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DRUGS: Use and Abuse Epidemiology Information

Posted on February 24, 2023 by Dr. Marcinko

By Staff Reporters

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“The staggering increase in methamphetamine-related deaths in the United States is largely now driven by the co-involvement of street opioids.”—Rachel Hoopsick, an assistant professor of epidemiology at the University of Illinois at Urbana-Champaign and lead researcher on a 20-year study (US News and World Report)

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How 3 companies came to dominate the PBM market

MORE: https://medicalexecutivepost.com/2022/09/21/podcast-pbm-money-flow-explained/

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More docs than ever use health IT for opioid prescribing

LINK: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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Drug Econometrics

LINK: https://medicalexecutivepost.com/2016/11/06/are-soaring-health-care-costs-hurting-the-u-s-economy/

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CITE: https://www.r2library.com/Resource/Title/082610254

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Filed under: Breaking News, Career Development, Drugs and Pharma, Experts Invited, Information Technology, Research & Development, Risk Management | Tagged: Drugs, OPIOID CRISIS?, opioids, PBM, pharma, Rachel Hoopsick | Leave a comment »

ELIXIR: Rite Aid’s New PBM [mail order pharmacy]

Posted on December 14, 2022 by Dr. Marcinko

By Staff Reporters

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When Rite Aid dropped roughly $2 billion in 2015 to buy its pharmacy benefit management (PBM) subsidiary now known as Elixir, the company had framed the investment as a strategic move to compete in the healthcare marketplace among rivals like CVS and Walgreens.

The deal quickly helped make Rite Aid $4.1 billion in its newly formed pharmacy services segment—including Elixir and other pharmacy services, according to the company—bolstering its financial standing the next fiscal year. Maybe it would no longer be the ugly duckling next to the cooler, sleeker swans.

It seemed to be working—for a while at least. But by 2018, analysts were recommending Rite Aid sell off Elixir to reduce the parent company’s debt. Still, Rite Aid stuck with Elixir in hopes of boosting its competitiveness in the retail pharmacy scene.

CITE: https://www.r2library.com/Resource/Title/082610254

This year, Rite Aid President and CEO Heyward Donigan was still painting a rosy picture of Elixir, saying in earnings calls that the PBM was gaining more members and Elixir’s operating margins were improving.

But a month after its latest earnings call in September, Rite Aid was hit with a class-action lawsuit accusing the company of making “false and/or misleading statements” to investors about Elixir’s status between April and September of this year.

READ: https://www.healthcare-brew.com/stories/2022/12/09/rite-aid-faces-a-class-action-lawsuit-over-its-pharmacy-benefits-subsidiary

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ORDER: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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Filed under: "Ask-an-Advisor", "Doctors Only", Drugs and Pharma, Health Insurance, Health Law & Policy, Healthcare Finance | Tagged: Elixir, mail order pharmacy, order, PBM, pharmacy, Pharmacy Benefits Managers, Rite Aid, Rite Aid's PBM | Leave a comment »

What is the “Good-Rx” Business Model?

Posted on November 14, 2022 by Dr. Marcinko

By Anonymous

GoodRx Holdings, Inc. is an American healthcare company that operates a telemedicine platform and a free-to-use website and mobile app that track prescription drug prices in the United States and provide free drug coupons for discounts on medications. GoodRx checks more than 75,000 pharmacies in the United States

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Good Rx makes money by perpetuating the, artificially set, high sticker prices of medications and receiving a portion of Pharmacy Benefits Manager [PBM] fees.

How it Works

GoodRx taps into PBM network for their “discounts” off of sticker price (e.g. Express Scripts, Optum Rx, Navitus … etc)

Consumer pays the newly “discounted” drug price.

Pharmacy pays PBM fee.

PBM pays GoodRx portion of the fee.

Good Rx adjusted EBITDA in 2019: $160 Million

Good Rx 2020 revenue is up 48% first half of 2020 – $257M

IPO: https://mobile-reuters-com.cdn.ampproject.org/c/s/mobile.reuters.com/article/amp/idUSKBN24Y0N6

Opinion:

This is not market value.

This is another hand in the cookie jar keeping healthcare prices artificially high.

The consumer is the one ultimately harmed.

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Filed under: Drugs and Pharma, Health Economics | Tagged: Good Rx, PBM, Pharmacy Benefits Managers | 3 Comments »

PHARMA: Will Americans Finally See Drug Prices Decrease?

Posted on November 4, 2022 by Dr. Marcinko

By Health Capital Consultants, LLC

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According to the White House, “Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications. Nearly 3 in 10 American adults who take prescription drugs say that they have skipped doses, cut pills in half, or not filled prescriptions due to cost.” In an effort to combat this growing crisis, both the federal government and private companies have taken a number of steps over the past year aiming to lower drug prices. This Health Capital Topics article will review those actions and the potential unintended consequences of these actions.

