In The News

UnitedHealth sued over prescription drug co-pay costs

October 5, 2016 By Reuters

UnitedHealth Group has been sued by three customers who accused the largest U.S. health insurer of charging co-payments for prescription drugs that were higher than their actual cost and pocketing the difference.  The lawsuit, filed Tuesday in federal court in Minnesota by three UnitedHealth customers, seeks to represent a nationwide class that it says could include “tens of thousands” of people insured by UnitedHealth.  Read more…

With new calls for congressional hearings, PBMs could be next on Capitol Hill’s hot seat

October 4, 2016 By Tracy Staton

Congress may be busy investigating Mylan and its EpiPen pricing, but that doesn’t mean its watchdog committees can’t turn a spotlight on pharmacy benefits managers, too.  After Mylan CEO Heather Bresch blamed PBMs for “incentivizing” price increases, pharmacists–including Rep. Buddy Carter, the only pharmacist in Congress–are calling for more scrutiny.  Read more…

 

Horizon settles Express Scripts rebates lawsuit

September 29, 2016 By Adam Rubenfire

Horizon Pharma has settled a lawsuit with prescription benefits manager Express Scripts related to disputed drug rebates.  Horizon Pharma USA, a Lake Forest, Ill.-based subsidiary of the Irish drugmaker, will pay $65 million to settle a lawsuit over $166.2 million in rebate payments that St. Louis-based Express Scripts said it was owed from Horizon, according to regulatory filings.  Read more...

 

The Diabetes Price War Claims Casualties

September 29, 2016 By Max Nisen

Through no fault of their own, 1,000 people just became victims of a drug-price war mostly taking place on another continent.  Danish pharma giant Novo Nordisk announced Thursday it is cutting 1,000 jobs (about half of them in Denmark), after last month slashing growth forecasts for 2016, citing lower U.S. prices for diabetes drugs.  Read more…

Lawmaker exposes pharmacy benefits abuses

November 21, 2013 By Jason Wallace

On Friday (Nov. 15), the House Committee on the Judiciary held a hearing on the state of antitrust enforcement, where committee members raised concerns about the controversial 2012 merger of Express Scripts Inc. and Medco, which created the country’s largest pharmacy benefit manager (PBM).

Bloomberg: Discount Drug Plans May Not Be Saving Medicare Money
March 21, 2013 By Alex Wayne
Preferred-pharmacy plans that promise lower prices for people who agree to buy their prescription drugs from certain stores may be costing the U.S. Medicare program more money to support, pharmacists said.  Read More…

CFO: Today’s Keys for Lowering Drug Costs
March 15, 2013 By Barry Eyre
Pharmacy benefits for active employees and Medicare-eligible retirees present an excellent opportunity to drive out unnecessary costs and improve risk management, driven by market dynamics as well as regulatory and tax changes. Read More…

Fraud Trial for WellCare Ex-CEO Shows Medicaid Abuse
November 20, 2012
In October 2007, Todd Farha and his company were thriving. The chief executive officer of WellCare (WCG) Health Plans Inc. had sold $57 million of his stock over three years as the share price rose seven-fold. Starting in 2002 with seed money from a George Soros fund, he had built WellCare into the largest insurer in Florida’s Medicaid program.  Read More…

FTC is mailing refunds to Medicare customers who relied on incorrect CVS drug prices
September 4, 2012
The Federal Trade Commission said that it is mailing refund checks to 13,000 Medicare Part D beneficiaries who were overcharged for drugs because a CVS Caremark Corp. business understated the price of the medications.  Read More…

Pharmacist, PBM lobbyists trade barbs
July 16, 2012
A battle is brewing to influence public opinion over the drivers of rising prescription drug benefit costs, cost-containment strategies and the path to meaningful health care reforms.On one side of this spirited debate to win the hearts and minds of HR and benefit practitioners, among other key stakeholders, is the National Community Pharmacists Association (NCPA) in Alexandria, Va., which claims that pharmacy benefit managers drive up health insurance costs and restrict patient choice.  Read More…

