Pharmacy Benefit Managers
-
Caught my eye — 07/26/24
Read more: Caught my eye — 07/26/24Let’s be honest, health policy has sort of taken a backseat when it comes to what we’re all tracking these days. And that’s okay. If you’ve taken a deserved timeout, let me catch you up on what caught my eye. Ice Ice Baby. The House of Representatives Committee on Oversight and Accountability released a report…
-
Caught my eye — 7/12/24
Read more: Caught my eye — 7/12/24Maybe it’s summer, maybe it’s an existential crisis but none of the news of late feels all that important. Not on my bingo card. This week the Federal Trade Commission released an interim report on pharmacy benefit managers (PBMs). It was a takedown of the industry but that’s just words, not action. Unless it isn’t.…
-
Getting nowhere fast
Read more: Getting nowhere fastMy mom said to never use the word hate but, honestly, I hate step therapy. I dislike prior authorization but step therapy, well I hate it. Both fall under the concept of utilization management which are barriers to access put up by payers (really pharmacy benefit managers (PBMs)) for cost or safety concerns. The idea…
-
340B, Caught my eye, Drug Prices, Inflation Reduction Act, Medicare Negotiation, Pharmacy Benefit Managers, State-based ReformCaught my eye — 05/24/24
Read more: Caught my eye — 05/24/24Coulda, woulda, shoulda. On Tuesday, the Senate Judiciary committee had a hearing on prescription drug prices. It became clear that comparisons to international prices remain a focus but so is patent abuse. I am not sure that’s a fair characterization. What companies are doing is legal and I’m not sure they’d be doing their fiduciary…
-
Caught my eye — 5/17/24
Read more: Caught my eye — 5/17/24Crab cakes and … horse racing. That’s what Maryland does. Mine will come with a side of Smith Island cake which I’m making tomorrow morning. Wish me luck. Odds aren’t stacked. The Centers for Medicare & Medicaid Services (CMS) announced that the Medicaid rule won’t contain the stacking provision. A little odd to pre-announce it,…
-
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…
-
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,…
-
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…
-
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…
-
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…
Latest news
- Caught my eye — 03/28/25
- Caught my eye — 3/21/25
- Caught my eye — 3/14/25
- Caught my eye — 03/07/25
- Caught my eye — 2/28/25
Categories
- 340B (33)
- Affordable Care Act (4)
- Alzheimer's (5)
- Biosimilars (20)
- Caught my eye (61)
- Cell and Gene (1)
- Chevron Deference (2)
- CMMI (10)
- Copay Accumulators (6)
- COVID (2)
- Drug Prices (30)
- Drug shortages (8)
- DTC (2)
- Employers (7)
- Generics (5)
- Health Equity (3)
- Healthcare Costs (28)
- ICER (9)
- Importation (2)
- Inflation Reduction Act (45)
- Insulin (4)
- IP (3)
- Long term care (1)
- Medicaid (6)
- Medicare Advantage (15)
- Medicare Negotiation (48)
- Medicare Part D (44)
- Medicare Transaction Facilitator (2)
- Medicare Transaction Facilitator (7)
- Obesity (20)
- On the Horizon (1)
- Orphan Drugs (3)
- Pharmacy Benefit Managers (28)
- Reference Pricing (5)
- State-based Reform (14)
- Supply Chain (1)
- Uncategorized (4)
- Utilization Management (1)
- Vaccines (4)
- Value (12)