Staying healthy and saving on health insurance are two things that can work hand in hand. In this interview that taps into health from our consciousness as well as the pharmacies and corporations, we have Kara Atkinson of Farley and Associates and Fred Meijering, the Market President with Echelon Advisors, to guide us. Starting with activating that desire to have better health, Kara talks about how to get and stay healthy with the information found in a 1937 book called Think and Grow Rich by Napoleon Hill. She discusses alignment, your burning desire, and making decisions based on what you value. Then we have Fred who explains the money-saving benefits that can be created if you know how to use them inside your health insurance benefit program. He emphasizes the importance of good healthcare practice and employees taking their prescribed medications.
Listen to the podcast here:
Healthcare And What It Means To You Part IV with Kara Atkinson And Fred Meijering
Mental Health That Saves Money On Your Health Insurance
We have two really special guests on the show. Our first guest is Kara Atkinson and she is out of Denver, Colorado. Kara works with us at Farley & Associates and she is our Manager for the state of Colorado. We’re going to interview her about a book that we have been studying called Think and Grow Rich. She is going to break down for us a chapter on desire and why desire is so important for your life and for your mental health. Kara has a lot of experience in the property and casualty and group health industry and when we were able to put our deal together with Kara for the state of Colorado, we knew that we had a quality person. I’m very excited to introduce Kara to you. Kara, how are you doing?
I’m doing great, Joseph. Thank you.
A lot of people that are reading this blog have probably not read the book Think and Grow Rich. This book was written in 1937 and it has been a fabulous, famous book for CEOs, CFOs, professional salespeople and the likes. Let’s get into desire and why desire is so important.
I know that the book Think and Grow Rich is one of the most pivotal books that have helped me and a lot of other people reach different levels of success at different times of our lives. It all falls down to one of the main principles for success, which is number one, a burning desire. With a burning desire, it can also be called your chief aim or your main definite purpose. It is the main parts of what creates everything else in your life. If you have an idea in your mind and you can see it in your eyes or your mind’s eye of what it is that you ultimately want, that is what’s called your chief aim or your burning desire. When you have a burning desire, you’re able to create and manifest in a different way than if you are more fickle or if you have more of a wishy-washy type of mentality. I would say that burning desire, desire in general is the most pivotal, one of the most important aspects of anyone’s success and that can go down to anything. It can be money, it can be relationships, it can be health, it can be a life experience. Every person has a different desire and everyone’s desire will be different. Whatever that desire is, that will be the driving force of who and what they create in their life.
A lot of people are indifferent on their goals and what they really want to accomplish in life. When we ask people to tell us what their goals are, usually you will get the Hominy comedies that they’ll start saying, “I’d like to be rich. Rich would be fun. I’d like to have better health.” They don’t have that desire. You have to spark that desire first before you can come into taking your first step of sitting down and starting to outline your goals. Have you started to see that as you begin to develop this philosophy in the Think and Grow Rich?
I would say that when it comes to desire, that’s even more important than motivation. It’s more important than passion and a lot of people have different perspectives. Once you’re able to really hone in and focus on what it is that you ultimately want, which can be a variety of different things, everything else becomes clearer. With the focus on what you’re wanting, the alignment happens a lot faster.
Explain the part about the alignment.
Alignment is when you have a goal and then your life begins to line up with that goal in a natural way. For example, I have a goal to run a marathon. My desire is to run a marathon and to run this marathon in the next year. As a result of that desire, now the alignment in my life will be small things like having very good quality running shoes, also having a regimen or a routine of going and running preparing my body for that marathon or for that event. That’s also going to include other parts that will start coming in like which vitamins to take, which amino acids are going to replenish the body the fastest and the most effective way. As that person or as I am running and on my way to practice for the marathon, all of a sudden I will come into contact with someone else who’s also running, practicing and preparing for that same marathon. Before you know it, you have what’s called alignment. Alignment is when your life’s actions are going towards your goals so seamlessly that everything is almost propelling you forwards without your conscious or effort needs to be taken. It is happening in a natural way.
It’s more pulling you in than this struggle of trying to accomplish something by willpower and trying to overcome something.
