One of the most complicated topics to cover in health care today is the role of pharmacy benefit managers (PBMs). Employers and health plans hire these middlemen to manage their prescription benefit programs for workers and health plan members.
Not only do PBMs contract with health plans, but some large health plans, notably UnitedHealthcare which owns Optum, have their own PBMs. Late last year, CVS Health, one of the nation’s largest retail pharmacy chains and owns Caremark, a PBM, said it would buy Aetna, one of the country’s largest health insurers. That deal is pending regulatory review, as Bruce Japsen reported for Forbes early this month. Continue reading
Consumers in states with high health care costs spend more than twice as much for certain services than consumers in other states, according to a new report from the Health Care Cost Institute.
Using health insurance claims, HCCI researchers also showed that among Americans enrolled in commercial health insurance plans, consumer prices for health care services vary by threefold within states. Continue reading
Health care costs lack transparency and are wildly variable, not just from region to region but sometimes from block to block within the same city.
It is a complex topic, with chargemaster prices, what insurers paid and what consumers pay (if anything). Then there are the administrative rules set by Medicare and Medicaid and the negotiated rates between insurers and providers.
It’s daunting, but Lisa Aliferis of KQED, Rebecca Plevin of SCPR and Jeanne Pinderof clearhealthcosts.com have teamed up to offer guidance for reporting on health care costs in this new AHCJ tip sheet.