Back in February, Managed Care Contributing Editor Joseph Burns wrote an article about Express Scripts (ESI) and their attempt to branch out behind its traditional Pharmacy Benefit Manager role and foray into managing overall health for a select group of companies. This appears to be a response to ever increasing pressure for transparent PBM contacts, … Continue reading Can a PBM Save Employers on Total Healthcare Spend?
This is a quick follow-up to the recent post about commercial insurance and businesses Ignorance, Inertia, and the Pharmacy Benefit. Among the observations made was a surprising tactic–some insurance companies refuse to carve out the pharmacy benefit from their insurance product offerings. If they do allow a carve-out, the medical insurance premiums often increase rather than … Continue reading Insurance Companies and PBMs
In a April 6 article, The Columbus Dispatch is reporting that a national PBM CVS Caremark is again in how water for what it pays pharmacies compared to what it charges the payer. The interesting aspect of this article is that it appears to pit CVS Caremark against Aetna, a company that CVS is attempting … Continue reading More Hot Water for National PBM?
Just in time for your Easter reading pleasure, this freshly posted article from Business Insider offers a great summary of recent PBM media coverage. Follow this link to read more.
In January, a PBM made headlines when it started aggressively dropping pharmacy reimbursements in several states. Arkansas pharmacists were among the first to recognize the problem and organize a response. Iowa pharmacists followed when they too observed the significant drop in reimbursement. The Iowa Pharmacist Association and state legislators immediately went to work. Shortly thereafter, … Continue reading Following up — PBM Agrees to Update MAC Prices in Iowa
Previously I reported that a PBM had been making headlines in Arkansas, with the Arkansas Pharmacy Association and their legislature working to correct severe cuts being made to their local pharmacists (Arkansas Leads the Way Against Anti-Competitive Actions of PBM). Similar issues have been observed in Iowa, with pharmacists in the state pushing the Iowa … Continue reading Minor Victory in Battle with PBM in Iowa
Recently, a prominent national PBM made significant and severe adjustments to their Maximum Allowable Cost (MAC) rates for generic drugs. As a result, here in Iowa we have seen a staggering increase in our Underwater (paid less than it costs us to purchase) generic prescriptions. The week that this change is obvious in the graphic … Continue reading Arkansas Leads the Way Against Anti-Competitive Actions of PBM
The role of Pharmacy Benefit Managers, the PBMs, in the US healthcare system has been detailed on this blog several times. And each time, it seems, the public is able to better understand how detrimental some of theses practices are to our healthcare system. A few days ago, a blog post from Lexology entitled PBMs and Drug Pricing: Congress and Major … Continue reading Unraveling of the PBM Industry?
The Thriving Pharmacist has spent some time in the past discussing MAC prices as they are applied to PBM-pharmacy contracts. The concept of MAC price, however, is also a tool used by the PBMs in their dealings with the payor. Despite being several years old, the article referenced below address how the PBM industry manipulates MAC prices on … Continue reading Don’t Get Caught By PBMs’ MAC Mousetraps (Repost)
AccessRx has published an excellent overview of the House Judiciary’s PBM Hearing. Click here to read their summary and analysis.