There’s no struggle in alignment. Alignment is flow. It’s when the flow of your life is moving forward. There’s no effort necessarily. Effort a lot of times is misconstrued. Effort is something which we can put forward, but it does not mean struggle. It does not mean resistance. It actually is the opposite. When you’re putting forward positive, aligned effort, you’re able to go with the flow and life will pull you towards your goals almost inevitably rather than finding roadblocks or obstacles that will come.When you have a burning desire, you are able to create and manifest in a different way than if you are more fickle. Click To Tweet
If your desire using the example of running a marathon, as you begin to think about that desire and to create it, then all of a sudden things will begin to line up as far as maybe you’ll start to be conscious of your diet. You’ll be conscious of your sleep. You’ll be conscious of taking better care of yourself in all aspects of your life. Talk a little bit about this pulling action that transpires.
The pulling parts of burning desire are part of one of the most important aspects of the desire coming into fruition. It is more of a subconscious experience that becomes conscious, if that makes any sense at all. When anyone has a chief goal and they visualize in their mind what it is that they desire, that instantly, that moment when the desire has been seen in the mind, your body is emitting out energy. That is going out into the world and creating exactly what it is that you see in your mind that you want. As your body is pulling and giving energy out, it is also simultaneously pulling you forward like a magnet towards your goal or towards that desire. The magnet effect is seen as a random thought or as an inspired action that will happen as a result of saying you want the goal.
For example, running a marathon, I always think that’s an easy one because we have a lot of control over accomplishing a goal like that. If you put your mind’s eye on running a marathon and crossing the finish line, the moment your mind has seen that happen, your energy is already projecting out towards that finish line. Before you know it, you’ll be inspired to go to the grocery store just to go get your typical daily routine or weekly routine of fruits, vegetables and food. While you’re there, you’ll notice because you’ve activated your reticular activating system a magazine that’s about running and do you want to run a marathon? Things like that will come into your existence not because they were never there, but because now your mind has been activated to become aware of what it is that you desire.
Now that awareness is activated, you’ll notice that magazine, which by noticing the magazine you’ll be inspired to pick it up. When you pick it up, there may be an article reading about how to enhance your chances of withstanding a long-term marathon or going through a long-term process. Now you’ll have more information about reaching your goal than you ever did before and it happens by accident. It’s not something that you went to the grocery store consciously thinking, “I need to change this or make this shift,” but it happens more like a magnet. It’s pulling you towards accomplishing what it is that you want to accomplish without your conscious mind needing to tell you what you’re doing. Instead, it’s activating in your mind what it is to be aware of. As you become aware of more in your environment that is in alignment with your goals, you will be inspired to take action and then those actions will lead to other actions. Those results typically are going to be a lot more profound than what most people could expect to see if they were to do this on their own.
In the normal human mind, we might make a list. We can say, “I want a list.” Number one, I have a goal to run a marathon, I need shoes. That’s something everyone can be aware of. It’s pretty basic. Number two, I need to train. We’re pretty aware of that as well. Number three, I need a routine and so on. We can have an awareness of what needs to happen, but then there will be tweaks that we don’t know that we need to make or small changes that we’re not aware of consciously could affect our ability to reach our goal in an even better way. We don’t need to know those things upfront because the way that we become aware, that part is going to pull us towards all those small changes that we need to make.
They’ll come to us in different ways, in different forms and in different experiences than what a person could consciously imagine in their mind. It happens naturally. You may go to the grocery store and see a magazine just as easily as you may go to the coffee shop and hear someone talking about a marathon. It’s all something that will come up and it will come forward and it will come into your life. It’s up to the person to take action and to go forward towards the energy that’s already coming towards them. That’s in alignment with what they want.
That desire piece has to start first. Even though we have or we think between 60,000 and 70,000 thoughts a day, when you start this desire piece on those thoughts, 90% of those thoughts are the exact same thoughts that you had. As you begin to create this desire and let’s say the thought jumped into your mind about running a marathon, you’re going to immediately think several different things all at one time. The human mind can juggle seven different thoughts at the exact same time while you’re speaking. There is a lot of firing and wiring that’s going on in the brain, but as you grab that thought and you start to create the desire piece, your next step and which is very critical is the action piece of, “If I want to run a marathon. I need to start listing the things that I need to put together,” like the shoes, like the better eating, like the sleep. A lot of people will stumble with a left-brain analytical of, “You can’t run a marathon. You’re twenty pounds overweight and you’re too old.” All of these negative things will try to come in and that’s what you have to grab through the desire to shut those negative things down and then start moving forward.
