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PAHCOM
photo of Lehigh Valley Pennsylvania

Lehigh Valley Pennsylvania Chapter

Allentown, PA

Next Chapter Meeting

Title/topic: New Member Connection: Learn what PAHCOM can do for you
Speaker: Steph Hanzl, RN, CCRP, CMM
Date: 08/22/2018
Time: 05:30 PM - 07:30 PM
Location: Ozgood's Neighborhood Bar & Grill
4 Lincoln Rd
Kutztown, PA 19530

The meeting is for ALL chapter members, we want to build networking relationships with our existing and new members. Steph Hanzl, our Vice President will review the benefits of PAHCOM Membership and give us highlights from the PAHCOM website that are helpful to new and existing members.

* chapter meeting will be followed by networking cocktail party

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Chapter News

05/31/2018 - Pharmacy Benefit Managers
Our Lehigh Valley PAHCOM Chapter meeting was held on May 23rd. Our speaker was Dr. Steven Boyd, PharmD, owner of Southern Scripts, a specialty solution pharmacy. Southern Scripts provides pharmacy benefit management (PBM) services for self-funded employer group health plans. Southern Scripts simplifies the PBM world by giving the employer group complete freedom, control and choice when structuring the prescription benefit plan. PBM’s are the middlemen between pharmaceutical companies and consumers. The PBM’s role is to negotiate the best drug prices on behalf of its customers that included large employers, health plans and Medicare and Medicaid populations. With the concerns about rising healthcare costs in the US; pharmacy benefits is a huge market. These are very large players, although this is changing almost constantly. Several of these companies are listed in the top performers on Wall Street. This is problematic because if your company is on the NYSE your goal is to pay dividends to your shareholders; not save money to the consumer or the employer or anyone for that matter. In fact, many of you probably have shares in these companies because they are top performers with constant maneuvering to stay in the top. Some of the largest are CVS, Caremark; Express Scripts, Argus (Medicaid and Medicare Part D), Walgreens, Envision and ProCare. These companies are all PBMs. There are 35 different revenue streams for PBMs. We were not able to address all 35 revenue streams however we did touch on the top revenue streams to the PBM. One of these revenue streams is the rebates. Typically the pharmaceutical company will pay a rebate; approximately one third paid for prescription drugs is traceable to rebates. These rebates are passed onto the PBM and the insurance company but rarely are the rebates paid to the employer group who is paying for the Pharmacy Benefit. Clearly, this should be labeled as a “kick-back” which should not be legal. Another major revenue stream is mail order. The PBM has their own mail order company; they buy the drugs in bulk, at a reduced fee; however they repackage the drugs which are mailed to the recipient. Many times these mail order drugs are charged more to the plan than when the patient goes directly to the pharmacy. This is another major source of revenue for the PBM. The PBM is also reimbursed for administrative costs through the prescription plan. This cost is passed on to the cost of the coverage premiums. Some PBMs charge 7.50 per claim. However if they make a mistake on the claim and need to resubmit the claim they will charge another 7.50 even when it is their mistake. In a graphic by the Wall Street Journal for a typical prescription drug that costs $300 the administrative fees total $18.00. The goal of Southern Scripts is to truly offer a more transparent way to do business with pharmacy benefits for employer groups without “playing” all of these games which do put up the cost of the health care delivery in this Country. If you are not familiar with how PBM work; I would encourage you to do a little research on this topic. You will be able to make changes in your work place but offering a different PBM as part of your health care benefits. It is a big job to make these changes but it will pay dividends in the long run.

04/29/2018 - GIFT A MEMBERSHIP BEFORE MAY 15th
The GIFT of Membership promotion has been extended through May 15th! Each of you that hasn't already GIFTED A MEMBERSHIP to a practice manager colleague that is a NEW member interested in joining PAHCOM and our Lehigh Valley Chapter can do so now. The new member will have a one year membership that affords them full access to all the benefits of a PAHCOM member. Have them use Promo Code: GIFT to claim their gifted membership and have them be sure to say that you referred them and that they attach themselves to our Lehigh Valley Chapter. For your gift, you will earn $30 in PAHCOM Bucks when the new member credits you for referring them. (Gift is for Medical Practice Managers, and cannot be used for Corporate Memberships.) If you have any questions about this process, please contact Cindy Fisher, CMM, HITCM-PP, our Membership Director and she will assist you. Let's take this opportunity to really grow our Chapter!

 

Chapter Contact

Suzette Benedick, MBA, CHC, CMM, HITCM-PP
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LehighValleyPA.pahcom.com

Chapter Officers

President:
Suzette Benedick, MBA, CHC, CMM, HITCM-PP

Vice-President:
Steph Hanzl, CMM, RN, CCRP

Secretary:
Aileen Naudascher, CMM, HITCM-PP

Treasurer:
Wanda Cronrath, LPN, CMM, HITCM-PP

Membership Director:
Cindy Fisher, CMM, HITCM-PP

CHAPTER CMMs

List CMM members

Chapter Support Liaison

Gail Eminhizer, CMM, CGCS, HITCM-PP

Chapter Points

Current points total: 925

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