Cost-Containment

The ruling underscores an escalating legal fight over who controls out-of-network reimbursement decisions.

Clear plan communications and careful provider network management may help.

New final federal regulations will also require plans and insurers to answer questions related to eligibility within five days.

"I have patients increasingly coming to me saying, 'I hear it's not as expensive to get the pharmaceutical-grade branded version, can we switch over?'" said Dr. Michael Weintraub, assistant clinical professor of endocrinology at NYU Langone in New York.

The direct-to-consumer pharmacy worked best when patients faced cost-sharing bills over $15 for a generic drug.

Workers ages 45 to 61 are filling many prescriptions, and they have many surgical procedures scheduled.