CVS/Aetna: State Regulators Urged to Investigate CVS Caremark Reimbursement Cuts, Solicitation Letters, as Part of Aetna Review

Independent pharmacists are urging state insurance regulators – as part of their reviews of the CVS/Aetna merger – to examine CVS Health’s recent move to slash smaller rivals’ prescription reimbursements and then offer to buy their stores.

The reimbursement cuts, some of which involved drugs used to treat digestive illnesses and other chronic conditions, occurred around October 25—five weeks before the December 3 Aetna deal announcement, a dozen independent pharmacists said. The cuts affected pharmacies in a number of states, including Florida, Kansas, Maryland, Ohio, Washington, and Wisconsin.  Read more …

Reported by The Capitol Forum on January 12, 2018

By Ivan Kelly

The Proposed CVS–Aetna Merger Could Threaten Patient Privacy

Aetna is notable for not selling anonymized patient data—but CVS, like many pharmacy chains, does.

The proposed merger between pharmacy chain CVS and insurer Aetna would give the new combined company greater leverage to engage in a commercial trade in patient data that is largely hidden from the public but completely legal.

Prior to the proposed merger, Aetna was notable among leading insurers for not selling anonymized patient data. By contrast, CVS, like many pharmacy chains, has long sold and traded prescription records without patient names to medical data mining companies such as IMS Health, which in November renamed itself IQVIA.

“Business being business, I’d be shocked if Aetna’s conservative policies weren’t relaxed following completion of the merger,” said Tom Russell, the former chairman of IMS, long the dominant medical data mining company.

Read more here…

  • By Adam Tanner on December 14, 2017
  • Scientific American

Insurance not always the best deal for prescription drugs

Just because a prescription is covered by insurance doesn’t mean that you’ll be paying lessfor them. In fact, you might be paying more, according to a New York Times/ProPublica report. The review found Americans may be overpaying for as much as one in every 10 prescriptions by using their insurance instead of seeking out an alternate source and paying cash.

The report said that the “shocking” revelation that individuals can do better for themselves than the drug prices negotiated by their insurers is revealing a problem that is far more complex than “the seemingly simple act of buying a bottle of pills.” It adds, “[A] host of players—drug companies, pharmacies, insurers and pharmacy benefit managers—are taking a cut of the profits, even as consumers are left to fend for themselves.”

Read more here…


The New Goal for PBMs: Transparency Opaqueness may be on the way out

In a bid to provide greater disclosure, some large companies have sought alternatives such as forming alliances as a way to purchase prescription drugs, bypassing the traditional PBM model. Others have turned to PBMs where revenue is  generated through a disclosed and fixed fee per member per month, or a per-claim administrative fee.

Pharmacy benefit administrators (PBAs), are also increasing in popularity. PBAs manage administrative services for the plan sponsor, including claims processing and data reporting.

Derek Daggett, Senior Sales Executive for San Francisco-based PBM SmithRx, told Drug Topics that he’s been seeing an increase in the number of transparent PBMs.

“Within the last five years, transparent PBMs have gone from being an outlier in the industry to now representing 40% of contracts,” he said. He added that the number of truly transparent contracts (meaning full disclosure of network contracts, no spread, and full pass through of rebates) is comparatively low.

Read more here…

December 12, 2017

New SCPC Comments to FTC Detail Steps to Foster Competition in Pharmaceutical Pricing and Supply Chain

2017 Year-End Focus on Drug Pricing by Senate HELP, House Energy and Commerce Committees Demonstrate Ongoing Saliency of Examining PBM Market Manipulation

WASHINGTONDec. 12, 2017 /PRNewswire-USNewswire/ — In the wake of issuing new comments to the Federal Trade Commission (FTC) detailing steps to foster more competition in the prescription drug marketplace, the Senior Care Pharmacy Coalition (SCPC) welcomed both House and Senate year-end hearings on drug pricing and associated supply chain issues to reform an opaque pharmacy benefit manager (PBM) business model that keeps consumers, lawmakers and regulators alike in the dark about pricing determinations and activities and that adds costs to consumers while reducing their access to clinically appropriate medications.

