PBMs
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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.
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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.
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Jorie Healthcare CEO Shares Why Automation is Critical to Revenue Cycle Management
The revenue cycle management business is using AI tools to automate cumbersome tasks to help hospitals operate more efficiently. It’s beginning to attract the attention of major healthcare organizations.
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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.
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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.
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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.
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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.
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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.
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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.
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Health Services, Payers, Legal
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.
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Navigating Healthcare’s Data Revolution: Priorities, Opportunities, and Challenges for Health Systems
Arcadia recently partnered with HIMSS Market Insights to survey executives, IT, technology, and clinical leaders. Here’s what we found.
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Bipartisan Legislation Efforts Build Against PBMs
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.
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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.
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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.
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Specialty pharmacy serving HIV patients wins arbitration against CVS in rare public case
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.
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Health plans, this is why real-time benefit tools have let you down
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.
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Free market is at risk because of PBM titans’ anti-competitive behaviors
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.