That’s also why burning desire is so critical and so important because we all go through left-brain experiences, doubts and possible reasons to stop or quit. There will be an infinite amount of opportunities to stop or not to achieve our goals, but the part where desire is so critical is where we are able not only to see ourselves experiencing the life that we are desiring, but it is so intense in our minds. When you have a burning desire, you have something so intense that it overshadows any doubts, any fears, any obstacles because the desire is more important than any perceived failure will ever be. Nothing will be able to stop someone. When they have that chief aim, when they have that ultimate desire, there are no obstacles that can stop someone who has a definite goal. When there is a definite goal, it comes from inside of you and that magnet will pull you closer.
In fact, I’ve realized that with the burning desire for especially achievement or certain levels of success, there will oftentimes first be a failure. A lot of times, especially on the higher levels, that failure will hurt pretty bad, but the desire will overtake any of the perceived pain of that failure. It will allow that person to transmute the pain of failure into the next level which is a desire for achievement. Taking the mind off of the left brain and taking our limitations away, we’re able to really accomplish so much more in our lives just by knowing what we want. A lot of times especially in America, we have an American culture idea of what we, “Should want,” the white picket fence, 2.5 kids, $1 million in the bank.
These are all goals that a lot of us have been exposed to or heard about, but it’s really important for a person to hone in on their own personal desires which are not going to be mainstream. They are not going to be what the media or what your neighbor has going on. A true burning desire is going to be unique for each and every individual. Finding that true desire inside of your heart, inside of your mind, that is going to be the fuel that will keep you going past any obstacle, past any downturn in the market, past any death, past any health problem, past anything that could potentially stop someone. A full-blown clear intention is one of the most powerful energies that exist and when you’re tuned in to one of the most powerful energies that exist, the magnet will be equally powerful and calling you forward. I think that’s why it’s one of the most important principles in the Think and Grow Rich book. If there is no definite chief aim, if there is no burning desire to have it come to pass, then all of the obstacles will sway you and all of the left brain negative self-talk, all of that will stop anyone. That’s what it’s designed to do, but if you have step one in place and you know what that desire is for you, then nothing will be able to stop that energy from going forward.If there is no definite chief aim, if there is no burning desire to have your goals come to pass, all obstacles will sway you. Click To Tweet
We’re covering in the second part of this are captive health insurance programs. One of the things that we’re covering for the next couple of episodes is about pharmaceutical benefits and how people can start to become conscious of their pharmaceutical spend. With healthcare now, it has gotten so expensive. It has started to get people’s attention. The word disease all starts in the mind. That’s why we’ve put this blog together to help people become aware that they really can change their health outcome once they get that desire. Money is a great motivator because healthcare has done nothing over the past few years but go up and up. As people started to become conscious of this and began to get aware of this through their desire, they can have a desire to have better health and so we’re no longer controlled. Science has told us that we’re controlled by our biology and that has been proven that’s not the case. It all has to do with thought and that critical element of thought is desire.
When you have a desire for health or not necessarily even health, when you have a desire for a lifestyle that includes being healthy, it requires a healthy, capable body and energy. When that is your desire, you’re actually able to change the DNA in your body to align with your desire. Desire is the most powerful energy. More and more people are becoming conscious of the cost of healthcare but also the costs on their body of the pharmaceuticals and of the different disease affects that are happening and they’re happening at a rapid rate. Even if you individually are not the person affected, a lot of us more and more know someone personally who is going through a very serious type of sickness or disease. We’re able to see firsthand what that suffering looks like and we can know right off the bat, “That’s not what I want. That is not the route that I want to go. That is not the life I want to lead.” It forces us to think about, “How can we live differently?”
The side effects of the pharmaceutical industry and the medication, if there is another way to obtain good health, you should start to look for this and to figure out what steps you need to take in order to stay away from the pharmaceutical drug. A lot of people have not been conscious of this and that’s why we’re bringing this up and a lot of people don’t realize how powerful their bodies really are. I believe that we’ve covered in one of the programs in times past that your body has the ability to generate eleven million kilowatt-hours per pound. That’s amazing. In effect, your body could literally light up all of North America. We’ve been programmed and conditioned to feel tired, to feel apathetic and all of those things that keep you in a humdrum state. Instead of creating a desire because those thoughts are thoughts that you create. You can make a decision to say, “I’m tired of having diabetes, high blood pressure and all of these other ailments.” You can make a decision to say, “I don’t want to have that anymore. I’m going to get my desire for health and change my future.”
