Search results: mandatory mail

DBN On Mandatory Mail

I’ve talked a few times about mandatory mail on the blog and after talking with Drug Benefit News (DBN), a few of my comments appeared in today’s publication.  One of the hypotheses in the article is that mandatory mail is growing (which doesn’t surprise me in this tough economy), and Ken Malley from Medco is […]

Communications Key To Mandatory Mail

I had an interesting question today about whether I thought mandatory mail would make a comeback.  I haven’t heard much lately about mandatory mail.  Rather than mandatory mail, I hear more people talking about restricted networks or programs like Maintenance Choice.  The follow-up to the question was why clients don’t implement mandatory mail.  It’s an […]

80% From Mandatory Mail – No Way

A PBM executive called me last week to ask about some information they got from one of the big strategy firms.  The PBM is trying to improve their mail order utilization.  They strategy firm said that 80% of mail order utilization is from mandatory mail…PLEASE.  I almost choked since I know the cost of that […]

Promotion vs. Nudging vs. Mandatory Mail

Although there is always a dialogue about the lifecycle of mail order, I think some of the work out of the Consumerology group at Express Scripts is interesting.  The frameworks that they apply internally are very similar to the technology and approach that Silverlink uses with the rest of the market.  [Kudos to Sean Donnelly […]

Pharmacy Satisfaction – Retail Beats Mail

With the new JD Powers survey, the gap between retail pharmacy satisfaction and mail order has widened. The average mail order satisfaction score was 797 for mail versus 837 (out of 1,000) for retail. I think one key comment from Scott Hawkins, director of the healthcare practice at JD powers was: “One of the key […]

FL Pharmacists to Fight Medicaid Mail Order

The Florida Pharmacy Association along with a local pharmacy in Florida have filed suit against the state for allowing Medicaid patients to use mail order.  This seems silly to me.  The mail order pharmacy ship has sailed a long time ago.  Approximately 13% of all prescriptions filled in the US are through mail order.  While […]

Mail Order Pharmacy – Good or Bad (Two Surveys)

I love when two parties (both with their own agenda) publish data that clearly shows that they are right.  Now, in this case, one quotes a 3rd party so I do give them more credibility.  And, the other (as I will show below) seems to not take the patient’s responsibility in mind. First, PCMA (Pharmaceutical […]

Home Delivery Versus Mail

Do you care what it’s called? Some people really dislike Mail Order Pharmacy and go with Home Delivery. I made that change when I was responsible for the product at Express Scripts. It becomes a little bit more meaningful when you talk about Mandatory Mail which is a benefit design where you are required to […]

Getting Back Into The Pharmacy Industry

After working at Express Scripts for almost 5 years and then selling into the PBM industry for almost 5 years, I’ve had the chance to lead and work on a ton of very interesting projects: Electronic prescribing Generic sampling Generic promotion – DTC, plan design, utilization management Formulary support programs Mail order promotion – mandatory […]

Mentions In The Press

This is a list of mentions in the press or articles / posts I’ve written in places other than this blog.  (Note: The frequency of this varies based on my role within my employer.) Inventiv Medical Management blog on consumer engagement. PHM Innovation Is The New Black on the CCA blog. AJMC TV YouTube interview […]

Highlights From the Takeda / PBMI 2011-2012 Prescription Drug Report

PBMI puts this out each year with funding support from Takeda. It is another one of those great annual reports full of lots of trend data for you to digest. Let me pull out a few of the things that stood out to me, but I recommend you read the entire thing yourself: Use of […]

Is The PBM A Fiduciary? I Don’t Think So.

I’m not a lawyer, but with the potential repealing of the Maine law regarding PBMs, it’s time to think about this question. Here’s a definition from A fiduciary duty is an obligation to act in the best interest of another party. For instance, a corporation’s board member has a fiduciary duty to the shareholders, […]

How Close Should Your Pharmacy Be?

The question of limited networks continues to be a hot topic with mandatory mail, Maintenance Choice, Restat’s Align, Humana / Walmart, and OptumRx’s new Value Network.  So, the core question is what are reasonable expectations for access.  Most people look to the “TRICARE access standard” which the Department of Defense uses: 90% of the members in […]

How To Select What Pharmacies Are In Your Network?

