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.
Multiple stakeholders are to blame for prescription drug costs, including pharmaceutical companies and PBMs, according to Merith Basey, executive director of Patients for Affordable Drugs.
Executives from Imagine360, Verily, BrightInsight, Lantern, and Rhapsody shared their approaches to reducing healthcare costs and facilitating digital transformation.
Express Scripts released several new solutions last week that aim to improve drug price transparency, including a cap on out-of-pocket costs for prescription drugs for consumers. The news comes amid increasing scrutiny against pharmacy benefit managers.
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.
Here is a selection of recent executive hires, departures and layoffs occurring across the healthcare industry.
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.
Closing cancer health equity gaps require medical breakthroughs made possible by new funding approaches.
Following an investigation, the AG claimed Express Scripts, “billed and obtained payment for prescription drugs from payers of workers' compensation claims in excess of amounts permitted by Massachusetts laws and regulations,” according to court documents.
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.
Centene is swapping CVS Caremark with Express Scripts. A recent survey that measured benefit leaders' satisfaction with their PBMs found that Express Scripts performed better than CVS Caremark.
The company is rolling out an app for users to show proof of vaccination using a QR code. It can automatically pull in vaccine records for people whose health plans use Express Scripts and who got vaccinated at a pharmacy.
As technology advances, AI-powered tools will increasingly reduce the administrative burdens on healthcare providers.
Some healthcare startups that offer at-home prescription deliveries and test kits have experienced delays with the USPS. They shared how they're navigating the changes.
Lightened regulations and cancelled appointments have led to an uptick in the number of patients using digital therapeutics. But companies still face many of the same obstacles as before, including securing coverage and reimbursement from insurers.
Senators Chuck Grassley and Ron Wyden are demanding that Cigna turn over documents on insulin pricing, as part of a larger probe on rising insulin costs. The lawmakers claim that large pharmacy benefit manager Express Scripts, which Cigna acquired in 2018, is failing to comply with the investigation.
Cigna CEO David Cordani shared more details with investors about two upcoming partnerships for the company with Prime Therapeutics and Oscar Health.
Digital health companies faced bad news going into 2020, from job cuts to dissolving pharma partnerships. But these struggles are part of an industry that is finding its identity in a crowded healthcare market.