Archive: Pharmacy Benefits

  • March 31, 2021

    Wee Dose of Radical Transparency | EP 11

    Chances are if you manage a self-funded health plan, you know how important specialty meds are to your overall costs. The complex administration of these high-costs drugs can be intimidating. But as an HR administrator, you shouldn’t be as there’s …

  • March 14, 2021

    Wee Dose of Radical Transparency | EP 10

    Less is more, right? When it comes to pharmacy benefits, this is absolutely applicable. It’s called Lesser of Language, or language in your PBM contract that instructs PBMs must use the lowest price of a drug on the market when …

  • February 19, 2021

    Wee Dose of Radical Transparency | EP 9

    Have you ever caught yourself forgetting what a certain acronym stands for? There’s so many in the world that we’re bound to forget one on occasion. It’s the same with the acronyms in pharmacy benefits.

  • February 4, 2021

    Wee Dose of Radical Transparency | EP 8

    Does the number 835 mean anything to you? It should. You need to make sure there’s language in your audit rights with your PBM contract that allows access to the 835 file.

  • January 13, 2021

    Top 4 Major Trends in Pharmacy Benefits We Saw in 2020

    While 2020 was a year that most of us would like to forget, a lot of movement happened in the world of pharmacy and pharmacy benefits. We at Team Apex saw several themes in 2020 and summarize many of our …

  • December 17, 2020

    What Rutledge v. PCMA Could Mean for PBMs in Indiana

    The holidays came a little early for Arkansas pharmacists when the Supreme Court of the United States (SCOTUS) provided its 8-0 opinion on the Rutledge vs. PCMA case in the favor of the State of Arkansas. The recent decision was …

  • December 10, 2020

    The 3 Things Your Employees Should Know About Pharmacy Prescription Drug Exclusions

    More and more self-funded employer group health plans are making some tough choices for 2021 and beyond with their plan benefits.

  • November 30, 2020

    Unlocking the Universe of Specialty Drugs and Therapies

    Just like the universe itself, the universe of pharmaceuticals is expanding, and has become extremely complex. Beyond the traditional pharmaceutical compounds, typically called “small molecule” drugs of yore, specialty drugs have arrived on the scene and are increasing pharmacy benefit …

  • November 17, 2020

    Amazon Announces Pharmacy Services

    This is the next large step beyond the PillPack acquisition in 2018. Amazon says that Prime members can get discounts of up to 80 percent on generic drugs and 40 percent on brand-name medications when paying without insurance.

  • October 19, 2020

    Beware The Preferred Vendor

    While this in theory sounds like a good idea – streamlining of data, integration of medical and pharmacy deductibles and out of pocket fees, etc. – it’s important to understand preferred relationships of any kind. Who benefits from this streamlining …

  • October 5, 2020

    Certificate vs. Certification: What’s the Difference?

    There’s a difference between receiving a certificate and receiving a certification. But what’s the difference? Why does it matter? A key difference between the two is experience. While a certificate is usually for newcomers and experienced professionals, certifications typically requires …

  • September 28, 2020

    Bigger Isn’t Always Better: Pharmacy Benefit Management Solutions

    Many think that in the land of pharmacy benefits there are only three major players – CVS/Caremark/Aetna, Express Scripts/Cigna and OPTUMRx/United Healthcare. While it’s true, they do own a big share of the market. They control somewhere between 70-85 percent …