Bad Insurer Practices

Boston Globe: Drug Plan Middle Men Under Scrutiny

They are the secret middlemen in the chain of rising prescription drug costs. Now there’s a substantial body of evidence that pharmacy benefit managers are costing public and private health insurance policies — and consumers…

Columbus Dispatch: Questions raised on how pharmacy benefit managers profit from specialty drugs

By Darrel Rowland
The Columbus Dispatch

Posted Apr 24, 2019 at 7:27

Pharmacy benefit managers are using the fastest-growing, most-expensive segment of prescription drugs to enrich themselves in Ohio, a new report indicates.

These middlemen in the drug supply chain are increasingly turning to specialty drugs — used to treat such…

Berkshire Eagle: Todd Brown: Dangers of Pharmacy Benefit Managers

By Todd Brown

BOSTON — Pharmacy Benefit Managers (PBMs) — hidden middlemen who work for insurers — are coming under increased scrutiny at both the federal and state levels for the role they play in healthcare costs. This is good and it is necessary because there are several…

Morning Consult: Ending Rebates Is the Right Thing to Do for American Patients

BY M. SCOTT NEWMAN April 12, 2019

This week, the Senate Finance Committee questioned executives from the top pharmacy benefit managers (to understand why drug prices have risen so drastically over the last several years. Coincidentally, the day before, on…

Worcester Telegram and Gazette: Step therapy not putting patients first

March 23rd, 2018

Continued access to a stable treatment can make all the difference for patients with chronic illnesses like arthritis, cancer, diabetes, hepatitis C, HIV/AIDs and more. Interruptions in treatment can lead to disease progression and unnecessary medical…

Commonwealth Magazine: Insurers ‘fail-first’ drug approach increases pain

WHEN YOU LIVE with debilitating pain it becomes a matter of degrees: How bad is it today? Can I get up and walk? Can I get through a day of work? Some days are better than others. Some days it’s simply just hard to get dressed.

I’ve been living with pain…

Lowell Sun: Physicians—not insurers—know what’s best for patients

Most people thankfully don’t have to think twice about getting up, maybe going to the gym, and going to work. But for someone like me, who suffers from a rare disease, life’s a little harder. I was diagnosed with rheumatoid arthritis when I was 39 years old. I’m not…

FOX 25: Prescription pricing strategy—where it the money going?

Boston 25 News is digging deeper into a prescription drug pricing strategy that some say is costing taxpayers millions of dollars.

Reporter Jim Morelli has been looking into this issue for months and found it has to do with the way many Medicaid prescriptions are handled in Massachusetts.

Morelli spoke with…

The Secret Drug Pricing System Middlemen Use to Rake in Millions

By Robert Langreth

Bloomberg: Not everybody reads the legal notices inside the Ottumwa Courier. But in January, Iowa pharmacist Mark Frahm noticed something unusual in the paper.

For years, Frahm’s South Side Drug bought pills from distributors, and dispensed prescriptions to the Wapello County jail. In turn, the pharmacy got…

Feeling the pain of rising drug prices? Blame the middle man

Wink News: While Washington wrangles with a replacement for Obamacare, patients across the country continue to battle one of the biggest everyday obstacles to good health care: Rising drug prices.

Prescription drugs account for 10 percent of the $3.2 trillion in overall health care spending, outpacing all other health…

Why a patient paid a $285 copay for a $40 drug

By Megan Thompson

PBS: Two years ago Gretchen Liu, 78, had a transient ischemic attack — which experts sometimes call a “mini stroke” — while on a trip to China. After she recovered and returned home to San Francisco, her doctor prescribed a generic medication called telmisartan to help…

Do prescription drug middlemen help keep prices high?

By Megan Thompson & Mori Rothman

PBS: Americans pay more for prescription drugs than any country in the world, and the pharmaceutical industry earns billions in profits each year. Critics blame pharmacy benefit managers, or PBMs, for a portion of those high costs through their role as middlemen between…

Critics say time to regulate powerful pharmacy benefit management industry

By Jim Morelli

Fox25 Boston: They may be the biggest part of the health care puzzle consumers have never heard of: Pharmacy Benefit Managers — a handful of large companies that, together, touch nearly every prescription medication dispensed in the United States.

