WINTER 2003
IN THIS ISSUE
    KICKING IT UP A NOTCH
    UP CLOSE
    PHARMACY TREND SURVEY
    MANAGED PHARMACY PROGRAMS
    NEWS YOU CAN USE
 
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Ken Dowell


Ken Dowell is a Stanton Group partner specializing in pharmacy consulting and auditing.

Pharmacy Benefit Management companies (PBMs) now control more than 70 percent of all consumer prescription drug purchases. Since these PBMs manage $100 billion worth of prescription drugs, it is essential that health plans and employers gain a clear understanding of their role in the health care benefits marketplace. A thorough understanding of the multifaceted PBM business and how the money flows in and out of the PBM is critically important when making pharmacy benefit decisions.

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KICKING IT UP A NOTCH by Charles Crispin, President & CEO, Evergreen RE

Keeping a close watch over medical expenses is not as simple as it sounds. Really understanding your costs, what is driving trend and how to make sure you are getting the most bang for your dollar is complicated at best. As our colleague Ken Dowell of the Stanton Group discusses in his article, understanding how pharmacy benefit management companies work and staying on top of PBMs - internal or external - could mean millions of dollars to an organization.

The same can be said about keeping your eye on medical trends that could potentially have significant impact on your bottom line if your reinsurance program has not taken those trends into account. It sounds like a simple process, but not so. (See Capitation Rates & Data article on medical expense trends). Services once traditionally excluded from reinsurance programs may be considered catastrophic claims today, which in turn can create havoc on surplus.

Read More

 
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KICKING IT UP A NOTCH by Charles Crispin, President & CEO, Evergreen RE

Keeping a close watch over medical expenses is not as simple as it sounds. Really understanding your costs, what is driving trend and how to make sure you are getting the most bang for your dollar is complicated at best. As our colleague Ken Dowell of the Stanton Group discusses in his article, understanding how pharmacy benefit management companies work and staying on top of PBMs - internal or external - could mean millions of dollars to an organization.

The same can be said about keeping your eye on medical trends that could potentially have significant impact on your bottom line if your reinsurance program has not taken those trends into account. It sounds like a simple process, but not so. (See Capitation Rates & Data article on medical expense trends). Services once traditionally excluded from reinsurance programs may be considered catastrophic claims today, which in turn can create havoc on surplus.

Read More