Affordable, quality health care. For everyone.

The Commonwealth Fund

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Role of a Pharmacy Benefit Manager in Providing Services and Flow of Funds for Prescription Drugs

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Pharmacy Benefit Managers: Practices, Controversies, and What Lies Ahead

pharmacy benefit manager

Health insurers often contract with pharmacy benefit managers, or PBMs, to negotiate the prices they will pay for prescription drugs. PBMs’ success in extracting rebates from manufacturers has helped to slow growth in Rx drug spending, but PBM practices may be increasing prices and hindering efforts to improve value.

Health Care in America – How Doctors Can Make Life Easier for Patients

When a homeless person gets discharged from hospital, he needs a safe place to recover. When a poor patient faces a high co-pay for a medicine she needs, she is often too embarrassed to tell her doctor – instead, she may not fill the prescription.

Doctors don’t typically try to solve these social problems, but some want to do better at understanding patients’ lived experiences. In this episode of The Dose, Ishani Ganguli and Janine Knudsen, both primary care providers at innovative clinics, talk to Shanoor Seervai about how they are trying to treat a patient as a whole person, rather than focusing on a single medical condition. They discuss the successes and challenges of caring for patients in their daily practice in light of the findings of a recent survey of people living with serious illness in the United States.

In Focus: How Unions Act as a Force for Change in Health Care Delivery and Payment

Unionized workers typically bargain for a package of wages and health benefits — giving them a vested interest in containing health care costs. And some union members have more than just skin in the game; they also have a seat at the table when it comes to deciding on their health benefits. In this issue, we look at efforts led by unions and their partnering employers to curb the costs of health benefits by making primary care more accessible, promoting evidence-based care, and leveraging market power to curb escalating prices for prescription drugs.

Q&A: Steering Employees Toward Higher-Value Care

In parts of the U.S., unions are leveraging health benefit designs and trusted relationships with members to promote healthy behaviors and steer people toward higher-value providers and treatments. Transforming Care spoke to three leaders in the field about what others can learn from these efforts.

Will the President’s Initiative to End the Spread of HIV Leverage Medicaid?

HIV and Medicaid

President Trump has said he hopes to stop the spread of HIV in 10 years. His 2020 budget calls for $291 million in new funding targeted to portions of 26 states, Washington, D.C., and Puerto Rico that account for a disproportionate percentage of new HIV infections and people living with HIV. But there’s no way to end HIV if we take health insurance away from people living with the disease and disregard one of our most powerful tools for ending its spread. Unfortunately, the President’s budget does exactly that by cutting $1.5 trillion dollars from the Medicaid program, which provides health insurance to four of 10 people receiving HIV treatment.

New Zealand

We feel called upon not only to condemn acts of violence and inhumanity such as those we have recently witnessed in New Zealand and here in the United States, but also to urge our national leadership — political, corporate, religious, philanthropic, educational — to condemn appeals to violence and bigotry, in all their forms, wherever they appear.