By Bruce Japsen
Originally published in Forbes, 8/29/18
Cigna said it is making progress with regulators to win approval of its acquisition of pharmacy benefit manager Express Scripts, confirming regulators in 14 of 29 states have signed off on the merger.
“Currently, Cigna has received approvals from 14 states,” the health insurer said Wednesday afternoon in a regulatory filing with the Securities & Exchange Commission. “Approvals from 15 additional states are conditions to closing the transaction.”
Auditor’s Report: Pharmacy Benefit Managers Take Fees of 31% on Generic Drugs Worth $208 Million in One-Year Period
From Press Releases - Ohio Auditor of State
Published August 16, 2018
Columbus – Ohio's Pharmacy Benefit Managers (PBMs) charged the state a “spread” of more than 31 percent for generic drugs – nearly four times as much as the previously reported average spread across all drugs, according to a new report by Ohio Auditor of State Dave Yost.
An analysis conducted by Auditor Yost’s staff found PBMs collected $208 million in fees on generic Medicaid prescriptions, or 31.4 percent of the $662.7 million paid by managed care plans on generics during the one-year period April 1, 2017 through March 31, 2018.
By Lucas Sullivan and Catherine Candisky
Published in The Columbus Dispatch, 8/14/18
The Ohio Department of Medicaid is changing the way it pays for prescription drugs, giving the boot to all pharmacy middlemen because they are using "spread pricing," a practice that has cost taxpayers hundreds of millions.
Medicaid officials directed the state's five managed care plans Tuesday to terminate contracts with pharmacy benefit managers using the secretive pricing method and move to a more transparent pass-through pricing model effective Jan. 1.
by Bruce Japsen
Published in Forbes, 2/1/18
The top insurance official in California urged the U.S. Justice Department to block the merger of CVS Health and Aetna, saying it would “have significant anti-competitive impacts on American consumers and health care and health insurance markets.”
The findings and recommendation by California Insurance Commissioner Dave Jones doesn’t derail the effort by CVS Health to buy Aetna, but the state regulator could have influence with the U.S. Justice Department as it evaluates the deal. California's insurance regulator described the Justice Department evaluation of the Aetna-CVS deal as "open" and outlined its reasoning for DOJ to block it in a 15-page letter.
Pharmacy First, a national network of more than 2,300 independent pharmacies, filed a lawsuit against Express Scripts in Federal Court to seek relief for, among other things, Express Scripts effectively excluding from its network of 83 million or more lives from Pharmacy First and all other Pharmacy Services Administration Organizations (“PSAOs”), except for four PSAOs handpicked by Express Scripts.
Kentucky, lawmakers discovered that PBMs, including CVS, pocket over 40% of the state’s annual Medicaid spending on prescription drugs.
It happened in Ohio, Arkansas, Iowa, New Jersey, New York and possibly other states. Pharmacy middleman CVS Caremark suddenly cut the reimbursements it paid community pharmacies for drugs, some of them far below pharmacists’ costs for potentially lifesaving medications.