Read more here…


Senior Care Pharmacy Coalition 

Dec 12, 2017, 10:35 ET

Always follow the flow of money

When I was just starting out as a writer, I had a single mentor who wouldn’t let up on me. Sometimes he would recite state secrets, even to a rookie.

Every other day, he’d off-handedly spout out a key piece of advice as if it came at random.

“The first paragraph should always say what the story’s about,” he’d command.  “In extreme cases, you’ll also need to tell readers why you’re telling the story at all. I see it in your piece, but it’s — let’s see — in the ninth paragraph. We’ll tear this up and start over, OK?”

I got accustomed to rewriting from the top. Invariably, the results would be much better. To prove it, I’d just read it aloud.

Then I started getting into gnarly business stories. Sometimes, there’d be an extra adrenaline shot — a dispute ended up in court. Or we’d learn someone had stumbled across a pot of missing money. It was then he’d counsel me: “When in doubt, always follow the flow of money. Do not get distracted. Follow the money wherever it comes and goes. Make sure you get the directional signs right. Some are in red and some in black. Do not be color blind.

Read more here...

    • Dave Danforth, Aspen Daily News Columnist



Views- How to improve pharmacy benefit management

The role of a Pharmacy Benefit Manager is to reduce the cost of prescription drugs through negotiations for deeper network discounts, higher manufacturer rebates and the application of clinical programs that direct members to the right medications.
The entire process is understandably complex and pricing isn’t always transparent — which can foster distrust in the system. Moreover, most PBMs receive compensation for each prescription filled, rather than for patient outcomes or eliminating inappropriate overutilization. Is there a better way for PBMs to deliver their services? Since prescription costs account for 20% of medical spending in the U.S. and are increasing at a rate higher than medical costs, it’s an important question.

Read more here

Employee Benefit News

by Michael A. Perry


Flurry of probes target insulin drugmakers and pharma middlemen

Insulin makers Eli Lilly, Novo Nordisk, Sanofi, and PBM CVS Health are targets in state investigations in Washington, Minnesota, and New Mexico. Attorneys general in those states are sharing information with Florida and California, according to various corporate financial filings. State and federal prosecutors appear to be looking into potentially anti-competitive business dealings that critics have leveled at this more than $20 billion niche market of the pharmaceutical industry, including whether drugmakers and middlemen in the supply chain have allowed prices to escalate in order to increase their profits. At the same time, class-action lawyers are bringing suits on behalf of patients. The price of insulin has reached record highs as Eli Lilly, Novo Nordisk, and Sanofi raised prices more than 240% over the past decade to often over $300 a vial today, with price rises frequently in lockstep, according to information technology firm Connecture.

Read more here

Kaiser Health News

By Sarah Jane Tribble



CVS Makes Blockbuster Aetna Bid

CVS Health Corp. CVS -3.54% is in talks to buy Aetna Inc. AET -0.02% for more than $66 billion as the drugstore giant scrambles to fortify itself against looming competition from Inc. AMZN 0.82% amid a continuing reordering of the health-care industry.
CVS has made a proposal to buy the health insurer for more than $200 per share, people familiar with the matter said. The talks may not lead to a deal, but in a sign of their seriousness, the companies’ respective chief executives— Larry Merlo at CVS and Mark Bertolini at Aetna—have met multiple times over a period of roughly six months, one of the people said.

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The Wall Street Journal

By Dana Mattioli, Sharon Terlep and Anna Wilde Mathews


When paying for drugs with insurance costs more than paying cash: Bill would require pharmacists to let their customers know

It seems logical that customers buying prescription drugs with insurance should pay less than if they pay the entire cost themselves. But sometimes, that is not the case, and patients end up unknowingly paying more if they use insurance.
“Pharmacists I talk to are very upset about this, because they see where patients are paying more for this medicine than they should,” said Todd Brown, executive director of the Massachusetts Independent Pharmacists Association and vice chairman of the department of pharmacy at Northeastern University.

Read more here By Shira Schoenberg,