Healthcare Reform And How It Can Effect The Distribution Of Prescription Medication

Jim Skinner
Presenter: Neal Howard
Guest: Jim Skinner
Guest Bio: Jim Skinner is the founder and president of the Smart Patient Academy, an insurance benefits enrollment and communications company based in Texas. Its sister company, JMS Benefit Solutions, is an insurance brokerage and consulting firm that works with mid-size employer groups, both domestic and foreign owned

Segment Overview
Jim Skinner discusses Healthcare Reform and how it can effect the distribution of Prescription Medications.


Health Professional Radio

Neal Howard: Hello. You’re listening to Health Professional Radio. I’m your host, Neal Howard. It’s our pleasure to have in studio today Mr. Jim Skinner, health insurance broker and also an expert, not only in health insurance but in the Affordable Care Act. He’s also a cancer survivor more importantly, and an author, the author of Smart Patient, Smart Money: The Essential Playbook for the New Health Care Consumer. How are you doing this afternoon, Jim?

Jim Skinner: I am doing well.  I appreciate the opportunity, Neal.

Neal: It’s my pleasure to have you in studio today As an author, Smart Patient, Smart Money: The Essential Playbook for the New Health Care Consumer available at Amazon, Barnes & Noble, and also at your website,, first of all, why did you write the book, and how did you come to found Smart Patient Academy?

Jim: Well, I’ll tell you.  If you’ve ever gone through, as I know you have, Neal, a cancer situation, you really feel lost, out of control, and somewhat intimidated in a system that doesn’t need to be that hostile.  It doesn’t need to be that hard.  So it took me probably about 10 years to go through this process and to come out the other side and distil some of my expertise in health insurance and combine that with the experience I had as a patient and pull that all together and found a company called Smart Patient Academy, whose real mission is to change the dynamics for the experience of the patient as a health care consumer.

In other words, to change that dynamic from being intimidated, out of control, and at a lack of confidence to one of being empowered and confident.

Neal: So basically, alleviating the fear that normally goes with an illness, especially one as a serious as cancer or something that requires chemotherapy or long-term care.  You’re attempting to give us tools to not be as afraid, yes?

Jim: Yes.  It’s to be more empowered as a patient and to help you navigate through the system.  It’s “smart patient, smart money,” but it’s not so much about the money as it is about the impact of the care, the impact on your life, how to help others navigate through the system.  Because let’s face it.  You and I are not always the patient.  We might be assisting somebody who’s a patient, who needs a hand.  So that’s why I wrote the book.  It’s trying to help people get through this process so they don’t have to reinvent the wheel.

Neal: Now, in your book, you include a chapter on prescription medication and how sweeping health care reform could possibly affect how these drugs are prescribed.  When it comes to the prescription drug problem, especially for someone in their upper years, is there any benefit that the Affordable Care Act can offer?

Jim: Well, there’s a lot of conflicting information, is what I would say to begin with.  So the way the Affordable Care Act or Obamacare was supposed to work and the way it’s actually working are two different things.  We’re wandering off into territory in a policy sense where we’ve never been before.  So I can tell you some of my instincts, some of the trends that I see going on.

Neal: Sure.

Jim: That’s about as good as anybody can get with this.  When it comes to exchanges, those are obviously … each state has its exchange, and if they opted out of creating their own exchange, then they had the federal exchange imposed upon them.  Part of the problems with the exchanges is that … let me back up one step.  Part of the problem with all of the health care reform is it jacked up the prices on individual policies 100 to 200 per cent.  They just really jacked them up.

So one of the ways that the carriers have tried to mitigate that rate increase a little bit is to change the policies that are offered through the exchanges versus what they would offer outside of an exchange.  So, for example, you might see something offered in the Kentucky exchange where you could go through and get a plan with a prescription drug plan.  But you’ve got to really read the fine print as to what’s on their formulary.  The formulary is the list, the menu, if you will, of covered drugs.  That’s a moving target, and they can change those at any time.

So just buying a policy with this prescription drug coverage in it doesn’t necessarily mean that the drug that you’re taking is going to get covered.  You’ve actually got to do some homework.  So you’re finding at the end of the day a lot of confused people, very frustrated people, which kind of goes back to regardless of what happens with Obamacare, we really need to be aware and ask a lot of questions and put on that consumer hat and be very inquisitive about the details of what you’re buying.

Neal: Now, you did talk about companies that offer information as to pricing from one region to another, from one doctor to another.  They help you to navigate through this 200 to 500 per cent price differential in the same type of procedure.  Are they are any companies, or is there any information that can do the same when it comes to prescription drugs?  For example–

Jim: Sure, same company.

