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Pharmacy Benefits Manager

Education, Healthcare, PBM, PBMs, Pharmacy Benefits Manager, Taxes

Salvage the Good from the Healthcare Debacle

August 1, 2009 Thomas Schatz

The healthcare reform juggernaut, arguably the most radical attempt to remake the economy and the nation’s healthcare infrastructure in history, was supposed to have flown through Congress before the August recess with nary a peep.  Instead, as Americans have gotten wind of its alarming provisions and exorbitant costs, the plan appears to be fizzling fast in the summer heat.

Healthcare, Housing, PBM, PBMs, Pharmacy Benefits Manager

A “Generic” Call for Change

June 1, 2009 Thomas Schatz

As Congress braces for the largest reform of healthcare in the nation’s history, lost in the debate has been an issue critical to federal and state healthcare budgets, as well as the ability of consumers to afford lifesaving drugs.  The issue is whether Congress should grant generic makers of the next generation of medications called “biologics” the same regulatory approval treatment it did for chemical drugs under the 1984 Hatch-Waxman Act.

Healthcare, PBM, PBMs, Pharmacy Benefits Manager, Taxes

Healthcare Reform: A Pricey Prescription

June 1, 2009 staff

President Obama promised this would be the year of health care reform, but many are bracing for what this “reform” could really mean.  After much anticipation, Democrats have started to unveil their healthcare reform plans, revealing new policy proposals that would, among other things, expand Medicaid, impose individual and employer mandates, enlarge the almost bankrupt Medicare program, create a new government-run healthcare plan, and cost at least $1 trillion over 10 years.  The overall result will inevitably be higher taxes, less patient choice, and ultimately, rationing of care.

Healthcare, PBM, PBMs, Pharmacy Benefits Manager

Medicare/Social Security Insolvency

May 1, 2009 Sean Kennedy

While the Obama Administration ratchets up support for government-run healthcare, which would be a new entitlement program, the government trustees who monitor the nation’s two largest entitlement programs, Medicare and Social Security, have reported that they are both less than a decade away from insolvency. 

Healthcare, PBM, PBMs, Pharmacy Benefits Manager

Massive Expansion of SCHIP

January 1, 2009 staff

Congress is poised to pass a massive expansion of the State Children’s Health Insurance Program (SCHIP).  Originally, SCHIP was designed to help low-income families who earn too much to qualify for Medicaid gain access to health insurance for their children.  However, under the bill currently being considered (H.R. 2), SCHIP’s income eligibility level would rise from the current 200 percent to at least 300 percent of the federal poverty level (FPL), or about $63,000 for a family of four.  In addition, some states don’t count certain types of income or have an approved waiver in order to boost eligibility for the program. 

Healthcare, PBM, PBMs, Pharmacy Benefits Manager

RAC-king Up Medicare Savings

November 1, 2008 Leslie Paige

The Centers for Medicare and Medicaid Services (CMS) released its most recent analysis of improper payments in the Medicare program on November 17, 2008.  The good news is that vigorous cost recovery programs have helped whittle the percentage of improper payments in the Medicare fee-for-service program from 3.9 percent in FY 2007 to 3.6 percent this year. 

Healthcare, PBM, PBMs, Pharmacy Benefits Manager, Taxes

Medicare Fraud: Not a New Story

September 1, 2008 Elizabeth Wright

Just before the August congressional break, Citizens Against Government Waste testified before a forum on Medicare fraud that was chaired by Sens. Mel Martinez (R-Fla.) and John Cornyn (R-Texas).  Sen. Martinez introduced S. 3164, the Seniors and Taxpayers Obligation Protection Act (STOP) of 2008, a bill that does several things to address the continuing problem of out-of-control fraud in the Medicare program.

Budget, Healthcare, PBM, PBMs, Pharmacy Benefits Manager, Taxes

Medicare Fraud: Not a New Story

September 1, 2008 Elizabeth Wright

Just before the August congressional break, I was asked to testify before a forum on Medicare fraud that was chaired by Sen. Mel Martinez (R-Fla.) and Sen. John Cornyn (R-Texas).  Sen. Martinez introduced S. 3164, the Seniors and Taxpayers Obligation Protection Act (STOP) of 2008, a bill that does several things to address the continuing problem of out-of-control fraud in the Medicare program.

Healthcare, Housing, PBM, PBMs, Pharmacy Benefits Manager, Taxes

Sen. Stevens Indicted

August 1, 2008 staff

On July 29, 2008, it was announced that Sen. Ted Stevens (R-Alaska) had been indicted by the Justice Department on seven counts of making false statements for failing to disclose $250,000 worth of gifts from a contractor.

Healthcare, PBM, PBMs, Pharmacy Benefits Manager

Staying Healthy by Eliminating Waste

August 1, 2008 staff

When President Bush announced the beginning of the President’s Emergency Plan for Aids Relief (PEPFAR) during his 2003 State of the Union speech, the five-year, $15 billion measure was announced as “the largest commitment ever by any nation for an international health initiative dedicated to a single disease.”  Targeting 15 “focus countries,” most of which are in sub-Saharan Africa, the plan embraced a three-pronged strategy based around prevention, treatment and care.

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