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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. On top of it all, pharmaceuticals are getting more expensive.
Because of its increased percentage of total drug spending, specialty drug costs are proving a major headache for plan sponsors. They need to find ways to control spending on these treatments, lest the cost of the drug benefit become prohibitive. Here are three ways to manage the cost of pharmaceutical benefits.
Congress and other policymakers continue to seek opportunities to lower costs for patients and the federal government. Pharmacy benefit managers (PBMs) are a key stakeholder in the drug supply chain, functioning as intermediaries between insurance providers and pharmaceutical manufacturers. appeared first on EMPLOYEE BENEFITS BLOG.
The changes mean some or many of your employees will see significant reductions in their pharmaceutical outlays, particularly if they have high copays or deductibles. The moves come after the Inflation Reduction Act, signed into law in 2022, capped out-of-pocket insulin costs for seniors on Medicare at $35 per month.
Reducing out-of-pocketcost-sharing for insulin does mean payers and insurers may be covering a greater share of the costs. However, some of those costs may be offset by increased medication adherence and reduced hospitalization rates, which would end up saving payers money in the long run.
And while consumers seem to have a love/hate relationship with HDHPs, many of those who take the time to fully calculate the total out-of-pocketcost of medical coverage and care realize that HDHPs, even with higher deductibles, can often save them money. Pharmaceutical Company & State Drug Assistance Programs.
Employer Refuses Reimbursement Request When the claimant provided his law firm employer with the CBD oil prescription and receipts for its purchase, the law firm refused to reimburse the claimant’s out-of-pocket CBD oil expenses on the basis that CBD oil was not a pharmaceutical drug.
The high courts ruling settles a long-running dispute that began when the claimanta workers compensation attorney appearing pro sesought reimbursement for the out-of-pocketcost of CBD oil recommended by his treating physician as a substitute for higher doses of opioid medication. LEXIS 389 (Mar. 20, 2025)].
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