Description: Regular column written by the chairperson of the Health Section Council.

Description: PBMs are positioned in the healthcare delivery system as the only entity that is not regulated for profitability. The Commercial Fully Insured Health Insurance Plans are heavily regulated by the State Insurance Commissioner who allows only 2%-3% profit margin. The self-funded Health Plans are regulated by ERISA fiduciary responsibility that prohibits excessive compensation. PBMs are classed as a service provider and are not regulated by either. This allows PBMs to implement large, unreasonable mark ups for profit. PBMs are massive commercial entities, states are trying to sue under antitrust law. PBMs found a sweet spot in the regulation. Large Insurance Carries understood that and either acquired large PBMs or merged with them. It is likely that a combination of measures will be needed to regulate PBMs. The most direct approach would be for Congress to pass a law establishing PBM as a fiduciary under ERISA just like an “investment advisor” providing advice for a fee. Establishing PBM as a fiduciary will help Courts and other Federal Agencies ensure that PBMs do not unfairly retain rebates and inflate the prices of Rx drugs sold to employer health plans, and the US population in general.

Description: This article examines the costs of mental health parity, presents the primary drivers of cost increases from legislation and shows evidence the initial cost projections were too high. From Health Section News, March 2005, Issue No. 49.

Description: This article outlines what the author learned from the Sixth Annual Quality Colloquium at Harvard. From Health Watch, January 2008, Issue No. 57.

Description: With many pharmacy benefit plans now considering whether to add a 4th tier for high priced specialty drugs, review and discussion also needs to be given to the other end of the pharmacy cost spectrum to see how costs can be reduced by promoting lower cost over-the counter OTC drugs. From Health Watch News, September 2006, Issue No. 53.

Description: This article provides the perspective of the Health Section's chairperson on Section activities, educational programs and the US healthcare environment.

Description: Recap of content contained in the October 2013 issue of the Health Watch newsletter.

Description: Volunteers and staff from the SOA are working with the Centers for Disease Control on public health initiatives to improve population health.

Description: Strategies to position Medicare Advantage plans for success during August resubmission.

Description: This article is intended to inform readers about the current state of mental health and health care in the US, as were it's heading moving forward.