All articles tagged with #pharmacy benefit managers
The Schmidtknecht family is suing a pharmacy benefit manager and Walgreens after their son Cole died from an asthma attack, which was exacerbated by a sudden price hike and lack of proper medication access due to formulary changes. The case highlights issues with opaque drug pricing and the influence of pharmacy benefit managers in the US healthcare system.
In response to the murder of UnitedHealthcare CEO Brian Thompson, Congress has introduced bipartisan bills aimed at dismantling major insurance monopolies by requiring companies to divest their pharmacy benefit managers (PBMs) within three years. The Patients Before Monopolies Act, sponsored by Senators Elizabeth Warren and Josh Hawley, targets companies like UnitedHealth Group, CVS, and Cigna, which dominate the U.S. prescription market. The legislation reflects growing public frustration with the healthcare industry, though its passage remains uncertain.
Shares of companies owning pharmacy benefit managers, including UnitedHealth, CVS Health, and Cigna, fell after a bipartisan bill was introduced to force health insurers or drug middlemen to divest their pharmacy businesses. The bill, backed by Senators Elizabeth Warren and Josh Hawley, aims to address conflicts of interest and reduce drug costs by separating pharmacy operations from health insurers. The legislation has caused significant market reactions, though its future remains uncertain.
Pharmacy benefit managers (PBMs), acting as middlemen in the healthcare system, are significantly driving up prescription drug costs for millions of Americans, employers, and the government by steering patients toward more expensive drugs, charging high markups, and extracting hidden fees, despite their role being to reduce drug costs.
Pharmacy benefit managers (P.B.M.s) like CVS Caremark, Express Scripts, and Optum Rx often make consumers pay more for medications than necessary. These middlemen, chosen by employers or government insurance programs, play a crucial role in determining drug costs. To find out if you're being overcharged, it's important to understand which P.B.M. manages your prescriptions.
Mainline Pharmacy is closing most of its locations due to the high cost of medications versus low reimbursement from Pharmacy Benefit Managers, resulting in a loss of over $350,000 from filling over 17,500 prescriptions this year. Rite Aid will take over prescriptions for affected patients, with only the Somerset and LTC locations remaining open for now.
CVS Pharmacy's new drug pricing system, CVS CostVantage, aims to simplify and increase transparency in the payment structure for prescription medications. However, it is unlikely to result in lower costs or greater clarity for consumers. The new model primarily affects the arrangements between CVS Pharmacy, pharmacy benefit managers (PBMs), and payors such as insurers and employers. While the initiative may reduce the cost of most drugs, the savings will be passed along to PBMs and payors, with no mention of cost savings for consumers. Critics question whether the move will actually decrease costs or if it is merely a response to pressure from Congress and competitors.
CVS is changing its drug pricing formula to increase transparency and simplify costs. The company will now base drug costs on the amount it pays for a drug, limiting the markup and service fee to customers. This move aligns with the industry's decision to be more straightforward with drug prices. The change will have a consumer impact starting in the first half of 2024 for those using cash pharmacy discount cards at CVS Pharmacy, and in 2025, the model will be launched with pharmacy benefit managers. The new pricing model is expected to benefit both pharmacies and consumers by providing more predictable reimbursement rates and potentially reducing overpayment for generic drugs.
CVS is changing its pharmacy reimbursement model, aiming to bring more transparency and simplicity to drug pricing. The new approach, called CVS CostVantage, will use a simpler formula that includes the cost of the drug, a set markup, and a fee to determine the drug's price and reimbursement with pharmacy benefit managers. While the move could change the cost of prescription drugs for some patients, it may not necessarily make all medicine cost less. CVS executives expect that more prescription costs will fall than rise for consumers, employers, and health insurers. The announcement comes amid ongoing efforts to address the high cost of medications and the lack of transparency in the pricing process.
Los Angeles County has filed a lawsuit against pharmacy benefit managers (PBMs) Express Scripts Inc. and OptumRx Inc., accusing them of colluding with drug manufacturers to promote addictive opioids as a safe pain treatment option. The county alleges that PBMs played a role in fueling the opioid crisis by determining which drugs get covered by insurance companies and how much patients pay for them. The lawsuit describes the devastating impact of the opioid crisis on the county's emergency rooms, schools, and child welfare system. Similar suits have been filed by other counties, alleging that PBMs turned a blind eye to signs of addiction and drug abuse.
Blue Shield of California is shaking up the pharmacy benefit management (PBM) industry by dropping most services from CVS Caremark and partnering with Mark Cuban's Cost Plus Drugs, Amazon Pharmacy, and other companies to purchase and deliver drugs. The move aims to lower prescription drug prices and could potentially save the insurer up to $500 million annually. This shift may encourage other insurers to follow suit or pressure PBMs to modify their practices. Blue Shield's new model will begin ramping up next year and fully launch in 2025.
Blue Shield of California, a non-profit insurer, plans to reduce its reliance on CVS Health as its pharmacy benefit manager and instead work with companies such as Amazon and Mark Cuban's drug firm to negotiate drug prices. This move comes as pharmacy benefit managers face scrutiny for their role in rising healthcare costs. Blue Shield will collaborate with five different companies to provide convenient access to medications while lowering costs. The insurer expects to save up to $500 million in annual drug costs once its multi-year strategy is fully implemented. CVS shares fell over 6% in response to the news.
The Federal Trade Commission (FTC) has voted to issue a statement cautioning against reliance on prior advocacy statements and studies related to pharmacy benefit managers (PBMs) that no longer reflect current market realities. The statement warns against relying on older FTC advocacy materials and reports, urging a reevaluation of these materials until the completion of the FTC's ongoing study of the PBM industry.
Georgia lawmakers missed an opportunity to reform a system that allows pharmacy benefit managers (PBMs) to pocket medication discounts intended to lower costs for Georgia patients. PBMs negotiate drug prices and rebates for health plans, but with little transparency and oversight, they have become one of the largest stakeholders in prescription drug access and affordability decisions in Georgia. Patients are struggling to afford critical healthcare due to insurance barriers and PBMs, causing them to pay more from their own wallets for their medications. Georgia lawmakers must take action to ensure rebates are passed onto patients to reduce healthcare costs for Georgians.
The Federal Trade Commission (FTC) has issued compulsory orders to two group purchasing organizations (GPOs), Zinc Health Services and Ascent Health Services, as part of its ongoing inquiry into pharmacy benefit managers (PBMs) and their impact on the accessibility and affordability of prescription drugs. The orders will require the entities to provide information and records on their business practices, including negotiating drug rebates on behalf of other PBMs. The FTC is investigating several PBM practices, including charging fees and clawbacks to unaffiliated pharmacies, steering patients towards PBM-owned pharmacies, and negotiating rebates and fees with drug manufacturers that may impact the costs of prescription drugs to payers and patients.