(Read more…)

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CITE: https://www.r2library.com/Resource/Title/082610254

ORDER: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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Filed under: "Doctors Only", Drugs and Pharma, Experts Invited, Glossary Terms, Health Economics, Health Insurance | Tagged: drug prices, Drugs, Health Capital Consultants LLC, PBM, pharma, pharmacy, Pharmacy Benefits Managers, Will Americans Finally See Drug Prices Decrease? | Leave a comment »

PODCAST: PBM Money Flow Explained

Posted on September 21, 2022 by Dr. Marcinko

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PHARMACY BENEFITS MANAGER

By Eric Bricker MD

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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Filed under: "Doctors Only", Accounting, Career Development, Drugs and Pharma, Ethics, Events-Planner, Funding Basics, Health Economics, Videos | Tagged: Eric Bricker MD, PBM, PBMs, Pharmacy Benefit Mangers, Pharmacy Benefits Managers | Leave a comment »

PODCAST: Surescripts [Gatekeeper for Electronic Prescribing Explained]

Posted on August 4, 2022 by Dr. Marcinko

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

DHIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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Filed under: "Doctors Only", Career Development, Drugs and Pharma, Ethics, Experts Invited, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Videos | Tagged: EHRs, electonic prescribing, EMRs, Eric Bricker MD, PBM, PBMs, Surescripts, Surescripts [Gatekeeper for Electronic Prescribing Explained] | Leave a comment »

Drugs, Money and the Middleman

Posted on March 14, 2022 by Dr. Marcinko

PIPELINE TO PROFITS

**A little more about that … Kaiser Health News infographic!**

By Dr. David E. Marcinko MBA via Georgia Pharmacy Association

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Recently, KHN ran an infographic from Kaiser Health News that gave a rough explanation of how the money flows in the sale of a brand-name drug.

After thinking about it a bit, Greg Reybold, Vice President of Public Policy & Association Counsel for the Georgia Pharmacy Association, noticed some fundamental flaws.

“The infographic helps shed light on a process that lacks fundamental transparency,” he said, “but it doesn’t reflect all of the practices engaged in by some PBMs.”

Furthermore, he added,

“There are times, unbeknownst to patients, when some PBMs charge patients copays that are significantly higher than the cost of the drugs themselves, or they steer patients to brand name drugs for which the PBM receives a rebate when there is a less costly generic available.”

He also noted the infographic:

“reflects that the pharmacy make a profit — when in fact there are many times pharmacies lose money on prescriptions they fill through low reimbursements, the imposition of different types of fees, and aggressive audits.”

http://www.gpha.org/

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

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Filed under: Drugs and Pharma | Tagged: cost of Rx drugs, Greg Reybold, KAISER HEALTH NEWS., PBM, Pharmacy Benefit Mangers | 3 Comments »

UPDATE: The Markets and is Billionaire Mark Cuban on [Rx] Drugs?

Posted on January 25, 2022 by Dr. Marcinko

By Staff Reporters

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Stock Markets: The major equity indexes staged a thrilling comeback to close solidly in positive territory. At one point, the NASDAQ was down nearly 5% and the S&P entered correction territory.

CITE: https://www.r2library.com/Resource/Title/082610254

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Mark Cuban: The billionaire owner of the Dallas Mavericks just launched an online pharmacy for generic drugs that looks to cut out middlemen and combat pharmaceutical industry price gouging by offering steep discounts. Set up as CostPlusDrugs.com with 100 generic drugs to treat conditions like diabetes and asthma. Cost Plus will not accept health insurance but claims its prices will still be lower than what people would typically pay at a pharmacy. “All drugs are priced at cost plus 15%!” Cuban tweeted.

READ: https://medicalexecutivepost.com/2022/01/23/podcast-the-mark-cuban-cost-plus-drug-co-mccpdc/

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Filed under: Alerts Sign-Up, Glossary Terms, Health Insurance, Investing | Tagged: CostPlusDrugs.com, Drugs, Mark Cuban, NASDAQ, PBM, prescription drugs, stock markets | 1 Comment »

PODCAST: The Mark Cuban Cost Plus Drug Co (MCCPDC)

Posted on January 23, 2022 by Dr. Marcinko

By Staff Reporters

Mark Cuban, not Congress, will give Americans cheaper prescription drugs

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When universal health care fails to pass in Congress, there’s always Mark Cuban to fall back on. The billionaire and Dallas Mavericks owner launched an online pharmacy this week in order to combat the price gouging of prescription drugs by large pharmaceutical companies.

Citation: https://www.r2library.com/Resource/Title/0826102549

The Mark Cuban Cost Plus Drug Co. (MCCPDC) will offer more than 100 generic drugs that will be purchased directly from the manufacturers and sold online with a 15 percent markup across the board and a small pharmacist fee. For context, pharmaceutical companies generally mark prices up at least 100 percent and up to 1000 percent in some cases.

