spending, but .... These policies tend to make consumers shoulder some of the cost of prescriptions and the cost could be a barrier to medication adherence.
The Motley Fool October 5, 2010 Andrew Bond	Wal-Mart Enters the Health-Care Fray Wal-Mart and Humana's partnership will have competitors scrambling.
BusinessWeek May 10, 2004 John Carey	Drug Prices: A New Covenant? The states' growing negotiating clout with Big Pharma raises crucial questions
Managed Care April 2005 Thomas Morrow	Specialty Pharmacy Meets Niche Company Expertise As new specialty pharmacy care becomes more dominant, companies devoted to managing these products and their associated costs are finding a market.
Managed Care February 2007 Martin Sipkoff	As Drug Payment Model Changes, Confusion Grows Among Insurers Purchasers are hopeful that life after "average wholesale price" will be simpler, fairer, and, with luck, easier to grasp.
Managed Care July 2005	Cost being equal, consumers prefer older drugs Seven out of 10 consumers would prefer a drug that had been on the market for 10 years or more, compared to a newer drug, even if the copayments were equal. This could be a sign that consumers are more inclined to start using generic medications.