For anyone suffering from a debilitating or life-threatening disease, the experience of procuring specialty medications is like having a second job. You are your own advocate working in a draconian system that was developed as a business, not a care service. When you’re finally successful, after what can be weeks of delays, you’re met with […]
As pharma becomes part of the value-based revolution, there are several lessons that can be learned from the ongoing development of value-based care.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
2023 is shaping up to be a crucial year for everyone involved – and affected – by the pharmaceutical industry. It's likely to be a year of experimentation for payers – and defensiveness for drug makers.
Requiring that PBMs bid on a per member per month guarantee would reduce the employer’s uncertainty by securing the actual per member per month cost to the employer.
A trade association for PBMs says that state PBM regulations in Oklahoma are preempted by federal ERISA and Medicare regulations.
In a rapidly changing and expanding healthcare environment, the secure exchange of health information and price transparency enabled by real-time benefit tools is critical to improve patient safety, lower costs and ensure quality care.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
Value-based pricing could have shown us with more certainty the real level of effectiveness of Aduhelm. Maybe it is worth paying something for; and value-based contracts are the only way to figure that out.
CVS Health intentionally prevented certain Medicare beneficiaries from accessing less expensive, generic prescriptions, according to a whistleblower lawsuit from a former senior CVS executive. Documents from the lawsuit were recently unsealed,. “In doing so, CVS Health has ensured astonishing profits for itself while passing the increased costs onto taxpayers and Part D beneficiaries,” the whistleblower […]
Capital Rx recently closed a $106 million Series C funding round, bringing its overall funding to $175 million. The upstart pharmacy benefit manager will use the funds to enhance its digital pharmacy platform as well as grow its user base.
Pharma companies often take the blame for high prescription costs. But a new, industry-sponsored survey shifts attention to insurance industry practices.
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
Congress must thoroughly investigate the anti-competitive behaviors of these conglomerates and act accordingly. Doing so will provide better outcomes both for patients and a more competitive marketplace for unaffiliated pharmacies.
A.J. Loiacono was speaking at MedCity INVEST in late March in Chicago when an audience member requested him to address whether it is sustainable to have a system where after insurance a drug costs $150 for consumers whereas with GoodRx the same drug is $6. Loiacono took aim at PBMs but also didn't spare the federal government.
The idea of helping millions of Americans with diabetes afford a crucial medicine has immense public support and even bipartisan adherents. But then, there is politics — between Democrats and Republicans, of course, but also among Democrats.
With its ruling to maintain the status quo, the FTC has decided to take a back-seat and force independent pharmacies to fend for themselves in their on-going fight to secure access to fair prices that allow them to stay in business and continue to serve their local communities and the well-being of their patients.
When your organization asks for a lowest-net-cost formulary, what you’re really saying is, “I want the deepest contractual discounts aligned with my formulary without disruption.”