This seems to be the “meta-question” that everyone is talking around.  Should every pharmacy be in the network? Should mail be allowed?  Should I do mandatory mail? How do I design a limited network?  Is it ok? What about any willing provider?  [should that just be about cost] Let’s start with the basics…You want a […]

Press Hits in 2010 (and before)

2010 was a good year.  21 press hits.  (Thanks to a great press team at Silverlink that supports my ideas.) Chaired and presented at the NCPDP event. Presented at the DMAA (CCA) event in DC. AHIP podcast on adherence. Drug Benefit News regarding the MLR impact on PBMs Drug Benefit News November re: PBM pricing Drug Benefit […]

Walgreens vs. CVS More Thoughts

This was definitely the hot topic yesterday. I talked to lots of people about it. I had a chance to give it some more thought last night. A few things dawned on me. 1. Timing. This was timed well from a Walgreens perspective. Managed Care RFPs are mostly over and employers are making their decisions […]

Walgreens and CVS Caremark – Coming to Blows

I’m surprised this took the 3 years to play out. I talked about this back in 2007. Today, Walgreens announced that they would no longer participate with CVS Caremark networks for new networks and renewals. (See the CVS Caremark response here.) Personally, I’m a little surprised they didn’t limit it just to the Maintenance Choice […]

09-10 Prescription Drug Benefit Report

As they have for the past few years, Takeda has sponsored a study by PBMI on employers and their prescription drug plans.  The report is called the 2009-2010 Prescription Drug Benefit Cost and Plan Design Report.  It has some interesting data.  (The survey is of 417 employers representing over 7M members and was completed in […]

Why Does WSJ Villanize CVS Caremark?

I was so annoyed when I read the WSJ this morning about CVS Caremark charging more for members that go outside the CVS store or mail order.  Come on guys.  This is a basic tiered network design.  It’s not unlike tiered formularies or preferred drug lists. First, it’s a plan design that was created and […]

Limited Networks

I was reading Charlie Baker’s post on Narrow Networks, and it made me think about this concept from a pharmacy perspective. In general, this is a default solution for mail pharmacy.  You can’t chose between Medco’s mail pharmacy and Express Scripts.  You have one or the other. And, Mandatory Mail is an expansion on this.  […]

60% Think We Are Headed To A Depression

You wonder how bad it is economically or where we are headed…look no further than the CNN poll out this morning showing that 60% of Americans think it is likely that we will go into a depression.  Not a recession, but a depression like many of us read about in the history book or saw […]

I Get A Different Conclusion

In the same Express Scripts’ investor deck, I have to disagree with the slide below which is supposedly proof that the Consumerology efforts are working. Showing me that the trend for a client who was above their norm last year (see drug trend comparisons), went down to 3% (year-over-year) increase (which is over both Medco’s […]

Takeda: Prescription Drug Benefit Report

Have you ever read the annual Takeda Prescription Drug Benefit Cost and Plan Design Report?  It is a great summary of data from 340 employers representing over 6M members and this version is based on data from May and June 2007. Here are my notes:  89% use tiered formularies.  [I am amazed that 11% still […]

PBMI Day One Notes

Just getting back from the first day of my first PBMI conference. Very pleased. Here are some notes / observations: PBMI was bought in the past 2 years by PSG (Pharmaceutical Strategies Group) which interestingly has numerous ex-Express Scripts people working there. Great opening speaker (E. Kinney Zalesne) who is the co-author of Microtrends (a […]

Glass Ceiling for Adoption of New Programs

A common discussion point that I have had with many people is why don’t companies adopt more cost control mechanisms.  Some typical programs from a pharmacy perspective would include: Limited formulary (cover less drugs) Percentage copay versus flat dollar copay Mandatory generics (you have to get the chemically equivalent generic if available or pay the […]

Shot Across the Bow or First Blow – Walgreens

I expected to see a lot more buzz yesterday after Walgreens announced that they were going to pull out of several contracts with CVS/Caremark over reimbursement.  Obviously, the two are huge competitors so I don’t find it surprising at all. I assumed CVS would push on Walgreens through their PBM contracts.  What I wonder is […]

PBM / Pharmacy Benefits Data (Takeda)

Takeda publishes The Prescription Drug Benefit Cost and Plan Design Survey Report (free to order here). I read the 2006 edition last night. It is full of great data that I would want if I were a consultant, a HR representative, or responsible for my companies PBM relationship. The document also points you to the […]

My Healthcare Experience

While you can see an highlighted version of my experiences in my LinkedIn profile, here’s a longer list of projects I’ve worked on in the healthcare area: Led the development of a health plan commercial go-to-market strategy to determine how to avoid pharmacy carve-out by PBMs. Led the identification of new opportunities around opioid management […]

Lipitor Going Generic

If you work in pharmacy, this has been on your radar since Zocor went generic years ago. Lipitor has been the biggest drug worldwide, and I believe the spend in the US is still almost $7B a year even with generic Zocor available. (See Consumer Reports on statins) Now, it appears that generic Lipitor (atorvastatin) […]

Prime Therapeutics 2010 Drug Trend Insights Report

I am way behind this year in getting thru the Drug Trend Reports and posting my comments.  I think I still have to do both the CVS Caremark report and the Walgreens report…and if I can get it, the SXC report also.  (You can see my thoughts from the Medco and Express Scripts Drug Trend […]