To someone who is not conscious or unaware already, it sounds like pie in the sky. Let me wish for something better and it will be. What it all comes down to is science has not only proven that the mind absolutely directly affects the body, but it’s also proven that by being more aware and conscious of our thoughts that we are thinking, we can change the DNA of our physical body. We can change the fact that even if you have generations of diabetes in your family, you do not have to have diabetes. Even if you have diabetes, you can change your body to heal itself, every single one of us. It doesn’t matter who you are or how you were born or what family bloodline you come from. All of us have a natural ease and natural health inside of us. Tuning into the health aspect and the ease part is all we have to do.
It’s going from disease into ease and the way that you do that is by switching the thoughts that you have on a daily basis. We have repetitive thoughts. The majority of what we think every day is the same recycled thoughts that we had. If now we are aware that we are recycling our thoughts, we can start programming our mind into thinking the thoughts that are going to cause ease, that is going to cause health, that is going to help your body become healthy and stay healthy. It then goes into autopilot. It’s as easy as those negative thoughts. It’s the positive. It’s amazing. It’s not a difficult task. It’s not about intense effort or a lot of information. It’s about having a desire for health, making that your chief aim, making that the most important aspect, and then allowing different ways of becoming healthier. It’s to come into your life and to become aware of them, taking action when you see them.
For example, someone with diabetes may say, “I’m sick of diabetes. I’m sick of poking my finger. I don’t want any more insulin. I want to live in a different way.” That moment that they say that, instantly they have manifested a healthy diabetes-free version of themselves that wants to come into manifestation. As much as they want to be healthy, their body also is matching that energy. It also wants to be healthy. All of a sudden, a commercial will flash on the TV that says, “Did you know that drinking apple juice is causing diabetes?” The person will say, “I drink apple juice every day.”
Now, you might be aware of something that you were not previously aware of that you can change. That one small change, even though it’s something menial, it’s just apple juice. That small decision will lead to other small decisions. Now, you’re no longer buying apple juice, but you’re in the apple juice aisle, you’re in the juice aisle and now you begin to start reading the labels. Maybe that person will become aware of the ingredients that are included in a majority of what they’re consuming. Their mind is aware of what they were not previously conscious of. They have the choice now to make a different decision. If they choose a different decision, then by default they will have a different result and it’s that easy.
A lot of people have missed it because it’s so simple. Being able to sit down and turn off the cellphone, turn off everything, the apps, and taking some time to sit down and to create that desire will take you into a quantum leap. That’s a great part about quantum physics that it will take you into that quantum leap that things will start lining up in your life to get you to that end goal. We’ve talked about that a lot of people are under the assumption that the brain and the mind are the same things when in fact they’re not. Your brain is an organ. Your mind is every cell in your body. Your body releases over 50,000 cells a second out of your body and those cells are going out based on the thoughts that you’re thinking.
That part that we talked about, that’s pulling that desire to you whether it’s good or bad. If you’re having bad thoughts, these bad things are coming towards you into your life. Getting on the diabetes piece that if people don’t control their eating habits, the diabetic future is where some bad things can happen with this. I was interviewing a guy, this was many years ago, and I was talking to him about his life insurance policy. He was a little bit of a heavyset guy and some way we came across diet and he made a comment of, “I like Blue Bell ice cream.” I think on the application we touched on diabetes. I told him, “You realize that when you get down that road, they will cut your feet off. Is it worth missing a foot over Blue Bell ice cream?” When he made the comment of, “I really like Blue Bell ice cream,” and that completely went over his head. I have always thought about that interview with that guy. I thought if somebody was going to cut a foot off, I would do anything to change that future event if I could.
That’s also because you understand the value of your feet. We all make decisions based on what we value. In that situation, I’m assuming that he has valued the feeling that he gets from Blue Bell ice cream more than anything else in his life. He values that feeling, nothing else matters. It’s almost like a burning desire. It’s the unconscious burning desire. He genuinely wants that feeling and it doesn’t matter if it’s going to cause them an arm or leg, a foot or his life because that feeling is what is important to him. That’s basically what happens in the other way when you have a burning desire for health.When you get to that point where you are truly aware of your power, that's when the burning desire comes into play. Click To Tweet
It can go either way. It’s a matter of what is most important, also educating yourself and understanding the purpose behind or the benefits behind being able to keep your feet, being able to keep your body in motion. It’s finding alternative ways to achieve that same feeling which I’m assuming is probably a great feeling, that enlightened feeling. I picture him eating his ice cream and bobbing his head a little bit, enjoying life. Nobody can mess with him and it’s his moment. It’s teaching him that there are other ways he can still experience that same great pleasure and not damage who he is, not destroy his health.
