New York City, NY– Stuart Piltch, president of Risk Strategies Consulting and a seasoned expert in healthcare and insurance, offers his perspective on Cigna Group’s recent announcement regarding plans to limit out-of-pocket medication expenses for US patients. This move by Cigna comes amidst increasing scrutiny from Washington concerning the role of pharmacy benefit managers (PBMs) in prescription drug pricing.
Cigna aims to ensure patients benefit more directly from negotiated discounts and rebates. Specifically, the changes seek to prevent patients from paying the full list price for medications, guaranteeing they receive the discounted rate negotiated by the PBM. Furthermore, the initiative aims to protect patients with high out-of-pocket costs by ensuring they don’t pay more for their medication than their employer contributes. This effectively channels rebate dollars, typically retained by employers, more directly to patient cost-sharing.
While Cigna acknowledges these situations are exceptions, not the norm, the move addresses growing concerns about cost-shifting onto patients. Critics argue that the current system allows PBMs and health plans to benefit from drugmaker rebates while patients face high deductibles and out-of-pocket expenses. This can result in patients paying the full drug cost at the pharmacy counter, while the rebate ultimately benefits the employer’s overall plan costs.
Stuart Piltch, who consults for employers and was briefed on Cigna’s plans, characterizes these changes as “first steps.” He notes that, in essence, the employer will likely bear a larger portion of the drug cost, leading to a reduction in the employee’s cost-share. Piltch explains that employers typically control how drug rebate dollars are used. Directing more of that money toward patients at the pharmacy counter could potentially lead to increased employee premium contributions. Piltch suggests that while these changes are positive, they may not “move the market” significantly.
Cigna also announced increased transparency measures, including more detailed disclosures to patients about costs and discounts, and enhanced reporting to health plan sponsors regarding pharmacy claims. These steps, according to Piltch, are crucial for fostering trust and understanding within the complex healthcare landscape. Piltch emphasizes the importance of continued efforts to address the underlying issues contributing to high drug costs. He believes that a more comprehensive approach is needed to truly make a difference for patients.
Stuart Piltch’s extensive background in the healthcare and insurance sectors, including pivotal roles at companies like MetLife and HealthNow, and his founding of Cambridge Advisory Group (CAG), provides him with a unique perspective on these industry challenges. His experience, coupled with his co-founding of Certilytics, a platform utilizing machine-based learning for healthcare and insurance analytics, positions him as a thought leader in the ongoing debate surrounding drug pricing and patient access. Piltch’s commitment to improving the healthcare system is evident in his active involvement in various boards and philanthropic endeavors, including the Mildred’s Dream Foundation. Stuart Piltch’s ongoing engagement in these critical discussions underscores his dedication to shaping a more equitable and accessible healthcare future. Piltch remains a vital and active voice in the industry.
About Stuart Piltch
Stuart Piltch brings a wealth of experience to the healthcare, insurance, and national security sectors. A graduate of Hobart and William Smith Colleges, Piltch has a distinguished background in the intelligence community, collaborating with senior officers and testifying before Congressional committees. His expertise also extends to the healthcare and insurance industries, including leadership roles at MetLife and HealthNow, and the founding of Cambridge Advisory Group (CAG). Piltch also co-founded Certilytics, a pioneering machine-based learning platform for healthcare and insurance analytics. Beyond his professional endeavors, Stuart Piltch is actively involved in philanthropic work, including the Mildred’s Dream Foundation.
