Drug Coverage - ClaimLinx

Consultants look at drug costs to find savings

by ClaimLinxMarch 24, 2021Leave a comment

ClaimLinx analyzes each company’s drug usage to find cost-cutting measures. First, it saves employers money. Most importantly, it helps workers be able to afford the medications they need consistently.

Why ClaimLinx Focuses on Rx Costs

Medications are one of the most important tools people have to maintain their health. However, prescription drug costs keep rising each year. By the end of last year, more than 20 generic drugs had a price increase of 29.4%. Also last year, the cost of more than 1,200 drugs rose by 5-6%. It’s a trend that has so far continued into 2021.

What research has shown is that when medication are expensive, people do not fill the prescription or do not do so consistently. In fact, between 20-30% of prescriptions are never filled because of costs. Up to 50% of medications for chronic illnesses are not taken consistently because they’re too expensive. That all adds up to a real impact on members’ health.

That’s why ClaimLinx prioritizes savings on prescriptions. We know it’s important for employees to take their medications consistently to be productive at work. We also know employers don’t have endless funds for drug coverage. To help with that, we focus on finding a balance between the two.

How ClamLinx Saves on Prescriptions

Our consultants get real-time data on prescription usage through our partner pharmacy benefit managers (PBM). Unlike with a standard insurance plan, ClaimLinx sets up a prescription drug plan with a PBM we trust. That allows our consultants to see which medications workers need and how much they cost. From there, our service team has many methods they can use to cut costs on prescriptions. That saves money for both the employer and the employee.

Enrolling in drug coupon programs

One of the ways ClaimLinx cuts costs on prescriptions is by researching drug programs and coupons for medications. These are many coupon programs through the manufacturers and through different pharmacies. There are also cost sharing programs available for those with financial need. We seek these out because they help the employer. But more importantly, they help the employee afford the drugs they need to stay healthy.

Moving members to a new plan

Another cost-saving measure is to move certain members on the plan to new health insurance plans with more prescription coverage or discounts. For some members, it makes more sense for them to be on a more comprehensive plan. The plan may be higher cost, but it will save in the long run if the drugs are expensive. Our agents are seasoned in taking this into account when finding members the plan that’s going to work best.

Finding generic version of drugs

As a part of ClaimLinx’s overall solution, we place an emphasis on educating members on costs so they can be good healthcare consumers. To help with that, we recommend members have an open dialogue with their providers about their prescriptions. We tell members to ask their doctors if they have chosen a brand name drug why that is. Is there an alternative that can achieve the same results. We also help workers research generic versions of brand name drugs, if they are available. Sometimes providers are unaware of the costs of prescriptions so it’s important to talk with them when the drugs are expensive.

Prescription Costs Keep Going Up – How Can You Save?

by ClaimLinxMarch 7, 2020February 10, 2022Leave a comment

It’s a problem we’re all getting to know very well. Prescription costs keep rising, and it can often feel like there’s nothing any of us can do about it.

The beginning of 2020 continued the trend, with more than 1,200 drugs’ prices increasing by an average of 5-6 percent and 20 generic drugs increased by an average of 29.4 percent, according to GoodRx.com. And the consequences are clear. In study after study, it’s estimated between 20 to 30 percent of prescription medications are never filled and up to 50 percent of medications for chronic illness are not taken consistently, according to a quote from a review in the Annals of Internal Medicine.

In the есоnomy tоdау, mаnу аrе caught with tremendous есоnomic рrоblеmѕ and оf course, medical соѕtѕ ѕееm to be еѕресіаllу out of control. If prescription drugs соѕts are tаkіng a hugе bite out оf уоur hоuѕеhоld budget, dоn’t dо wіthоut the іmроrtаnt drugѕ уоu need. Tips and advice on ѕаvіng mоnеу on prescription costs рrоlіfеrаtе but if уоu fоllоw these tips уоu will ѕее quite a dіffеrеnсе in уоur рrеѕсrірtіоn spending.

Onlіnе Pharmacies

Many hаvе fоund thе еаѕе аnd ѕаvіngѕ that have been found uѕіng оnlіnе рhаrmасіеѕ. Mоѕt of them оffеr generic drugs at truly hіgh savings, аnd mоѕt are dереndаblе to ѕhір you уоur рrеѕсrірtіоnѕ uроn receipt оf уоur рауmеnt. Yоu wіll, of course, need to іnvеѕtіgаtе аnу online рhаrmасу уоu mау come in contact with. Your bеѕt bet is word of mouth recommendations, thuѕ if you are frіеndѕ with othеr реорlе whо either ѕhаrе уоur condition or take рrеѕсrірtіоnѕ thеmѕеlvеѕ, dоn’t bе ѕhу аnd аѕk whо thеіr рrеѕсrірtіоn рrоvіdеr іѕ. Thе аnѕwеrѕ mау lead уоu tо a fаntаѕtіс оnlіnе pharmacy that wіll ѕаvе уоu a tremendous amount of mоnеу. Уоu hаvе tо bе willing to take thе time аnd do the research.

