Health Insurance Industry Issues and Legislation

While controlling costs are important, member acceptance, engagement and satisfaction are all keys to successfully implementing an RBP plan. Secure, user friendly apps are an excellent member engagement and communication tools.

Specialty Drugs, like Harvoni, make up only 2.2% of all written prescriptions, but they account for 50% of all drug expenditures, and according to Express Scripts, they cost the U.S. health system as much as $100 billion per year. Medical costs make up almost half of that total. They can be reduced during the plan year without involvement of plans' PBM and with minimal changes to plan documents.

Sometimes savings can come in other forms other than dollars and cents. In the case of a 23-year-old blind female with Lyme disease, Osteoporosis, HHV-6, Uveitis, Juvenile Idiopathic Arthritis, and Bartonella, her mother requested personal assistance services to assist in household services, meal preparation and transportation. A Medicaid program from a Mid-Atlantic state initially deemed the request not medically necessary.