Kevin Knauss: Health, History, Travel, Insurance
Posts related to pharmacy benefits, coverage for prescription drug medication, networks, with health insurance plans.
Blue Shield of California, as well as other health plans, would like to break away from the large Pharmacy Benefit Managers and some of their distorted incentive and pricing structures. Unfortunately, the Pharmacy Benefit Managers perform many tasks involving price negation, handling the payments process from pharmacy to health plan, and managing the pharmacy network.
Kaiser is unique in that because they manage their own pharmacies, we can get a look at the ordering habits of opioids, and by extension, the prescribing of those opioids by Kaiser doctors. With a pharmacy like Costco, that has a higher ordering rate for higher strength doses of hydrocodone, it is hard to pinpoint which doctors or medical groups are prescribing the stronger drugs. It may not even be a doctor in Sacramento County.
By the time I had all the fun in the urologist’s office, the prostate pain had virtually disappeared. My PCP and I had theorized before the PSA test that the new mountain bike I bought, with the knife-like seat, may have traumatized the pudendal nerve, a common problem among cyclists. I had stopped riding my new bike and the pain gradually subsided. The next PSA test result was a 4, confirming that I needed to buy a new bike seat.
I have no problem with these pharmacies running online porn shops. But if they can give the retail price for dildos, vibrators, and prostate massagers, you would think they could advertise their retail price for Abilify, Advair Diskus, Enbrel, Humira, Lantus Solostar, Remicade, or Sovaldi. These are some of the top selling brand name drugs people rely on every day to maintain their health.
Individual and family plans offered through Covered California in 2016 will include new pharmacy prescription drug benefits. The benefit, also mirrored in many off-exchange health plans, caps the amount a consumer must pay every month for a particular prescription. While that sounds straight forward, the rules surrounding any pharmacy deductible and tiered drug formulary can be complicated and confusing.
When Covered California decided to force health insurance companies to cancel their policies on December 31, 2013, they set in motion a cascading effect that have left many new plan members without access to prescription drug coverage. At least two pharmacies have recognized the problem and are offering help to cover vital prescription medications to new Affordable Care Act health plan members that have yet to received neither member ID numbers nor an invoice.
Even though health insurance plans have been greatly simplified with the introduction of the metal tiers of Bronze, Silver, Gold and Platinum under the ACA, careful consideration should still be given when comparing the coverage and benefits. In particular, for many people that have recurring brand name prescriptions medications, selecting the least expensive Bronze plan […]
