The PBM Model of the Future: Why Payers Are Unbundling PBM Services
Javier Gonzalez, Chief Growth and Commercial Officer at Abarca, about why payers are increasingly looking for alternatives to the traditional PBM model.
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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.
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.
What CVS Stands to Gain by Setting Up Biosimilar Subsidiary Cordavis
Pharmaceutical industry observers say CVS Health’s creation of Cordavis, a new biosimilar drugs company, is part of a strategy to make its move into this market as profitable as possible.
MedCity Moves Podcast: Recent Hires, Layoffs & an Interview with Danny Sanchez, CEO of EmpiRx Health
In this month's episode, we dive into some of the recent executive appointments occurring in the healthcare sector, as well as layoffs affecting the industry. We also hear from Danny Sanchez, who recently became the new CEO of EmpiRx Health, a value-based pharmacy benefit manager.
Medicare Drug Negotiation Is the Model for the Future of Drug Pricing, Abarca CEO Says
For the first time ever, CMS is preparing to negotiate prices for drugs paid for by Medicare. This has sparked a huge debate — will the creation of this taxpayer-funded drug negotiation infrastructure be a failed experiment, or will it become the standard for the future of drug pricing in this country? Jason Borschow, president and CEO of Abarca Health, says it's the latter.
Is Interoperability Tech Worth the Investment? Experts Say Yes for 3 Reasons
Panelists at a recent healthcare conference expressed optimism about the automation technology that health plans, pharmacy benefit managers and providers can adopt to facilitate real-time data sharing. They said that such technology has potential to improve medication adherence, reduce costs and save time for both providers and payers.
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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.
Mark Cuban’s Cost Plus Drugs Turns Focus to Employers
Through the partnership, the organizations are launching EmsanaRx Plus. The product supplements employers' current pharmacy benefit offerings and provides access to Cost Plus Drugs' discounted medications.
Express Scripts Must Pay State AG $3.2M for Allegedly Overcharging for Prescriptions
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.
With PBM satisfaction on the decline, Centene switches to Express Scripts
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.
States should be allowed to regulate PBMs, according to 35 state AGs advocating in Oklahoma case
A trade association for PBMs says that state PBM regulations in Oklahoma are preempted by federal ERISA and Medicare regulations.
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.
PBM WithMe joins health navigation platform Castlight’s partner network
The company touts its personalized approach to helping patients who need the most support with medications, like those who are managing multiple health conditions.
Why the FTC’s recent decision to not study PBMs might hurt consumers and independent pharmacies
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.
3 forecasts for the PBM industry in 2022
The current landscape heading into 2022 will keep pharmacy benefits under the microscope. Plan sponsors will evaluate their PBM’s pricing model to determine if their contract will deliver predictable costs, more opportunities for increased savings and improved care for their members.
CVS sues pharmacy benefit startup Capital Rx over ‘unenforceable’ non-compete clause
After Capital Rx’s former medical director of pharmacy services got a job offer at CVS, the PBM startup claimed he couldn’t work there because of a noncompete agreement. CVS recently sued the company, saying its non-compete clause was unenforceable.
Anthem, Humana join hedge fund administrator to launch technology for PBMs
The hedge fund administrator SS&C Technologies Holdings will be the majority stakeholder, while the two payers will each hold a minority interest in the joint venture, dubbed DomaniRx. The company will develop a claims adjudication platform to support its operations.