Neal: Oh, the same companies do the exact same thing?

Jim: Yeah, The same companies can shop for you a procedure, like an MRI, or they can shop for you prescriptions as well.

Neal: Now, are these companies, are they operating at an additional cost?  You’re already paying for your premiums for your new health care that you’re required to have.  Is there an additional cost, or is this information that they can give free of charge?

Jim: No.  The one that I’m talking about, that I was referring to, was generally offered through a company.  It’s an additional, say, $5 a month, something like that for that service.  But you can go out to websites like  I have some other sites that are listed in the book that talk about kind of a do-it-yourself approach to shopping prescriptions.  Let me give you an example of a success story on prescriptions, because it’s not all bad news.

We had a customer come in … we did some training out there for a group, and this guy came back to me several months later, and he said, “Hey, Jim.  I just wanted to let you know that I was shopping a prescription.  I had my prescriptions at Walgreens.  You told me that one of the cheaper places to go get drugs is over at Costco.  So what I did is I called up Walgreens and told them I was going to move all my prescriptions to Costco, which really did.  I just went online and looked up, and the prescription was significantly lower.”

What Walgreens ended up doing was they said, “You know what?  We’ll do a price match for you on every drug that Costco offers.  And oh, by the way, here’s a $50 gift certificate for not moving your account.”

Neal: Huh.  A little incentive to stay.

Jim: Right.  Exactly.  So it does in particular pay to go look for prescriptions and shop for prescriptions.  Most people know about generics, but I’ll just repeat that if you’re taking a name-brand drug and there’s a possibility of a generic, you should be asking for that.  This is another piece of the puzzle that you need to ask your doctor about, and a surprising number of people don’t do this.  Let’s take one step or one key bit of information that most people don’t know is they think that their doctors know the prices of things.  They do not know.

Doctors do not know the price of anything.  If they do, it’s just through personal experience.  So it’s like going to dinner with somebody who’s ordering off a menu, and they’re buying lobster dinner and you’re paying the bill.  You might have been happy with a hamburger, but he’s ordering the lobster because it’s the last thing on his mind and it looked good.  So my point is, unless you ask the doctor to write a prescription in a way that gives the pharmacist the flexibility to find the lowest-cost alternative, you might just be paying a lot of money for prescription that’s not necessary.  It’s a real simple question.

Neal: With so much information out there, it just seems to me that the intimidation factor could be overwhelming.  You transition back to just saying, “Well, you’re the doctor, help me.”  You give up, basically, is what I’m saying.  You give up because the information is just overwhelming.  In your book, Smart Patient, Smart Money, you kind of compress and concentrate information in a digestible, understandable format, yeah?

Jim: Exactly.  We try to put it in language that people understand, and we make analogies that make sense to all of us.  It’s not insurance-ease.  We tell people how to digest it and make it somewhat entertaining as well.

Neal: Because we’re not all doctors.

Jim: Yeah.  No, we’re not all doctors.  I was on a phone call earlier today, and they were talking about a study that was done by one of the big accounting firms that said that only one out of eight people in the United States with health insurance actually know what a co-pay is and a deductible is.  One out of eight.  A lot of people are very lost, and they do get intimidated.  That’s why I wrote the book, is they need guidance.  They need some hand holding.  They need confidence.  It doesn’t need to be as overwhelming.

And I think my biggest pet peeve is that almost every medical situation people have gone through that you can imagine, someone else has gone through before you.  They’ve tackled these problems before you.  Yet all this information and these stories are siloed someplace, and there’s nobody releasing this information, so as a new consumer of health care, a new patient, you don’t need to reinvent the wheel.  Somebody went through it before you.  So you should be able to learn.  That’s why we created this company and wrote the book.

Neal: Great, great.  You’ve been listening to Health Professional Radio.  I’m your host, Neal Howard.  We’ve been talking to Jim Skinner today, health insurance expert and also well-versed in the Affordable Care Act.  We’ve been here today talking about how some of the changes in the new law will affect us as we search for prescription  medications.  Also, we’ve been talking about how not to place so much confidence in what your physician may know as related to pricing.  That is a bit of information  that I certainly didn’t know.

I was almost positive that when my doctor prescribed something, he knew exactly what the cost was.  Or if he recommended a procedure or a specialist, that he knew what was going to be coming out of my pocket and that he knew how much it was going to cost overall.  That’s just not the case.  So your new book, Smart Patient, Smart Money, is designed to help people like myself to navigate the new health care law and also to educate other health care professionals to have a better impact when it comes to taking care of patients.

It’s been great having you here with us today, Jim.

Jim: I appreciate it, Neal.  Thanks so much.

Neal: Transcripts of this program are available at and also at

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