CalPERS Selects CVS Caremark as PBM, Replacing OptumRx
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.
The Big 3 PBMs are Countersuing the FTC. Does Their Argument Have Any Teeth?
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.
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MedCity News Pivot Podcast: How Emergency Departments Are Using Real-Time Data to Improve Outcomes
How can AI benefit and improve patient outcome in the emergency department? Watch the latest episode to find out.
The FTC Is Suing PBMs Over Insulin Prices. Will It Be Successful?
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.
Payer’s Place: David Calabrese
OptumRx's Chief Clinical Officer shares his insights on the latest developments and trends he's seen in the healthcare industry.
House Committee Chairman Launches Investigation into PBMs, Rising Drug Costs
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.
Q&A: As Congressional Heat Builds on PBMs, What Is the Message From the Industry Lobby?
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?
The Power of One: Redefining Healthcare with an AI-Driven Unified Platform
In a landscape where complexity has long been the norm, the power of one lies not just in unification, but in intelligence and automation.
Getting off the PBM Merry-go-Round: How Late-stage Offer Tricks Take Employers for a Ride
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.
Why are Healthcare Costs So High? Blame the Middlemen
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.
Telehealth, online pharmacy key focus for UnitedHealth, leaders say
UnitedHealth's 2020 revenue jumped by $15 billion from the year before. As the payer gears up for 2021, leaders except to see demand for telehealth and online pharmacies continue, driving their focus on these services.
Some startups grapple with USPS delays in medication delivery
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.
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Esperion Sets Its Sights on New Areas While Maintaining Commitment to Cardiovascular Health
In a recent interview, Esperion president and CEO, Sheldon Koenig talks about the reality of statin intolerance and his company’s expansion into new diseases
Why a VC frustrated by the PBM industry decided to start an alternative
Boston, Massachusetts-based WithMe Health launched out of stealth with $20 million in funding and Oak HC/FT Partner Chris Price at the helm.
Justice Department approves $69 billion CVS Health-Aetna deal
Regulatory approval for the purchase is predicated on Aetna's previously announced plans to sell off its Medicare Part D business to WellCare Health.
PBM practices harm care for cancer patients, oncology professional group says
In a position statement, ASCO said PBM practices can result in medication dispensing errors, harm physicians' ability to treat patients and drive up costs.
Report: Government can put an end to PBM drug rebates, HHS secretary says
Cracking down on manufacturer rebates for PBMs is part of administration plan to cut drug and out-of-pocket costs.
UnitedHealthcare personalizes Health4Me app to close care gaps
Before the end of the year, UnitedHealthcare will add "clinically focused" notifications to Health4me, based on individuals' claims data.