When the Referee Owns the Team — and Tennessee Changes the Rules
At the center of this issue is a simple question: should the entities responsible for managing prescription drug benefits also own the pharmacies that profit from those decisions?
Trump Strategy to Rein In Drug Prices Revives ‘Most-Favored Nation’ Plan of His First Term
President Trump’s executive order provides a framework for tying the prices of U.S. pharmaceutical products to the lower prices paid in other countries, what’s called most-favored-nation pricing. If drug companies do not lower their prices accordingly, the order proposes other strategies, such as importing drugs from other countries.
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Healthcare Leaders Support FTC’s Second Report on PBMs, While PBMs Criticize Findings
On Tuesday, the Federal Trade Commission released its second interim staff report on prescription drug middlemen. The report examines the impact of PBMs (specifically CVS Caremark, Express Scripts and Optum Rx) on specialty generic drugs, highlighting substantial price markups by PBMs on medications for cancer, HIV and other conditions.
What Might the Future of Prescription Drugs Look Like Under Trump?
Experts agree that the incoming Trump administration will likely shake things up in the prescription drug world — most notably when it comes to research and development, drug pricing and PBM reform.
With Direct-to-Patient Zepbound, Eli Lilly Takes a Stand Against Compounders and PBMs
Eli Lilly now offers vials of obesity medication Zepbound directly to self-pay patients at a nearly 50% discount off the drug’s list price. But more than offering patients a lower-cost alternative, this move represents a strategic stance against certain pharmaceutical industry players.
PBMs Are in Regulators’ Crosshairs But Are Regulators Missing the Point?
Proposals targeting misaligned financial incentives, price transparency, and pharmacy access are important and necessary reforms. But the consequences of failing to address pharmacy benefit managers’ use of market power to block competition and extract monopoly profits from payers and consumers will not be limited to drug costs – it will change all of healthcare for generations.
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The Healthcare Payments Industry Has a Perception Problem
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
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.
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.
High-cost Pharmacy Claims, Medical Inflation Among Top Threats for Employers
When asked what the biggest threats facing them were, 94% of employers said high-cost pharmacy claims, 91% said medical inflation and 91% said million dollar treatments being approved by the FDA, according to a new survey from the Midwest Business Group on Health.
PBMs Come Under Fire During Senate Hearing
The Senate Commerce Committee held a hearing Thursday, which discussed how the Pharmacy Benefit Manager Transparency Act would affect practices by pharmacy benefit managers, including clawbacks. Some questioned why PBMs are even necessary.
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Making Pharmacy Benefits Transparent and Returning Control to Patients and Employers
Transcarent wants to transform the digital pharmacy benefit experience, enabling self-insured employers and their staff to make more informed choices.
3 ways to reform the pharmacy benefits industry
At the upcoming INVEST Digital Health conference in Dallas set for September 28, in collaboration with Health Wildcatters, a panel discussion on the future of pharmacy benefit managers will be part of the larger conversation on employee benefits. AJ Loiacono, CapitalRx CEO, shared his perspective on the topic.
Register for MedCity INVEST Digital Health and take part in a discussion on pharmacy benefit management
The MedCity INVEST Digital Health conference in Dallas September 28 in collaboration with Health Wildcatters marks our first conference in the Lone Star state and new themes embracing employee benefits and the financial experience in healthcare. Register today!
Former OptumRx CEO launches startup Waltz Health with $35M, promising to lower drug costs
Pharmacy benefit managers have been widely criticized for opaque drug pricing practices. But Waltz Health, which was co-founded by former PBM executive Mark Thierer, aims to use insider knowledge and tech solutions to lower drug costs.
Pharmacies face extra audit burdens that threaten their existence
Pharmacy benefit managers, or PBMs, suspended in-person audits because of covid last year, shifting to virtual audits, much as in-person doctor visits shifted to telehealth. Amid added pandemic pressure, that means pharmacists are bearing significantly more workload for the audits.