News Wire

Health Care Policy: PBMs’ Medicaid Role Under Attack in Some States

February 8, 2018 reported by The Capitol Forum

The Medicaid role of Express Scripts, CVS/Caremark and other pharmacy benefit managers is under siege by Appalachian state legislators proposing bills that would curb or stop entirely a reliable revenue stream for the companies.

In Ohio and Kentucky, legislators proposed bills last month to replace PBMs with state agencies in performing the most important duties in managing the Medicaid recipients’ prescription benefits. West Virginia’s state Medicaid agency didn’t wait for legislation and last year unilaterally ended PBMs’ role in the program.  Read more …


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