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PBMs

Pharma is Scrambling to Respond to Upcoming Medicare Drug Pricing Negotiations

June 16th, 2023|Categories: Featured, Industry News|Tags: , , , , |

With Medicare drug price negotiations, pharma is looking for a move to either delay or block the process and prepare for it in the meantime. Merck and the US Chamber of Commerce filed suit against the Centers for Medicare and Medicaid Services (CMS) earlier this month. Others, including the industry group PhRMA, have spelled out potential consequences of the negotiations.

PBMs in the Hot Seat: Scrutinizing and Regulating the Industry

June 16th, 2023|Categories: Featured, Industry News|Tags: , , , , |

Pharmacy benefit managers (PBM), which act as middlemen that help set formularies and drug prices, have faced a wave of US congressional scrutiny in recent months. This includes hearings, committees, and even legislation. In a new Mintz article, catch up on all the latest updates on federal activities targeting the industry and its practices.

Drug Prices from Major Brand Names Dropped ~50% Last Year

June 15th, 2023|Categories: Featured, Industry News|Tags: , , , , , |

According to new data released by the Drug Channels Institute, brand-name drug prices from 10 key manufacturers dropped by half last year after discounts and rebates were accounted for. The manufacturers include Eli Lilly, Johnson & Johnson, Novo Nordisk. Much of the savings, however, have gone to pharmacy benefit managers.

PBM Industry Pushes Back Against Pharma Lobbyists

June 6th, 2023|Categories: Featured, Industry News|Tags: , , , , |

Amid growing scrutiny of pharmacy benefit managers (PBMs) at the public and congressional level, a PBM industry group has launched an ad campaign pointing the blame back at pharma for high drug prices. The group argues that the pharmaceutical industry has spent millions of dollars on advertising and lobbying that places the onus of high drug prices on PBM practices while side skirting their own responsibility for setting list prices.

Better Employee Health Through Specialty Rx Carve-Outs

June 2nd, 2023|Categories: Featured, Industry News|Tags: , , , , |

Specialty Rx carve-outs allow for dedicated management of high-cost specialty medications by bypassing traditional pharmacy benefit managers (PBMs). Doing so, according to a new article in Corporate Wellness Magazine, can help improve employee health by applying specialized expertise to coverage decisions, better coordinating care management, and reducing costs.

Talking 340B with Sara Hearn of RxBenefits

May 19th, 2023|Categories: Featured, Industry News|Tags: , , , , |

The US 340B program requires drugmakers to provide certain medications at a significant discount to safety-net care centers that provide care for patients in economically disadvantaged areas through Medicaid and Medicare Part B. In a new BenefitsPRO interview with Sarah Hearn of RxBenefits, learn how the 340B program has impacted manufacturers and commercial payers.

FTC Requests Information from Group Purchasers in PBM Probe

May 18th, 2023|Categories: Featured, Industry News|Tags: , , , , |

During its ongoing probe into the pharmacy benefit manager (PBM) industry, the US Federal Trade Commission (FTC) requested information regarding two group purchasing organizations, which negotiate discounts for PBMs. The two companies included Zinc Health and Ascent Health Services, adding to the growing list of companies interrogated in the probe.

Exploring Insulin Pricing Practices and Their Effects on Patients

May 18th, 2023|Categories: Featured, Industry News|Tags: , , , , |

Shortly after the passage of the US Inflation Reduction Act, which capped the price of insulin for some patients, three major drugmakers pledged to drop list prices for their insulin products. In a new IQVIA article, learn more about the role of insulin in diabetes management, the underlying forces driving insulin prices, and how this affects patients.

PBMs and Pharma Leaders Point Fingers During US Senate HELP Committee

May 11th, 2023|Categories: Featured, HEOR Feature, Industry News|Tags: , , , , |

At yesterday’s US Senate Health, Education, Labor, and Pensions (HELP) Committee hearing, representatives from pharma and the pharmacy benefit manager (PBM) industry are blaming one another for high prescription drug prices. While PBMs argue that drugmakers could lower list prices on their own, pharma reps argue that PBMs’ practices drive drug prices up.

US PBM Bill Markup Hearing Postponed Until May 11th

May 3rd, 2023|Categories: Featured, HEOR Feature, Industry News|Tags: , , , , |

US Senators were geared up for a hearing to markup a bill targeting practices of the pharmacy benefit manager (PBM) industry that are alleged to be anticompetitive and drive up drug prices. However, this meeting has been delayed until May 11th so that the markup can occur after a May 10th hearing featuring testimony from major pharma and PBM leaders.

US House Committee to Hold PBM Hearing

April 26th, 2023|Categories: Featured, Industry News|Tags: , , , , |

Today, April 26th, a representative for the pharmacy benefit manager (PBM) industry will speak before the US House Energy and Commerce Health Committee in a hearing focusing on improving transparency and countering anti-competitive practices. The industry, to be represented by Kristen Bass of the Pharmaceutical Care Management Association (PCMA), has faced significant public and congressional scrutiny in recent years over allegations that their processes are opaque and push smaller pharmacies out of the market.

US Senate Finance Committee Unveils Plan to Regulate PBMs

April 21st, 2023|Categories: Featured, HEOR Feature, Industry News|Tags: , , , , |

A group of US senators in the Senate Finance Committee have released their plan to implement regulation targeting the pharmacy benefit manager (PBM) industry. The plan proposes changing how PBMs get compensated for drug sales, increasing transparency, and holding them financially and legally accountable for violations.

