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.

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.

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.

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.

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. 

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.

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 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.

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.

A bipartisan group of House representatives introduced the Drug Price Transparency in Medicaid Act on Friday. The bill would ban spread pricing in Medicaid programs.

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.

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. 

Confidentiality agreements typically prevent the public from obtaining a window into the cases against pharmacy behemoths but a public court filing makes this one different.

Every health plan is required to use real-time benefit tools, which allow physicians to access drug pricing and a patient’s benefit information at the point of care. But, to date, RTBTs haven’t delivered on the promised savings.

Congress must thoroughly investigate the anti-competitive behaviors of these conglomerates and act accordingly. Doing so will provide better outcomes both for patients and a more competitive marketplace for unaffiliated pharmacies.

Now is the time for Congress to answer President Biden’s call to action and pass meaningful drug pricing reform that addresses the artificially inflated cost of drugs by manufacturers, PBMs, and payer formulary relationships.

A.J. Loiacono was speaking at MedCity INVEST in late March in Chicago when an audience member requested him to address whether it is sustainable to have a system where after insurance a drug costs $150 for consumers whereas with GoodRx the same drug is $6. Loiacono took aim at PBMs but also didn’t spare the federal government.

The PBM industry—a transaction-driven industry that highlights economic distribution, resting squarely on price, rebates, and discounts—has consistently let down employers and patients with models that behave like retail.

Independent and community pharmacies seek to prevent UHG and Change merging into a “corporate monster” that will stifle competition.

PBMs today have a tremendous opportunity to help address health disparities by shifting current drug pricing and “cost vs. access” conversations to value-based discussions.

Opioid overutilization is a public health crisis, and PBMs with programs aimed at curbing abuse and educating providers can have a positive and substantial impact on clients and their members.

GoodRx priced its long-awaited IPO between $24 and $28 per share. The company could raise up to $969 million in funding.

A panel discussion at the 2020 J.P. Morgan Healthcare Conference brought together industry executives to talk about the issue of high drug prices. The conference concluded Thursday.

The Washington Post and other outlets reported that the administration has withdrawn a proposal to end rebates between pharmacy benefit managers and drugmakers.

The proposed rule, which will be officially published on Wednesday, is part of the Trump administration’s blueprint for reducing out-of-pocket drug prices. However, others have said it could raise premiums and have doubted how much power the administration truly has.

The company emphasized that the increases mostly amount to 3-5 percent and affect only 10 percent of its portfolio, but declined to reveal which drugs are affected.

In a position statement, ASCO said PBM practices can result in medication dispensing errors, harm physicians’ ability to treat patients and drive up costs.

Transparency in pricing negotiations is key to ensuring costs are brought down, experts say, pointing to state-level legislation to mandate it.

Approval for the deal – which still needs antitrust regulators’ blessing – comes months after shareholders approved CVS-Aetna merger.

Value-based drug pricing appears to be on the horizon, but there are multiple possibilities for how it will be implemented, expert says.