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PBM Forum Wrap Up: Greater Transparency, Further Congressional Review Needed to Lower Drug Prices - United States House Committee on Oversight and Government Reform

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READ: https://www.msn.com/en-us/money/other/its-quite-a-country-when-mark-cuban-not-congress-will-give-americans-cheaper-prescription-drugs/ar-AAT2KJ3?li=BBnb7Kz

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PODCAST: Pharma Rebates to PBMs

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Filed under: Breaking News, Drugs and Pharma, Experts Invited, Health Economics, Health Insurance, Healthcare Finance, Videos | Tagged: Drugs, drugs costs, Eric Bricker MD, generic drugs, Mark Cuban, Mark Cuban Cost Plus Drug Co., PBM, Pharmacy Benefits Managers | Leave a comment »

PODCAST: What is a Medication Formulary?

Posted on January 13, 2022 by Dr. Marcinko

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By Eric Bricker MD

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Why Are Certain Medications Non-Formulary?

What Are Formulary Tiers and Its Rules?

Formularies Have Many Rules Associated With Them:

1) Prior Authorization – Approval Must Be Given by the Health Insurance Company/PBM Before They Agree to Pay for a Medication.

2) Step Therapy – Certain Less Expensive Generic Medications Have to Be ‘Tried’ First and Fail Before a Doctor Can Prescribe a More Expensive Brand-Name Medication.

3) Mandatory Generics – If a Brand Name Medication Has A Direct Generic Equivalent, Then the Insurance May Only Agree to Pay for the Generic and Not the Brand.

4) Mandatory Mail Order – Certain Chronic Medications That Are Filled for 90 Day Supplies Must Be Filled via Mail Order and Not at the Retail Pharmacy.

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PODCAST: https://www.youtube.com/watch?v=kEjDBp9HdBk

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HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

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Filed under: "Advisors Only", Drugs and Pharma, Experts Invited, Videos | Tagged: brand name drugs, drug formularies, Drugs, Eric Bricker MD, Formulary, generic drugs, medications, PBM, Prior Authorization, Rx, step therapy | Leave a comment »

PODCASTS: How Prescription [Rx] Coverage Works

Posted on December 19, 2021 by Dr. Marcinko

Formulary Tiers, PBM, Rebates, Spread-Pricing Explained

By Dr. Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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YOUR COMMENTS ARE APPRECIATED.

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Filed under: Drugs and Pharma, Experts Invited, Funding Basics, Glossary Terms, Health Insurance, Healthcare Finance, Practice Management, Videos | Tagged: Anthem, Caremark, Cigna, CVs, DEA, drug rebates, drug tiers, Drugs, Eric Bricker MD, Express Scripts, Formulary, Health Insurance, medications, Optum, PBM, PBMs, pharmacy, prescription coverage, Rx, spread drug pricing, UHC, United Health Care | Leave a comment »

PODCAST: Using “GoodRx” to Check Prescription Prices

Posted on August 18, 2021 by Dr. Marcinko

BY ERIC BRICKER MD

YOUR THOUGHTS AND COMMENTS ARE APPRECIATED.

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CITE: https://www.r2library.com/Resource/Title/0826102549

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Filed under: Drugs and Pharma, Experts Invited, Videos | Tagged: Drugs, Eric Bricker MD, GoodRx, PBM, prescriptions, Rx | Leave a comment »

The PBMI Innovation Challenge

Posted on August 6, 2021 by Dr. Marcinko

There’s still time!

Submit your innovative solution in patient health management to the Pharmacy Benefit Management Institute (PBMI) Innovation Challenge by August 6, 2021 for the chance to be among one of the 5 finalists selected to pitch their ideas before a panel of judges at the PBMI 2021 Annual Meeting!

Be sure to submit your idea by August 6, 2021 for the chance to be featured in an upcoming issue of Managed Healthcare Executive with a full-year integrated marketing program valued at over $100K, in addition to formal acknowledgment at this year’s PBMI Conference.

REGISTER: https://events.pbmi.com/event/31593a7e-d661-4ea5-abf2-5aa6473e1a14/summary

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Filed under: Drugs and Pharma | Tagged: Drugs, PBM, pharma, Pharmacy Benefit Mangers | 1 Comment »

PODCAST: PBM Formulary Waste Exposed in Commonwealth Fund Study

Posted on July 30, 2021 by Dr. Marcinko

15 Self-Funded Employers Analyzed Their Pharmacy Claims Data in Conjunction with the Commonwealth Fund and Discovered the Following Regarding their PBM FormularIES

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Click to access mike-stahl-phd-mba.pdf

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Filed under: "Doctors Only", Drugs and Pharma, Experts Invited, Glossary Terms, Health Economics, Health Insurance, Healthcare Finance | Tagged: Eric Bricker MD, PBM, PBMs, Pharmacy Benefit Mangers | Leave a comment »

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**A little more about that … Kaiser Health News infographic!**