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Healthcare is about to get more expensive. Cell and gene therapy is today’s hot topic as drugs such as Zolgensma, at $2.4 million per dose, strike fear in the eyes of stop-loss insurers and plan sponsors. But the conditions for which those drugs are prescribed are, so far, pretty rare. And the insurance industry is able to spread the risk over the larger population. Viewpoints from Craig Hasday But now there is a new scourge about to hit the market – genomics’ “killer app,” the liquid biopsy. This “killer app” of the genomics world, called MCED (Multi-Cancer …

… and copayments. It does not include premiums, out-of-network cost-sharing, or any costs not covered by the plan. Insurers are required to disclose both providers’ negotiated rates and allowable out-of-network charges for providers and for prescription drugs. Prescription drug disclosure is required to include rebate information. Viewpoints from Craig Hasday It will be interesting to see how the market responds. Seen as their market differentiation, provider and pharmacy discounts and allowed charges have been closely guarded by pharmacy benefit managers (PBMs), insurance carriers and network gatekeepers. Plan sponsors have actively encouraged comparison pricing for medical services …

Viewpoints from Craig Hasday Lucrative profit potential, along with political and economic pressure to reduce healthcare costs, has spawned consolidation and vertical integration of traditional insurers and pharmacy benefit managers. But costs continue to escalate, and these traditional markets will no doubt be challenged for solutions. Mergers, consolidation and innovation have combined with political agendas with multiple opinions even within the Democratic and Republican parties. Healthcare is a fragmented and inefficient industry in the United States and nearly 20% of U.S. Gross Domestic Product represents a significant opportunity for the nation’s largest companies to do it better. Walmart …

Viewpoints from Craig Hasday Trying to regain momentum in the election polls, President Trump released four executive orders that he claims will “completely restructure” the prescription drug market. However, most analysts agree that there is not much new and nothing revolutionary in these orders. The most potentially impactful of these orders is a rehash from a prior Presidential Blueprint in May 2018. One order requires middlemen to pass along all discounts received to Medicare patients. Good idea, except for the provision that requires the Secretary of the Department of Health and Human Services (HHS) to confirm the order will not …

Viewpoints from Craig Hasday The Fortune 500 list is out, and I was slightly surprised to see that the big four health insurance companies: UnitedHealthcare, CVS-Aetna, Cigna and Anthem are all in the top 30 U.S. companies ranked by revenue. These companies represent nearly $757 billion in revenue and include the three largest pharmacy benefit managers (PBMs): Optum, Caremark, Express Scripts, and Anthem has now started Ingenio, a new, but certain to be powerful, PBM. They represent $437 billion in market value, $30 billion in profits, and have about 759,300 employees. The revenue results do not factor …