Generic Drugѕ

Even the Fооd аnd Drug Admіnіѕtrаtіоn (FDA) tеllѕ uѕ thаt generic drugѕ hаvе thе ѕаmе active ingredients and thе ѕаmе еffесt аѕ brаnd-name drugѕ, thuѕ it makes no ѕеnѕе to adhere to brand-name drugs when a gеnеrіс drug саn bе gotten for up tо 80% less.

It іѕ оf trеmеndоuѕ importance thаt you соnѕult wіth your рhуѕісіаn rеgаrdіng роѕѕіblу ѕwіtсhіng tо a gеnеrіс drug іnѕtеаd оf thе еxреnѕіvе brand-name drug уоu аrе taking. If уоu dо your research аnd fіnd thаt there is a gеnеrіс drug that will perform just аѕ wеll for уоur соndіtіоn, аѕk роіnt-blаnk whу уоu cannot tаkе X іnѕtеаd оf Y?

Phаrmасеutісаl Cоmраnіеѕ

Shоuld уоur соndіtіоn require you to take a раrtісulаr drug that іѕ a brand-name drug and іt іѕ еxреnѕіvе, you саn оftеn ѕреаk tо thе maker оf thе drug for a Patient Aѕѕіѕtаnсе Program (PAP) whеrе аrrаngеmеntѕ mау bе mаdе fоr either free or reduced-соѕt drugs. Of соurѕе, thе hеlр muѕt bе аррlіеd for аnd bаѕеd оn your vеrіfіаblе іnсоmе the company will dесіdе іf уоu qualify fоr ѕuсh аіd. The forms for this tуре of hеlр are uѕuаllу available on thе іntеrnеt and will require your doctor’s signature as wеll.

State Hеlр

Уоur раrtісulаr state mау аlѕо offer hеlр with рrеѕсrірtіоnѕ that may be paid соmрlеtеlу fоr уоu, оr at lеаѕt offer уоu reduced-cost drugѕ. Agаіn, mоѕt оf thіѕ hеlр will be bаѕеd on verifiable іnсоmе. Mоѕt states оffеr a drug аѕѕіѕtаnсе рrоgrаm.

Partnership for Prеѕсrірtіоn Aѕѕіѕtаnсе (PPA)

The Partnership for Prеѕсrірtіоn Assistance рrоgrаm is a group оf drug companies, раtіеnt advocacy оrgаnіzаtіоnѕ, health care рrоvіdеrѕ, аnd соmmunіtу groups. ClaimLynx offers help to раtіеntѕ whо mау nоt have рrеѕсrірtіоn аvеrаgе to find аѕѕіѕtаnсе рrоgrаmѕ that fit thеіr nееdѕ. we can оffеr access to many public as wеll as рrіvаtе раtіеnt аѕѕіѕtаnсе рrоgrаmѕ. We also provide prescription savings cards that can reduce the cost of your prescriptions.

Yоur Dосtоr

Above all do nоt fоrgеt tо іnсludе your Doctor in уоur search for lоwеrіng уоur prescription costs before either cutting down оn уоur prescriptions уоurѕеlf оr wоrѕе yet, ѕрlіt оr share mеdісаtіоnѕ. Уоur health іѕ extremely important, dо nоt jеораrdіzе it for реnnіеѕ saved whеn there is оthеr viable hеlр аvаіlаblе.

Trump administration tackles drug advertising

by Whitney FaberMay 31, 2019May 31, 20191 Comment

Coming this summer: another addition to the “fine print” on all those drug commercials. Under a new rule announced this month by the Trump administration, pharmaceutical companies will have to reveal how much their drug costs during TV commercials.

The rule is set to go into effect this summer and will require drug companies to include the price of a drug if it exceeds $35 for a 30-day supply, or the usual course of therapy.

The move is meant to increase transparency in the industry and ideally force pharmaceutical companies to lower its sticker prices on drugs for fear of appearing too expensive.

“Requiring the inclusion of drug list prices in TV ads is the single most significant step any administration has taken toward a simple commitment: American patients deserve to know the prices of the healthcare they receive,” said Alex Azar, Health and Human Services secretary.

As expected, drug companies pushed back on the new rule. Representatives said they fear including drug prices during commercials will discourage customers from asking their physicians about the drug because they believe they cannot afford it. The new rule stipulates listing the price before any discounts or health insurance coverage, which could lower the cost.

It is notable, however, that because of rising costs an increasing number of Americans are being forced onto high deductible health plans, which can often lack the comprehensive drug coverage required to significantly reduce the cost of prescriptions.