“Together they process nearly 75 to 80 percent of…

Insurers’ ‘fail-first’ drug approach increases pain

By Chantelle Marcial

Common Wealth Magazine: When you live with debilitating pain it becomes a matter of degrees: How bad is it today? Can I get up and walk? Can I get through a day of work? Some days are better than others. Some days it’s simply just hard…

WATCH: Patients who rely on expensive medication worry about changes

Fox25 Boston reports that patients with expensive medications are concerned about changes to discount programs. The changes include forbidding drug-maker discounts from going towards deductibles and instead applying them towards costs paid by insurance companies. This will cost patients thousands. Watch here

Patients, Not Profit Margins, Need to be Insurers’ Priority

By Patricia Goldsmith

Morning Consult: It seems like an easy question: Do you want your doctor to provide the best medical care for you? It should be that easy, but apparently, it’s not.

As a longtime advocate for cancer patients, I have often helped…

Paying Cash For Prescriptions Could Save You Money 23% Of Time, Analysis Shows

By Sydney Lupkin, Kaiser Health News

Washington Post: As a health economist, Karen Van Nuys had heard that it’s sometimes cheaper to pay cash at the pharmacy counter than to put down your insurance card and pay a copay.

So…

Hank Investigates: Prescription Copays

By Hank Phillippi Ryan

WHDH: You might be paying more than you have to for your prescription drugs and have no idea. Hank Phillippi Ryan reveals how asking one simple question could save you money at the pharmacy. 7 Investigates.

When you pick up your prescription at the drug store you…

Many cancer patients skip drugs because of high cost, study suggests

By Marie McCullough

The Morning Call: Many cancer patients are not taking prescribed oral treatments because of high costs, a study led by University of Pennsylvania researchers suggests.

Using a national database of Medicare and private health insurance claims in 2014-15, the researchers looked at whether patients’ unreimbursed expenses were a deterrent to…

Customers sue UnitedHealth over prescription drug co-pay costs

By Brendan Pierson

Rueters

UnitedHealth Group Inc (UNH.N) has been sued by three customers who accused the largest U.S. health insurer of charging co-payments for prescription drugs that were higher than their actual cost and pocketing the difference.

The lawsuit, filed Tuesday in federal…

New National Poll: Patients Concerned About Uncertain Costs and Quality of Coverage

Business Wire

7 in 10 report that they or someone they know had trouble using their health insurance in the past year

Insurance premiums top list of family budget concerns

WASHINGTON–(BUSINESS WIRE)–The Partnership to Fight Chronic Disease (PFCD) today released…

Premiums soar 21 percent for popular health plan

By Felice J. Freyer

The Boston Globe

Thousands of people who buy subsidized health insurance will face substantial premium increases — an average of 21 percent — if they want to keep the only plan that gives them access to certain prestigious Boston hospitals.

That insurer, Neighborhood Health Plan, has raised…

Insurance Company Refuses To Pay For Hepatitis Drug That Could Save Woman’s Life

A drug that could cure her Hepatitis C is available, but for 25-year-old Nichole it isn’t an option.

Her insurance company, Tufts Health Plan has denied the claim four times.

Nichole was the victim of a crime and the perpetrator infected her with Hepatitis C. Since then, she has been living…

Cancer Meds Often Bring Big Out-Of-Pocket Costs For Patients, Report Finds

By Julie Appleby November 19, 2015

Cancer patients shopping on federal and state insurance marketplaces often find it difficult to determine whether their drugs are covered and how much they will pay for them, the advocacy arm of the American Cancer Society…

High Out-Of-Pocket Costs Prevent Access To Medication

Higson: Help with high drug costs

Living with a chronic disease is not easy. It’s a challenge that both my husband and I deal with every day. For many of us living with long-term diseases, the hope that the Affordable Care Act would eliminate worries about the high cost of healthcare hasn’t rung true.

Doctors visits, repeated tests, finding…

HIGH-COST HEALING

Expensive new specialty drugs offer hope to patients with rare and chronic illnesses but also leave many worrying about paying for them

BY FELI CE J. FR EYER I GLOBE STAFF

Every year, Cora Higson fills out a sheaf of forms and waits several long, anxious days to…

COSTLY CO-PAYS

Anchor: Those suffering from chronic pain are looking for relief, and they’re actually turning to Beacon Hill for help. A new bill will help make drugs for chronic and rare diseases more affordable, drugs many fear they’ll have to go without, simply because they can’t afford them. …

PRESCRIPTION CAP: Bill would help curb prescription costs

Monahan: The Affordable Care Act was designed to make health insurance less expensive, but for some patients with chronic conditions, the cost of prescription medications has grown increasingly unaffordable. A proposed bill in the Massachusetts legislature would cap those costs, keeping patients from financial hardship.

Cora Higson…