A judge recently blocked an Arkansas law that would have banned PBMs from owning and operating pharmacies in the state. Although the state plans to appeal, one expert says the law likely has no future.
CalPERS has entered into a five-year agreement with CVS Caremark, who will provide outpatient prescription drug benefits for about 587,000 members enrolled in basic or Medicare HMO or PPO plans.
Arkansas became the first state to pass a law banning pharmacy benefit managers from owning pharmacies, aiming to curb their market power and reduce drug costs. But major PBMs like CVS and Express Scripts are suing, claiming the law is unconstitutional.
On Tuesday, the Federal Trade Commission released its second interim staff report on prescription drug middlemen. The report examines the impact of PBMs (specifically CVS Caremark, Express Scripts and Optum Rx) on specialty generic drugs, highlighting substantial price markups by PBMs on medications for cancer, HIV and other conditions.
After the FTC filed a lawsuit in September, accusing the three major pharmacy benefit managers of anticompetitive rebating practices related to insulin, the defendants reversed roles and became plaintiffs. In November, they countersued the agency, arguing that its lawsuit is unconstitutional.
The Federal Trade Commission has sued CVS Caremark, Express Scripts and Optum Rx, alleging that they engage in "anticompetitive and unfair rebating practices” as it relates to insulin. One legal expert believes the FTC might win this legal battle.
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Blue Shield of California is cutting many of its ties with CVS Caremark (though not all) and adding four additional partners for its prescription drug benefits. These partners include Mark Cuban Cost Plus Drug Company and Amazon Pharmacy. The changes are needed to disrupt the current broken system, said Salina Wong, senior director of clinical pharmacy programs at Blue Shield of California.
CVS Caremark and GoodRx created a new program called Caremark Cost Saver, which will become available starting January 1, 2024. Through the program, eligible CVS Caremark commercially insured members will have access to GoodRx’s prescription pricing on generic medications.
James Comer (R-Ky), House Committee on Oversight and Accountability chairman, sent letters to the Office of Personnel Management, Centers for Medicare and Medicaid Services and the Defense Health Agency asking for documents that show how PBMs’ practices are affecting federal government healthcare programs. In addition, he sent letters to CVS Caremark, Express Scripts and OptumRx, asking them to provide information on their tactics.
The largest six pharmacy benefit managers are being scrutinized by the Federal Trade Commission, while Congress is debating the Pharmacy Benefit Transparency Act. Meanwhile, states have their own ideas for reining in what they see as excesses of the industry. With all this heat, what is the message from the head of the Pharmaceutical Care Management Association?
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High prices have drawn other critics, as well, including President Joe Biden. He renewed his call for a broad price cap during his annual State of the Union address. Pharma companies insist they have been part of the solution.
California's Office of the Attorney General contends that drugmakers and pharmacy benefit managers work together to “aggressively raise the list price of insulin in lockstep with each other to artificial levels.” Insulin manufacturers deny the allegations, pointing to availability of lower-cost versions of their products.
Large employers, particularly self-insured companies, can demand a better and fairer system. They can use their contracting power to insist that their plans cover all FDA approved drugs.
Confidentiality agreements typically prevent the public from obtaining a window into the cases against pharmacy behemoths but a public court filing makes this one different.