Posts filed under ‘benefit design’

Reference Pricing — Coming soon to a health plan near you?


There is great interest in reference pricing in the US for select medical procedures and branded drugs. While only 10% of mid-sized and large employers are utilizing reference pricing, more than 2/3 of employers have an interest in this payment technique. If it takes hold, there is a potential impact on utilization, revenue and quality of care that manufacturers will need to address.

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Continue Reading November 11, 2015 at 6:00 PM Leave a comment

MedSpan Musings — Tips for better payer market research


2015 08 25 rodin the thinker for MedSpan MusingsMedSpan Musings — Tips for better payer market research  

The benefit covering a drug is not always obvious
When discussing benefit coverage of drugs with payers, remember that some health plans at first cover drugs under the medical benefit and then transfer those costs each month to the pharmacy benefit. Be sure to probe for this approach and its implications for drugs administered in physicians’ offices and alternate sites of care.

October 12, 2015 at 5:51 PM Leave a comment

Payer 101: The respondents you need for your payer market research study


At MedSpan Research, we’re proud of the expertise we’ve gained over the past 17 years in an important but not well understood sector of the healthcare industry: payers. Today, we’ll continue with the Payer 101 series that we started in September by covering the key types of payer respondents to include in your next payer market research study.

To recap, the term ‘payer’ is broadly defined as any entity that reimburses the use of healthcare services or products. The term commonly refers to health insurance companies (otherwise known as health plans) as a whole, or to a key decision-maker at a health plan, such as a medical director. In the first post in our Payer 101 series, we focused on the former definition. In this second part of our series, we’ll go into more detail about the latter.

Continue Reading October 12, 2015 at 4:02 PM 1 comment

Gene therapy — The price is right?


The introduction of the first gene therapy presents challenges for payers. These costly therapies will require new approaches in terms of pricing benchmarks and reimbursement methodologies.

Continue Reading October 2, 2015 at 4:32 PM 1 comment


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