Capital Rx, Prime Therapeutics Form Strategic Alliance
Through a new strategic alliance, Prime Therapeutics will be the only PBM — aside from Capital Rx — to use Capital Rx’s JUDI platform.
Blue Shield of California CEO on PBM Shakeup: ‘It’s Going to Become the Norm’
During a fireside chat hosted by MedCity News at ViVE, Blue Shield of California CEO Paul Markovich discussed the company's decision to largely move away from CVS Caremark as its PBM and partner with several other companies.
With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?
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.
2024: A Pivotal Year in Curbing Pharmacy Costs
2024 stands at a critical juncture in the battle against soaring pharmacy costs. In 2023, prescription drug costs rose by 8.4%, a 31% increase from the prior year. Stopping this cost escalation requires restructuring the role of pharmacy benefit managers (PBMs) from multiple fronts. On one front, Congress must pass the proposed legislative reforms that […]
Pharma Just Increased the Price of Hundreds of Drugs. PBMs are Minimizing the Impact for Health Plans, Employers and Patients
While pharmaceutical companies continue to raise list prices year-over-year, we work behind the scenes to fight the trend by driving competition, negotiating with drugmakers and incentivizing the use of less expensive medicines that deliver the same clinical value.
Report: Less than Half of Employers Are Confident In Integrity of Hospitals, PBMs
About eight in 10 employers think drug costs, high-cost claims and hospital prices are a “significant threat to affordability,” according to a new survey from National Alliance of Healthcare Purchaser Coalitions.
White Bagging Policies Endanger the Lives of Cancer Patients
Insurers and PBMs are increasingly implementing white-bagging policies, which require oncology practices to obtain physician-administered infusions and other medications from designated specialty pharmacies often owned by or affiliated with insurers and their PBMs.
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A Personalized Approach to Medication Nonadherence
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.
CVS Exec: We’re Going To Find Out if Blue Shield of California’s New Drug Model Will Lower Costs
Blue Shield of California recently switched up its pharmacy benefit model by distributing responsibilities to several different vendors. The model has the potential to increase drug costs, but it remains to be seen, according to Creagh Milford, SVP of retail health at CVS Health.
Senate Finance Committee Advances Bill Targeting PBMs
The Senate Finance Committee voted 26-1 to advance the Modernizing and Ensuring PBM Accountability Act. The bill has several provisions, including delinking PBM income from prescription drug prices under Medicare Part D and banning spread pricing in Medicaid.
Nearly 2,000 Organizations Urge Congress to Pass PBM Reform
A coalition of nearly 2,000 employers, patient advocates, pharmacies, providers and businesses sent a letter to Congress on Wednesday urging the passage of legislation that would reform PBM practices.
National Alliance of Healthcare Purchaser Coalitions Develops Playbook for Managing Drug Costs
The National Alliance of Healthcare Purchaser Coalitions released a playbook on Monday that outlines the key concerns employers have about pharmacy benefit management, and provides several recommendations for employers.
Maximize Revenue and Patient Care with Strategic Weight Loss Management
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
How Payers Can Cut Through the Noise and Optimize Their PBM Partnerships
As payers work to optimize their PBM partnerships, the complexity of their agreements makes it important to increase the understanding and apply best practices to ensure transparency and value. Prioritizing the PBM relationship is critical for payers to provide competitive, cost-effective pharmacy benefits.
AHIP Targets Big Pharma in New Campaign
America’s Health Insurance Plans' new campaign aims to show how health insurers are working to create savings for Americans while also targeting Big Pharma (or more specifically drug manufacturers) for increasing drug costs. The ads will be distributed on TV, social media and streaming services.
2 Senators Release Framework Targeting PBMs
Senate Finance Committee Ranking Member Mike Crapo (R-Idaho) and Chair Ron Wyden (D-Oregon) introduced a bipartisan framework that lays out the key challenges federal prescription drug programs are dealing with, as well as potential solutions.
Express Scripts Launches New Solutions To Advance Drug Price Transparency
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.
Ohio Sues Express Scripts, Cigna, Prime Therapeutics and Humana Calling PBMs “Modern Gangsters”
The complaint alleges multiple violations of the Valentine Act, Ohio’s antitrust law, which prohibits price fixing, controlled sales and other agreements that restrain trade and hurt competition. David Yost, the attorney general decried the practices of PBMs saying that they hurt everyday Ohioans dependent on life-saving drugs like insulin.