As a Blue Bell ice cream fan, being to have Blue Bell ice cream in moderation is a great thing. I’m not knocking that piece of it, but it is that story and it’s that desire that once he really became conscious of saying, “I need to cut out a lot of this sugar in my life. I need to go walking more. I need to start having better positive thinking. I need to begin to work on my body so I can, when I accomplish goals, have my treat of Blue Bell ice cream.”
That’s right and still get that elated feeling. It’s all in moderation. I feel whenever any disease is happening, it all comes down to being out of balance. The balance is on a cellular level if we’re talking the science of a disease, it’s a cellular imbalance. All of the imbalances that come in the body, on a cellular level, they originate in the mind.
When a doctor begins to ask you about family history, that begins to program in you that, “My father died of heart disease when he was 45. His father died of heart disease in his 40s. I’m now 35.” Now, all of a sudden that thought has started to kick in when the truth is this, your family history has nothing to do with your future. However, the medical industry will lead you to believe that it does, that it’s all heredity, and that is not the case.
In fact, even the DNA, even if on a technical level you’re carrying the DNA of diabetes, even that DNA must be activated by the mind. Even if you’re carrying some hereditary disease, that does not mean you are inevitably going to have that disease. It’s a switch in the mind of whether that DNA will be activated or not. It’s all programming of the masses and feeding into the lie that we have no control over what happens to our lives. That’s not the truth at all. The truth is whatever you believe, whether you believe it will affect you or you don’t believe it will affect you, you’re right. It’s up to you. It’s up to your belief. I’ve met people on numerous occasions who have been diagnosed with cancer. I’m telling you the number of miracles that I have witnessed by simple shifts in their mind and it took something as serious as a diagnostic of cancer before that individual was aware enough of their own power.
Sometimes that’s what it takes. However, when you get to that point where you are truly aware of your power, that’s when the burning desire comes into play. Those people, every single one of them that beat cancer or have cancer miraculously disappear or the doctors will reexamine them and say, “It looks like it’s gone. I don’t know what happened. Some miracle came.” That happens 100% of the time because that individual has a burning desire to live. They refuse to allow any doctor to tell them what their body is going to do. Instead, they change their belief system. They put it on a whole brand new hat of beliefs and they act on them in a different way. They think in terms of health, they think in terms of why their life is important. They think in terms of how they want to live moving forward. They focus their mind on life. When you’re focused on life, death cannot consume you and it’s amazing. It’s those small changes in your thought process and in those small changes and the belief system that create the massive miracles that we see on a regular basis, especially with cancer and tumors. Those two are very common to have immediate remission and instant disappearances.
Darkness never puts out light.
It’s interesting because when it comes to health, especially now, we’re in a very interesting time where almost all people will have some form of critical or chronic disease in their lifetime. That being said, statistics-wise, to me it really is highlighting that imbalance of our thought systems and our belief systems as a nation. The amount of time that people spend focused on making money or focused on looking good versus the amount of time that they focus on living abundantly is very out of balance. As a result, you see a lot of diseases and you see it on increasing scale. I think that’s because people are buying into the belief that if someone in their family has a disease, then they’re going to by default also get the disease. The moment they decide that’s the truth for them, they’ve activated it. That right there is what will activate a disease in your body even if you’re a happy, positive person. Believing that you are inevitably going to inherit some form of disease will cause it to manifest. That could be why we see such an increase at such a rapid speed.
When you look at the television programming, I was in an airport and happened to look up at the screen. Seeing the pharmaceutical content, seeing the constant barrage of programming onto the American people of healthcare and issues, what that’s doing is bringing in more worry, more concerns. A lot of people don’t know how to get out of that. The best way of getting out of it is unplugging the thing because there’s nothing out there that’s worth watching. As humans, for the most part, we’d love to be complacent. We’d love a routine. We’d love to get in a routine and when we start to get out of a routine, it’s uncomfortable for us. The reality is if you’re comfortable, you’re in the most dangerous position of your life.
