Pharmacy costs are dropping, imaging is not an issue, physician expenses are growing modestly, and while PT payments are going up a bit, much of that is fee-schedule driven.
The problem area — and it is a big one — is facility cost. (There’s another, more insidious problem we’ll get to later.)
A recent HealthAffairs article highlighted the facility problem: The median price paid by auto insurers and other non-conventional commercial insurers was 2.8 times Medicare reimbursement in 2010, and 3.8 times Medicare six years later.
First, what are the factors driving this?
It’s refreshing to see this problem hit the real media, but many payers have been quietly alarmed about facility pricing issues.
Unpacking the HealthAffairs article, there are a few key takeaways:
What does this mean for you?
If you're not at the table, you're on the menu.
Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.
Jan 24-27, 2019
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