Providence Councilman Calls for More Savings in Prescription Benefits Contracts
July 16, 2012
Providence City Councilman David Salvatore this week will introduce a resolution requesting an independent audit of the City’s pharmacy benefit management (PBM) agreements, according to a press release .  Read More…

NCPA Declares July “Celebrate Independents Month” for Independent Pharmacy
June 26, 2012
In the days leading up to July 4th or Independence Day, the National Community Pharmacists Association (NCPA) wants to recognize the month of July as “Celebrate Independents Month” for the independent pharmacy industry. NCPA represents the interests of the owners of more than 23,000 independent community pharmacies. Read More…

Rep. Austin Scott: Bill would shed light on shadowy world of pharmacy benefit managers
June 19, 2012
Health care costs are rising at an unsustainable rate. As a former small business owner, I’ve experienced these rapidly rising costs first-hand. Over the years, I’ve also heard from doctors (like my father), pharmacists and countless patients about different factors that unnecessarily drive health care costs higher. One frequent complaint is that middlemen create waste, especially in the area of prescription drugs. Read More…


The Texas Tribune: Medicaid Overhaul Causing Pain for Some Pharmacists

June 15, 2012
By Becca Aaronson
Not long after the state rolled pharmacies into Medicaid managed care in March — an effort to save tens of millions of dollars a year — Ronald Barrett noticed something unusual at Oak Cliff Pharmacy, his store in southern Dallas. When he entered a child’s prescription into his computer to see how much he would be reimbursed by CVS Caremark, the managed care plan’s pharmacy benefit manager, he received an error message. A phone call indicated that the child’s prescription had already been filled, at a CVS pharmacy down the road. Read More...


Pa. and Wash. Reps: Fight for small businesses, protect our community pharmacies

March 22, 2012
By Rep. Tom Marino (R-Pa.) and Rep. Cathy McMorris Rodgers (R-Wash.)

The Federal Trade Commission will soon make its final decision on the $29.1-billion merger of two of the largest pharmacy benefit managers in the country. While concerns have been expressed about this specific merger, particularly its impact on mail order and specialty pharmacies, the debate raises much broader concerns about jobs, the economy, protecting small businesses, and ensuring that our loved ones have the best possible access to high quality health care.  Read more…

Other states view Ky. as cautionary tale with managed care transition, consultant says
March 14, 2012
States like Kansas that once looked to follow Kentucky into the world of managed care of Medicaid now are trying to learn from the state’s mistake of rushing into it, said health care policy consultant Shannon Turner.  Read more and watch the video…

PUTT President Dave Marley’s Letter to the Editor on stltoday.com
February 22, 2012
In “A prescription for a tantrum” (Feb. 12), Kevin Horrigan shines a light on some of the dirtiest secrets of America’s prescription drug model. It has enraged pharmacists and astute consumer advocates for years, and all Americans deserve to know the truth. Pharmacy benefits managers, third-party administrators of prescription drug programs, unnecessarily drive up drug costs by charging absurd mark-ups to the prices they pay manufacturers for prescription drugs. Meanwhile, they line their own pockets and their CEOs make off with multi-million-dollar salaries. It’s a system that benefits no one — except the PBM. Read More…

PUTT Featured on AARP’s Inside E Street
February 20, 2012
Who Benefits When Drugs Go Off Patent?
Pharmaceutical companies limit the competition of generics when patented drugs lose their exclusivity.  This Inside E Street takes a look at the strategies pharmaceutical companies take once a blockbuster drug goes off patent — strategies aimed at limiting both competition and, unfortunately, your savings on your meds.  Watch Video…

Senior Vice President of NCPA drafts letter to White House about savings in federal prescription drug programs
January 9, 2012
In his letter to the Director of Office of Management and Budget, Jacob Lew, Senior Vice President John M. Coster, Ph.D., R.Ph. outlines a number of savings that could be achieved in federal prescription drug programs. Coster indicates that savings could be achieved through transparency and pass through of rebates, better management of drug therapy, increased generic use in medicaid, by eliminating PBMs from the FEHBP, and more. Read More…