Typically, when somebody has a life-altering event, at that point they wake up and say, “What do I need to do? I need to change.” Instead of saying, “I really want good health. I’m going to go get my yearly checkup. I’m going to get these things to make sure that there’s not something that I need to focus on and work on.” That gets back to that desire piece. In order to have good health, you have to have a desire for good health. This is why this is so important to CEOs and CFOs that your employees get their minds wrapped around this concept. It’s going to cost you a lot of money in the long run under your health insurance if you don’t begin to promote your employees for much better mental health. Kara, let’s bring in Fred Meijering with Echelon Advisors.Employees foregoing their prescriptions in order to save money is not a good a healthcare practice. Click To Tweet
As America goes, so goes the rest of the world and healthcare is a massive issue all over the globe. There are other countries that are going to start watching how America deals with their healthcare and how we are able to get our costs under control. That’s why I’m so excited about this piece that we’re going to do on the pharmacies and how corporations can really grab hold of their healthcare cost and their pharmaceutical cost. I had not brought that up to you before, so I wanted to let you know that the rest of the world is reading. No pressure, but let’s get into this thing. Fred, let’s talk about the pharmacy benefit managers because those guys are going to be key in order to reduce the healthcare expense.
I can do a pretty deep drill down into that. That’s helpful. I think when people read this, they don’t necessarily read all five at the same time. If we dive into this and highlight that, I can set it up early as one of the five parts which we’ve talked about in all of them as we’ve gotten into different places.
You have the floor, my friend, so take it away.
Continuing on our journey of de-bundling health plans and highlighting the independent nature and the ability to control all of the elements in the captive space, I thought we’d take a little deeper dive into the PBM, the Pharmacy Benefit Management program. You might recall the five elements for the selection of the network to rant, how the claims funds are handled? Who’s the third-party administrator? What are the stop loss and reinsurance arrangement and provider? Who’s going to do Pharmacy Benefit Management? We think about healthcare costs in the United States, they’ve been rising steadily for the past two decades. With that of course is the cost of prescription drugs and it’s become less and less affordable to get name-brand drugs and medication and there’s really no relief in sight. In fact, our indications are the opposite that they’re going to continue to rise as fast or faster than any other healthcare spend area.
The Centers for Medicare and Medicaid Services projects by the year 2022, prescription drug costs will grow to $355 billion annually. That’s in contrast to $40.3 billion that was spent on prescription drugs in 1990. That’s going from $40.3 billion to $355 billion in less than 30 years. With drug costs increasing at a faster rate than any other healthcare spending, now’s the time for employers, especially in our de-bundled arrangement to review that cost and what savings are available in mitigation strategies to help curtail that rapid spin. Ensuring your employees, your staff has the correct medications important for their health and also for your bottom line when you think about things like retention, sick days and time off and that sort of thing. Employees who only use main brand drugs might forego their prescriptions in order to save money, which is not a good healthcare practice.
This leads to lost productivity, increased employee stress and a whole host of issues related to not taking their prescribed drugs. Alternately, some employees might have a variety of main brand drugs that they take. While it’s good that they are taking their medications and attempting to stay healthy, using only name brand drugs means higher costs for employers, plan sponsors and the end-users, which is the employee. I think the first step in unpacking that and making it affordable is the consideration of generic drugs. Generic drugs can sometimes be misunderstood and labeled as subpar or not up to the same quality standards as main brand prescription drugs. Consumers recognize the brand name and consider an unknown label as an inferior product. This is unfortunate because generic drugs are not only of the same high quality as the main brands, but they usually cost much less, oftentimes 80% to 85% less.
An interesting factoid here is the United States saved nearly $1.5 trillion over the past several years by using generic drugs according to Anthem, who uses one of the most expensive Pharmacy Benefit Management systems that I’m aware of. Moreover, according to the US Food and Drug Administration, generic drugs are important options that allow greater access to healthcare for all Americans. They are copies of brand name drugs and they’re the same as those brand name drugs in dosage, in form, safety, strength, route of administration, quality, performance characteristics, intended use and all the ways that you might think about how something could be similar. An important key element about driving as much prescription business as you can to the generic part of the PBM is employee education. If generic drugs are the same high quality as brand names and they cost less, the question would be, why isn’t everyone using them?
