The Leapfrog Group, a national watchdog organization of employers and other purchasers focused on health care safety, this week released the spring 2022 Leapfrog Hospital Safety Grades for nearly 3,000 U.S. general hospitals. It is the only hospital ratings program based exclusively on hospital prevention of medical errors and harm to patients on over 30 measures of patient safety.
In Texas 230 hospitals were graded with 45 in the Houston metroplex. Fifteen hospitals earned As, 16 Bs, 10 Cs, and 4 Ds. Click here to see how hospitals in your network performed.
Employer Health Plan Fiduciary Concerns?
Should employers be concerned about fiduciary liability resulting from their health benefits plan and reporting requirements under the 2021 Consolidated Appropriations Act?
Similar to ERISA fiduciary litigation that resulted from improper management of 401(k) Plans, concern is now raised about improper oversight of health plans.
Join us on June 8as local and national experts present the Texas and Houston results of the RAND 4.0 Hospital Price Transparency Study, the NASHP Hospitals Cost Tool, and the Sage Transparency hospital value dashboard. The availability of this information coupled with noncompliance with the CAA is a topic of national concern among employers.
The Real Deal with PBM Contracts and Drug Rebates
A recent episode of the podcast Relentless Health Value featured Scott Haas, SVP with USI Consulting, who spoke about The Real Deal with PBM Contracts and Drug Rebates. This is an important 30-minute listen for all employers as they struggle to understand the pluses and minuses of rebates. Key points made include:
Process is most important
Eliminate variable contract terms for generics
Do not provide your claims database upfront when contracting with a PBM
Not all rebates are rebates
100% Pass Through PBMs may not always be a bargain
Insist on generic pricing for specialty "generics"
Never let a third party own the contract with the PBM
Ensure proven generics are not excluded from the formulary
Biosimilar Adoption Will Help Achieve a Bipartisan Goal
An opinion pieceby clinical pharmacist and health economist Robert Popovian presents an optimistic viewpoint on the future use of biosimilars. Biosimilars provide significant savings and encourages competition in the biopharmaceutical marketplace but the United States needs to do more to empower uptake and address adoption barriers.
Biosimilars singularly are responsible for saving millions of dollars for the true payers of the health care system – patients, employers, and the government. Such savings have been realized despite hurdles erected by PBMs and insurers as they strive to maximize their rebate contracts, thus blocking biosimilar access. Unfortunately, the potential success story has some potholes as the FDA has created unnecessary uncertainty in the competitive landscape.
It will be up to employers to better understand the conundrum and insist that their consultants and PBMs first and foremost act in best interest of clients.
Is My Drug Copay Coupon Charity - or a Bribe?
In a recent Kaiser Health News editorial pieceElizabeth Rosenthal, MD, editor-in-chief and former reporter for The New York Times, describes copay assistance as profitable charity.
Drug manufacturers, directly or through nonprofit foundations, disburse money to subsidize patient copays as a form of what they seek to characterize as charity. They often deduct from their income taxes the billions they pay out.
But the federal government sees it differently. It considers manufacturers' copay coupons and copay assistance programs to be illegal kickbacks, inducing patients to use and doctors to prescribe more expensive drugs when cheaper ones might suffice. As a result, it severely limits the use of such assistance to patients covered by government insurers, a particular financial hardship for patients on Medicare.