CVS Caremark to pay $20 million to three states over fraud allegations
December 16, 2011
Pharmacy and prescription drug management company CVS Caremark Corp. has agreed to pay nearly $20 million to settle three lawsuits involving allegations that the company defrauded pension systems in three states, including California’s giant pension fund, attorneys said. The whistleblower lawsuits, filed by two former CVS Caremark pharmacists, accused the company of reselling returned drugs, changing prescription orders to make them more expensive and submitting false reports about how long it took to fill prescriptions. … Read More…

Pfizer Maneuvers to Protect Lipitor from Generics
December 13, 2011
You may like your copay, but a local pharmacist said you may still be paying way too much, even with generic drugs. Bob Buckley explains how in the Buckley Report. The pharmacists for Truth and Transparency Group started with nine people discussing the issue over email. It now has 750 members across 42 states. Watch The Video…

Pfizer Maneuvers to Protect Lipitor from Generics
November 30, 2011
Lipitor is so valuable that its maker, Pfizer Inc., is practically paying people to keep taking the blockbuster cholesterol medicine after generic competition hits the U.S. market this week. Pfizer has devised discounts and incentives for patients, insurers and companies that process prescriptions that will, at least for the next six months, make the brand name drug about as cheap as or cheaper than the generics. Pfizer also has spent tens of millions of dollars this year on marketing to keep patients on Lipitor, which loses patent protection Wednesday. Normally when a drug’s patent ends, generic rivals grab nearly all its market share in a year or less, and the original maker quietly shifts focus to its newer products. … Read More…

As Lipitor Goes Off Patent, What Will Happen to Price of Your Prescription?
November 30, 2011
The first generic version of the world’s top-selling drug, the cholesterol-lowering Lipitor, is due to come on the market Dec. 1. Drug market analysts have long speculated on the strategies its manufacturer, Pfizer, might use to hold on to at least some of the profits for a blockbuster drug that has earned up to $12 billion a year over the past 15 years. But even experts were taken aback by the scale and ingenuity of the Pfizer counter-attack against generic competition. The drugmaker has launched an unprecedented campaign to persuade patients to stay with Lipitor instead of switching to the generic, atorvastatin. … Read More…

Pfizer’s Lipitor: How Big Pharma Blocks Reimbursement Of Generics
November 30, 2011
Good news! You learn that today, November 30, 2011, a generic version of Lipitor® is going on sale for the first time. You have been using Lipitor® as an adjunct to your diet to reduce your cholesterol, So you run down to the pharmacy and ask to have the generic atorvastatin, at a fraction of the price you have been paying for Lipitor®, the world’s top selling drug made by Pfizer. What happens? There’s a good chance you’ll be told by the pharmacist that generic atorvastatin is “not available” but brand-name Lipitor® is. Why? … Read More…

Pfizer Maneuvers to Protect Lipitor from Generics
November 30, 2011
Lipitor is so valuable that Pfizer is practically paying people to keep taking its blockbuster cholesterol medicine after generic competition hits the U.S. market this week. Pfizer has devised discounts and incentives for patients, insurers and companies that process prescriptions that will, at least for the next six months, make the brand name drug about as cheap as or cheaper than the generics. Pfizer also has spent tens of millions of dollars this year on marketing to keep patients on Lipitor, which loses patent protection Wednesday. Normally when a drug’s patent ends, generic rivals grab nearly all its market share in a year or less, and the original maker quietly shifts focus to its newer products. … Read More…

Questions Raised About Prescribing Atorvastatin, 180-Day Period Costs
November 29, 2011
Pfizer, Medco, and pharmacy groups are all battling to get their voices heard after a November article in The New York Times raised questions about prescribing Lipitor versus atorvastatin (the new generic form of Lipitor). Pfizer loses its patent protection for Lipitor on November 30. The Times’ article claimed that Medco Health Solutions and other pharmacy benefit managers (PBMs) were instructing drug stores to block prescriptions for atorvastatin beginning December 1. Pfizer executives acknowledged to Drug Topics that the manufacturer is offering Lipitor at or below generic cost during the first 180 days of the generic introduction, when the generic medication is typically priced higher at about 15% to 20% less than the brand. After 6 months, when other generic forms of Lipitor will be allowed on the market, the generic price is expected to decrease. … Read More…