The problem could be employee education. As part of our de-bundle captive approach, we’re constantly encouraging enhanced employee communication and awareness as an effort to arm employees to become part of the solution that controlling the unsustainable increases in the health plans and at the same time elevating their health. We should teach the employees the value of buying generics so they can save money for themselves and for the health plan. Another interesting little factoid, according to the Food and Drug Administration, generic medications save $3 billion every week and more than $150 billion annually. With boosting the use of generic medications by incorporating these strategies with the consumer in consumer-driven health plans, the prescription coverage of design that can potentially save you, employees, significant money. We know that to be the case. A good way to begin employee education is by integrating information about generic drugs in the benefit communication. It’s the open enrollment in the periodic things that are sent out by employers to employees about their health plans. Sending informational articles or emails to employee, explain the difference between generic and brand and encouraging them to request generics when filling a prescription.
You may even wish to reach out to those employees through social media with additional information about that. The FDA has a generic drug approval checklist and we find this checklist to be a powerful tool when we’re talking to groups about generic drugs. According to the FDA, a generic drug must follow the following checklist before they can be considered for FDA approval. The first is the drug pharmaceutically equivalent to the main brand. Second is the manufacturers’ ability to make the drug correctly and consistently. The third is the active ingredient is the same as the brand drug. Fourth is the active ingredient gets to the place in the body where it has the effect. It has to take the same route once it’s been ingested.
Next to the inactive ingredients of the drug are safe, the fillers and those things, followed by the drug must not break down over time. The drugs container must be appropriate to ensure unaffected quality, meaning the container that the pills are in or the foil wrap preserves that drug for the period of time of the prescription or beyond. The drug information label is the same as the brand and relevant patent or legal exclusivity on the brand have expired. Once those patents of the brand had expired, then the generic market is open to other manufacturers to make that same drug based upon that checklist.When your life's actions are going towards your goals so seamlessly that everything is almost propelling you forward, you’re in alignment. Click To Tweet
Let me see if I understand this correctly as far as the name brand, you’re basically paying for that name brand. Everything else is the same.
Exactly right. If you think about it in terms of the entrepreneur that I know you are, let’s say you invented a cure for a disease of some kind or you created a drug that had a better impact on a certain pathology or disease. You created that, you built that, you took it to market, you paid the millions of dollars in R&D to get that ready for market, you got FDA approval as a brand and it goes out as a specialty or something. You want to recoup all the money you spent getting that to market. There’s a shelf life on how long you can have the exclusive patent on that drug. It’d be the exclusive provider by extension control the price of that drug. When that patent expires, then your ingredients and your drug can be made by others and brought to market as a generic, but it is the same as what the original was.
Most pharmacies typically don’t tell you that there’s a generic available unless you ask them, is that right?
That’s right. If you think about the whole process of going to the physician for care and then the physician determines that you need a certain prescription to take care of what ails you, that decision process is not always centered around what’s a least expensive, most effective way to do this for my employee. It tends to have more to do with what’s top of mind and other factors around making that choice. A lot of times when you’re getting your prescription filled and you ask the pharmacist, “Is there a generic equivalent for this?” They’ll do a quick look or they might already know. I’ve done this personally, Joseph. I have them call back to the doctor’s office to see if we can get the script altered to the generic. I’ve never had my physician say no to that. They don’t really care. I think the primary concern of the physician is the impact of the drug on her patient. It’s a little bit more mindful about that. What’s interesting in the PBM that we use in our captive arrangement is we actually build that into the process. If something is prescribed, then there’s literally a check for generics, step therapies, those things before that prescription was fulfilled.
Is that done at the doctor’s office, that checklist? Is that at the pharmacy that there’s an instruction to check to see if there’s a generic?
It’s done by the PBM or the Pharmacy Benefit Manager. They’ll filter it there, which is a powerful thing. Our de-bundled captive approach is that we get to put those legal filters into the PBM on those things to help cost mitigation and to help drive to make sure that there is the generic or not, to make sure that less expensive step therapies may have been tried. There are things that happened before that expensive prescription is fulfilled or sustained for that individual. The priority in that process is number one, highest quality healthcare for the employee. Number two, it’s the lowest possible price. It continues our journey here on bringing consumerism to healthcare spending. Based upon what we’ve talked about, why wouldn’t you use a generic for a fraction of the cost if it’s available to you? When you continue on our PBM journey here, beyond using generic drugs, there’s a number of other ways to save money for the company and many carriers or third-parties offer options like mail order or other unique cost-saving programs.