Cigna PBM Announces New Pricing Strategy

April 14th, 2023|Categories: Featured, Industry News|Tags: , , , |

Cigna has announced a new pricing plan for its pharmacy benefit manager (PBM) arm that it promises will lead to increased transparency. The move comes as the PBM industry faces increasing public scrutiny over its lack of transparency and allegations of anti-competitive practices that drive up drug prices for patients and payers.

US Senators Looking to Make Changes to Upcoming Legislation on Generics and PBMs

April 7th, 2023|Categories: Featured, HEOR Feature, Industry News|Tags: , , , |

US Senators Bernie Sanders (I-VT) and Bill Cassidy (R-LA) are looking to April 19th when they can start deliberating on changes to an upcoming piece of legislation about generic drugs and the pharmacy benefit manager (PBM) industry. The bipartisan effort comes after increasing public and congressional pressure on PBMs and drug prices.

PBMs Catch Heat from Both Parties in US Senate Finance Committee Hearings

March 30th, 2023|Categories: Featured, Industry News|Tags: , , , |

US Senators from both sides of the aisle put forward several ideas on how to reform the pharmacy benefit manager (PBM) industry, which negotiates drug prices and coverage decisions between pharma, payers, and pharmacies. Although the senators acknowledged that PBMs cut prices for many patients, they lambasted the industry’s lack of transparency and practices that raise costs for older adults enrolled in Medicare part D.

Patient Advocacy Groups Embroiled in Copay Suit with PBMs

March 7th, 2023|Categories: Featured, Industry News|Tags: , , , , |

A rule from the Centers of Medicare and Medicaid Services (CMS) allows pharmacy benefit managers (PBMs) to ignore copay assistance programs from drug manufacturers when accounting for out-of-pocket drug costs for patients. Patient advocacy groups have filed suit against CMS to contest this rule from the Trump Administration.

Abarca CEO: Drug Pricing to Follow Model Set by Medicare Drug Negotiations Going Forward

February 21st, 2023|Categories: Featured, Industry News|Tags: , , , , |

With the impending Medicare drug pricing negotiations in the next few years, the future of drug pricing is uncertain in the US. According to Jason Borschow, CEO of the pharmacy benefit manager (PBM) Abarca Health, thinks that the pricing model will be the default for the pharma and biotech industries going forward.

Optum Rx Launches Tool to Match Patients with Cheapest Generic Drug Prices

January 24th, 2023|Categories: Featured, Industry News|Tags: , , , , |

The massive pharmacy benefit manager (PBM) Optum Rx has launched its Price Edge tool that promises to lower generic prescription drug prices to patients. Price Edge scans through prices and pairs patients with the most affordable generic that matches their prescription. Purchases will apply to patients’ deductibles and out of pocket maximums, the company says, and will be applied to members automatically.

Insulin Manufacturers and PBMs Sued by State of California in Pricing Practices Dispute

January 13th, 2023|Categories: Featured, Industry News|Tags: , , , , |

The US state of California has filed suit against three major pharmacy benefit managers (PBMs) and the three largest insulin manufacturers over practices meant to spike the price of insulin. The pharma companies, including Novo Nordisk, Eli Lilly, and Sanofi, are accused of colluding, while the PBMs are accused of designing rebates to encourage manufacturers to raise list prices.

Managed Healthcare Executive Top PBM Articles of 2022

December 29th, 2022|Categories: Featured, Industry News|Tags: , , , , |

Managed Healthcare Executive has covered pharmacy benefit managers (PBMs) extensively over the past year, as the industry and its practices face increasing scrutiny. In a new compilation, the Managed Healthcare Executive staff share their most viewed articles about PBMs in 2022. The first is about the 3 titans in the industry.

AJMC View: PBM GER Fees Threaten Specialty Pharmacies

December 26th, 2022|Categories: Featured, Industry News|Tags: , , , , |

Many medically integrated specialty pharmacies (MIPs) take a hit when filling prescriptions due to PBM fees known as generic effective rate (GER). This can reduce patient access by disincentivizing the prescribing of these drugs. In a new AJMC View, authors Darrel L. Willyard, PharmD, and Alexis V. Fanshier, BA, explain how GERs impact specialty pharmacies and patient health outcomes.

Improving Medication Access by Addressing Price Instability

December 15th, 2022|Categories: Featured, Industry News|Tags: , , , , |

US citizens and residents pay more for prescription medication than those living in any other country, causing many to forgo life-saving medication. This problem is worsened by seemingly random fluctuations in price due to shifting rebates, discounts, and formulary inclusion on the part of drugmakers, payers, and pharmacy benefit managers (PBMs). Tackling price instability by considering national drug acquisition costs may be the first step to addressing high drug prices.

Employers Reaping Benefits from Patient Assistance Programs

December 14th, 2022|Categories: Featured, Industry News|Tags: , , , , |

An increasing number of employers are leveraging patient assistance programs intended for patients to help cut spending on employee health plans. These programs, long objected to by many employers, are offered by drugmakers to help cover expensive treatments when a plan deems the treatment nonessential due to cheaper alternatives. This has led to employer plans changing essential status to capitalize on these programs.

Will Global Drug Price Transparency Improve Access for Patients?

December 9th, 2022|Categories: Featured, Industry News|Tags: , , , , |

With conversation building worldwide about growing drug prices, many have recommended efforts to increase global drug price transparency. This allows countries to make comparisons when negotiating prices with drug manufacturers. However, easy comparisons are not always possible, and the problem of high drug prices goes far beyond manufacturers.

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