Facing Generic Lipitor Rivals, Pfizer Battles to Protect Its Cash Cow
November 29, 2011
For the last year, Pfizer has been laying the groundwork to combat the looming competition against Lipitor, forging deals with insurers, pharmacy benefit managers and patients to meet or beat the price of its generic replacements. … Pfizer’s strategy so far is limited to the first 180 days after Lipitor goes off patent. During that period, under law, generic competition is limited and the first entries have historically charged fairly high prices to recoup their costs. After the first six months, any company can enter the generic market, and prices plunge. … The discount is also extending to many Medicare prescription drug plans that will dispense Lipitor even if patients ask for generics, according to a memo released by an advocacy group called Pharmacists United for Truth and Transparency. Read more…

Plan Would Delay Sales of Generic for Lipitor
November 11, 2011
The biggest introduction of a generic drug in pharmaceutical history is being met with tough business strategies by Pfizer and pharmacy benefit companies, according to recent letters to pharmacists. Many drugstores are being asked to block prescriptions for a generic version of Pfizer’s Lipitor starting Dec. 1, when the company loses its patent for the blockbuster cholesterol drug and generic competition begins. Medco Health Solutions, among the nation’s largest pharmacy benefit managers, is one of the companies issuing instructions, seeking to have pharmacists keep filling prescriptions with the more expensive Lipitor for six months. Read more…

Medco Won’t Cover Generic Lipitor for Coventry Health Members
November 11, 2011
Medco Health Solutions Inc. (MHS) will block low-cost copies of Pfizer Inc. (PFE)’s cholesterol drug Lipitor for some patients after the treatment loses patent protection this month, according to a memo to pharmacists. Medco, pharmacy services company based in Franklin Lakes, New Jersey, will make only brand-name Lipitor available to Coventry Health Care Inc. (CVH) members starting Dec. 1, according to the document, which was provided to Bloomberg News by Pharmacists United for Truth and Transparency, a advocacy group representing more than 600 independent pharmacists. Read more…

US pharmacists slam “unjustifiable PBM Rx price mark-ups”
November 6, 2011
A national coalition of US pharmacists and pharmacy owners has begun a public information campaign to “expose the unjustifiably high prices of prescription drugs set by pharmacy benefits managers [PBMs].” The coalition, Pharmacists United for Truth and Transparency, which has members in 40 US states, describes PBMs as an “unregulated, multibillion-dollar industry” that controls prescription health plans for more than 200 million Americans and says it has begun the campaign to protect benefit plan sponsors and enrollees from overpaying for prescription drugs. Read more…

New pharmacy group announces national campaign against PBM abuses
October 15, 2011
A growing number of concerned pharmacists and pharmacy owners have formed a coalition dedicated to exposing “widespread abuse and manipulation by pharmacy benefit managers [PBMs],” mandatory mail order, and other “threats to the practice of pharmacy,” a recent press release announced. Adopting the name Pharmacists United for Truth and Transparency, the newly incorporated entity has raised $100,000 and hired a New York City consulting firm to help it in its mission. Read more…

New Coalition of Pharmacy Owners Targets PBMs
October 10, 2011
A group of pharmacy owners has formed a coalition to address concerns regarding pharmacy benefit management (PBM), mandatory mailorder prescriptions, and other key issues. The group, called Pharmacists United for Truth and Transparency, includes 100 pharmacists and pharmacy owners from 30 states. The coalition aims to expose questionable PBM practices and misinformation about the cost of prescription drugs. Read more…

PTR Pharmacy Podcast Episode 27 Dave Marley Pharmacists for Truth and Transparency
October 5, 2011
TruthRx is an organization whose mission is to expose the many schemes that the larger, publicly traded PBMs use to inflate their profits at the expense of their self insured clients.  We are an organization comprised of various pharmacy professionals from all over the country who have direct knowledge of the inner workings of the PBM industry. Read more…