I want to talk a little bit about some of those options. Some of these programs are carrier-specific, it might not be available to you. However, your provider may have a comparable or even different program. Any consult that we do with a group or a new brokerage or agency that we work with, we describe what these things are and the PBMs that we use on our plan. That becomes an important conversation piece when you’re bringing a client into a health captive. What are your priorities around the PBM? Is that to be the least inconvenient? Is it to be the most effective? That’s part of the console. It almost seems silly to me is it’s a half-tablet program and this program aims to reduce the number of tablets that a participant consumes while they still get the same strength of the medication. I’ll give you a quick example. If an individual needs fifteen milligrams of daily medication and they receive a prescription for 30 tablets, with a half-tablet program, individuals that receive a prescription for fifteen tablets with 30 milligrams strength. Instead of taking one, they would take a half tablet. What’s really crazy is so many times they’ll pay half for that prescription but get the same thing. We’ll even provide the tablet splitter for that. Little things like that are interesting and helpful.
Go back to the splitter and expand on that. Is that a mechanical device?
Yes, like a mini guillotine. Participants on the program only pay half of their usual script copay because they’re receiving half the number of tablets. At the same time, individuals who pay co-insurance would be paying a smaller percentage for fewer tablets. This little splitter, I don’t know think they cost $5 but it has a little indention where you put the pill. Oftentimes, there are different sizes of indention and you set it in, you push the thing down, it splits the pill for you. It’s really not difficult at all, but it can be big savings. Continuing on with other ways to control pharmacy costs, one strategy is called strategic exclusions. In this example, the carrier will monitor newly-launched, high-cost medication and will exclude it from the benefit coverage if it meets specific criteria. For example, an expensive new drug might not be offered if there’s a low-cost equivalent over in the market. This approach can save participants lots of money and not expose them to those high costs because the vast majority of people are going to the dock for something they don’t know if their scripts should cost $50,000 or $50. Excluding those drugs, which we can do in our PBM when there’s an equally as effective, less expensive approach, it’s a bit costly.
Without having that, they pretty much have an open checkbook of whatever somebody prescribes to a patient without somebody looking over their shoulder.
That’s exactly right. We call that the blind check phenomenon because if you leave it unchecked, you are allowing them to write that check on your behalf and charging whatever prescribing, whatever. This is another aspect of bringing consumerism into this equation by being aware of these things and knowing what to ask.
That really affects the employer at renewal time.
It really does. Claims should be and are the number one driver to any increase you might receive in the middle. There are even some common-sense strategies as we continue our discussion about how can we save money in the pharmacy space. Another program is called Refill and Save. This program gives discounts on copays. For those who fill their prescription on time or on schedule. The idea here is that with chronic diseases, we’ll be more engaged and better manage the conditions and UHC, what their high-priced PBM says, the participants around $240 away. Thinking about the way you handle the refill, if you’ll take mail order for 90 days and all of those approaches, you can say money on the exact same script in that way.
Another strategy is called progression prescription. In this program, similar drugs are evaluated on a cost basis and the participants are directed to cost-effective options before progressing to a more expensive alternative. We touched on something similar to that before. This is a filter that when their prescription goes through, it pings back to the patient or the participant to engage in that conversation actively either at the pharmacy counter for a bounce back to the decision or at the time the script is issued by the submission.
Fred, thank you so much for sharing this great information with us and we’ll have to pick this up next time. I’d like to leave you with this thought before we go. It’s taken from the book, Think and Grow Rich, “Success requires no apologies and failure permits no alibis.” We’ll see you back here next time. Until then, have a great day.
- Farley & Associates
- Think and Grow Rich
- Echelon Advisors
- Centers for Medicare and Medicaid Services
- US Food and Drug Administration
About Kara Atkinson
Joined Farley and Associates in July 2019. The opportunity that Farley and Associates have created for me and their product lines along with the in-depth training was well worth the 90-day process of getting connected to this system. I have been in the insurance industry for almost eight years, and I have never had this much training and support.
I work with large employer groups and am the district manager over the state of Colorado. I also work with new associates in helping bring them through the training process for life, health, property, and casualty advisory services and products.
About Fred Meijering
The executive team at Echelon Advisors has a great diversity of experience in the insurance and alternative-risk financing business. Practicing at all levels and in various different positions, from small boutique shops to the largest of national brokers, the wealth of knowledge and experience they all brought to the table collectively, ultimately came together to create Echelon Advisors.
The business environment is changing, and organizations are having to become more and more competitive to stay relevant. Because of this, we decided to focus our organization’s strategy on partnering with our clients to create innovative insurance solutions to help position them for success.