“If drug companies are ashamed of those prices—lower them,” President Donald Trump tweeted shortly after the rule was announced.

Industry experts do not necessarily oppose the new rule, but are skeptical it will result in substantial cost reductions, especially because enforcement of the law is left to the drug companies themselves.

If one drug company fails to include the pricing information in an ad, a competitor can file a lawsuit under the deceptive and unfair trade practice provisions of the Lanham Act. No additional oversight plan has been announced by the Trump administration.

The consensus among Americans appears to be that added transparency in the pharmaceutical industry may be helpful, but is no guarantee. According to a POLITICO/Harvard poll in the summer last year, 63 percent of Americans favored including price information in drug advertisements, but only 28 percent believed it would lower costs.

As for the ClaimLinx team, we don’t expect this to bring about big change in the industry. If it does, though, you can bet we will be ready to use it to our advantage to lower costs for members and clients.

President Trump highlights healthcare in State of the Union

by Whitney FaberFebruary 8, 2019Leave a comment

Health care has long been a priority for the Trump administration, and the President used his State of the Union speech this week to highlight his priorities when it comes to improving health and bringing down costs for consumers.

Ahead of the speech, the Trump administration released its plan to curb drug prices for Americans, especially those under 65. His plan proposes eliminating the legal protections that allow pharmacy benefit managers to accept rebates from drug companies for brand-name drugs. Rebates would instead be credited to patients when they fill their prescriptions at the pharmacy.

These after-the-fact discounts are seen by many as one of the driving factors pushing up the list price of drugs. President Trump focused on the struggle this can cause, as many Americans are increasingly responsible for paying larger portions of these prices.

He also called for more transparency in general in the healthcare industry, asserting that if hospitals, drug companies and insurers had to “disclose real prices,” consumers would have more information that would foster more competition.

“It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, this is unfair, and together we will stop it. We will stop it fast. I am asking the Congress to pass legislation that finally takes on the problem of global freeloading and delivers fairness and price transparency for American patients.”

There is bipartisan support in Congress for legislation to bring down drug prices and to improve healthcare pricing overall, but any bill would likely face strong opposition from lobbyists from pharmacy benefit managers, pharmaceutical companies and insurers.

Complicating the issue as well is the current climate in Washington with the divided government. It is still unclear if Congress will be able to work with the President on key issues like these, while so much time and energy is being spent on other subjects, like border security and the government budget.

President Trump went on to talk about his hopes for increased funding for research on treatments for childhood cancer and a cure for HIV and AIDS in the United States within the next 10 years. He called on Democrats and Republicans to pass his budget, which seeks additional funding for the National Institute of Health for both initiatives.

Both priorities are largely seen as an outreach to Democrats and as issues the country could unify around. No specific legislation outside of the budget proposals have been released.

Overall, President Trump’s State of the Union address covered a wide range of topics but his focus on these initiatives shows healthcare remains a priority for the administration.

It will be a game of watch-and-see as Trump’s own campaign for reelection becomes increasingly underway. He may want to tout a big legislative win regarding healthcare on the campaign trail, especially as efforts to “repeal and replace” the Affordable Care Act were unsuccessful early in his presidency.

State of the Union Spotlights Pharmaceutical Problem in America

by Christopher RoachFebruary 1, 2018December 4, 2019Leave a comment

Pharmaceutical companies’ stocks took a hit just after the State of the Union address, when President Trump listed drug pricing as one of his “greatest priorities” this year. Medication prices across the board have been rising sharply, occasionally with consequences from Washington.

For example, Turing Pharmaceuticals former CEO Martin Shkreli was called to appear before Congress when he raised the price of the AIDs medication Daraprim from $13.50 per pill to $750 per pill in 2016.

There have not yet been any policy initiatives to force drug prices down, and until there are, prices are likely to continue to rise — with insurance companies finding more ways to pass this burden onto you, the consumer.

One of biggest changes I’ve seen among my own clients is many medications have changed tiers, resulting in a much higher cost share for members. So a drug that was once in Tier 2 and covered with a $50 copay may now have switched to Tier 3 with a $150 copay — for the same drug at the same insurance carrier. That’s a pretty shocking price hike in a matter of just a few months.

I’ve also seen many insurance carriers adopt a Mandatory Generic Substitution for a growing number of medications. This requires members only receive the generic version of a drug, or pay the difference for the brand name version.

Then some drugs have fallen off of insurance carriers’ formularies altogether, meaning they are no longer covered at all. Most often this happens when a drug has become so expensive even insurance carriers are having trouble paying for them. So imagine how the average consumer feels.

All in all, this is not a problem exclusive to 2018 alone, but it is a problem that will only get worse until sweeping changes are made to how drugs are priced. So please, Mr. President, make the drug industry great again.