Pharmacy Benefit Managers
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Return of the MAC (Well I tried to tell you so)
Read more: Return of the MAC (Well I tried to tell you so)Last week MedPAC, the Medicare advisory committee to Congress, had a really interesting session on generic drug pricing in the Medicare prescription drug program (Part D.) There is always so much focus on branded drugs that an opportunity to flip the script and learn about the 90% of prescription drug utilization in Part D (and…
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Talking a big game, the Rx is in the mail
Read more: Talking a big game, the Rx is in the mailConfession. I think Mark Cuban’s Cost Plus Drugs is underwhelming at best and, at worst, the death of independent pharmacies. I’ve been following it since inception, and I just can’t get excited about it – at least not yet. Cost Plus Drugs dispenses about 3,000 generic drugs. There is the transparent price, a 15% markup,…
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340B, Biosimilars, Caught my eye, Employers, Importation, Obesity, Pharmacy Benefit Managers, State-based ReformCaught my eye — 03/15/24
Read more: Caught my eye — 03/15/24It was one of those rare weeks in Washington, DC where the weather was just perfect. I mean not if you suffer from allergies, but for everyone else. Same Same. Last week we had the State of the Union, this week we had the President’s Budget release. For what it is worth, the budget is…
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Delinking and Breaking the hold of PBMs
Read more: Delinking and Breaking the hold of PBMsLast week I did an explainer on what pharmacy benefit managers (PBMs) are and where the pain points were and why there was a focus on PBM reform. There is a lot of buzz around PBM bills on Capitol Hill last year with lots of bills in motion but, for now, I’d thought I’d hone…
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PBMs Explained
Read more: PBMs ExplainedThere is a lot of talk about pharmacy benefit manager (PBM) reform. How PBMs aren’t transparent with pricing and can charge patients more at the point of sale than the drug costs the PBM. But I realized today that perhaps some background on PBMs and how we found ourselves here could be helpful for some…
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Caught my eye, Copay Accumulators, Inflation Reduction Act, Medicare Part D, Pharmacy Benefit ManagersCaught my eye — 3/1/24
Read more: Caught my eye — 3/1/24It took my until 5 pm on Thursday to figure out why there was a frog on the Microsoft tool bar. Leap year. Frog. Leap. Sigh. I prefer not. Congress seems to have hit the pause button (at least temporarily) on pharmacy benefit manager (PBM) reform. And that sort of felt okay because, realistically, things…
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Caught my eye — 2/23/24
Read more: Caught my eye — 2/23/24Gross to Net, a Saga. As soon as I saw Adam Fein’s Drug Channels article on Gross to Net in Part D redesign, I knew it would throw off my day. It was just catchy enough to cause a buzz and get the attention of Heads of Market Access at pharmaceutical companies and start the…
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Caught my eye — 2/16/24
Read more: Caught my eye — 2/16/24Honestly? Not a lot caught my eye this week. Maybe we were all heads down getting stuff done before a long weekend? You say MPPP, I say smoothing. Late yesterday afternoon the Centers for Medicare & Medicaid Services released Draft 2 guidance for the Medicare Prescription Payment Plan. I’ve heard Michael Ward from Alliance for…
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Biosimilars, Caught my eye, Drug Prices, Healthcare Costs, Medicare Advantage, Medicare Part D, Pharmacy Benefit Managers, ValueCaught my eye — 2/9/24
Read more: Caught my eye — 2/9/24A whirlwind of a week. I regrouped on Wednesday and got a run in and some pottery wheel time and then it all fell apart again (in a good way) on Thursday where I forgot to leave my desk for hours and hours. One of those “I love working” and forget time exists. So much…
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PBM Reform: A Different Bite at the Apple
Read more: PBM Reform: A Different Bite at the AppleYesterday afternoon, I caught the story that Johnson & Johnson was being sued by an employee who claims that the company (as an employer) was overpaying its pharmacy benefit manager (Express Scripts) and that these overpayments result in higher premiums, higher out-of-pocket expenses and limited increase in wages. The lawsuit uses an example of a…
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