Eliminating Prescription Overspend | Advocate for Independent Advisors, TPAs, MGUs & MEWAs | NEXTGEN A Team | YOUPowered Emerging Leader Finalist 2023 | Speaker
The recent J&J lawsuit, which charges a breach of “#fiduciary duties” is a landmark case that understandably has plan sponsors concerned (https://lnkd.in/eNPYAGhT) There is a simple way to “de-risk” with the tools the federal government afforded plan sponsors with passage of the Consolidated Appropriations Act #caa, specifically regarding the RXDC reporting requirement. After successfully filing these reports for CY 2020, 2021, and 2022 we observed many employers forgoing the opportunity to seize their data and understand the dollars flowing through their #prescription program. They instead allowed #pbms and TPA’s to submit on their behalf, in aggregate. Part of this was understandable due to confusion around the new law, and the ridiculous deadlines that were associated with complying. Now more than ever, plan sponsors should consider individual reporting and filing. Consider a plan member claiming that their employer is in “fiduciary breach” because they believe their drug costs are too high. The results provided back to the plan sponsor through the individual reporting process can help validate that the sponsor either: -Knows where all the dollars are going, including rebates, fees, spread pricing etc. and is confident they are not overpaying OR The report is eye opening in showing there is an egregious amount of overspend, and they are taking action to correct the problem(s) Both of these are substantially better than “we allowed our TPA and/or PBM to file on our behalf; we are compliant but don’t have access to the reported data.” We partnered with the best in the business to provide a cost-effective solution to this problem based on a number of requests from our #clients to help them navigate the new, cumbersome requirements. Now going into our fourth batch of reporting, we believe the CY 2023 reports will be the most efficient to date. Link in the comments for more information on how we can support you! Judi Martin, CSFS Shyla Hadley Granite Peak Analytics, LLC Lauren Wells Healthcare Reporting #pbm #cfo #ceo
GARY HATTENDORF
10mo
There is value for plan payers and sponsors to engage their members to participate in managing the cost of care. And this litigation is an outcome of that. Transparency, or lack thereof, can be blatant and hit you like a ton of bricks if you are not careful. Forcing change from the grassroot is more effective than policy changes and prudent regulation. However, coupled together properly, we just may continue to see progress in helping make medications more affordable and accessible.
Jeffrey Diekema
10mo
This just adds to the old addage from my earliest TPA days: Information is your friend--get as much of it as you can! The bevy of transparency rules and the CAA are making it possible--and required! Thanks for commenting!
Eliminating Prescription Overspend | Advocate for Independent Advisors, TPAs, MGUs & MEWAs | NEXTGEN A Team | YOUPowered Emerging Leader Finalist 2023 | Speaker
10mo