(Reuters)—Kentucky Attorney General Andy Beshear said on Thursday he had launched an investigation into allegations that pharmacy benefit managers (PBMs) had overcharged state health insurance programs for drugs and discriminated against independent pharmacies. The investigation comes against the backdrop of widespread criticism of rising costs of prescription medicines in the United States, with PBMs, middlemen… [Read More]
Search results for: pharmacy benefit managers
Rheumatologists Air Frustrations with Pharmacy Benefit Managers at Annual Meeting
SAN DIEGO—Pharmacy benefit managers (PBMs) and their impact on drug prices and access to high-cost medications by the patients rheumatologists treat was a major theme at the 2017 ACR/ARHP Annual Meeting Nov. 3–8. In one session, industry experts tried to clarify the role for prior authorizations and drug formulary policies and explored ways to constructively… [Read More]
U.S. Probes Contracts Between Drugmakers, Pharmacy Benefit Managers
(Reuters)—The U.S. Attorney’s Office for the Southern District of New York is investigating contracts between drugmakers and companies that manage prescription benefits, according to regulatory filings. Federal prosecutors have approached at least three companies, including Johnson & Johnson, Merck & Co. and Endo International Plc., demanding information about their contracts with pharmacy benefit managers. Pharmacy… [Read More]
Health Insurer Anthem Takes Pharmacy Business in House, Taps CVS to Help
(Reuters)—Health insurer Anthem Inc will start managing its billions of dollars of patient prescriptions itself in 2020, it said on Wednesday, ending a deal with Express Scripts Holding that had deteriorated into lawsuits over terms. Anthem, which sued the pharmacy benefit manager last year over claims of being overcharged by $3 billion annually, said it… [Read More]
Novartis to Pay $390 Million in U.S. Settlement over Pharmacy Kickbacks
WASHINGTON (Reuters)—Novartis Pharmaceuticals Corp. will pay $390 million to settle U.S. charges that it paid specialty pharmacies illegal kickbacks in exchange for inducing patients to refill certain medications, according to an accord announced Friday. The settlement between a U.S. unit of Swiss drugmaker Novartis AG, the federal government and more than 40 states concerns payments… [Read More]
U.S. Drug Benefit Managers Clamp Down on Specialty Pharmacies
NEW YORK/LOS ANGELES (Reuters)—In recent days, the largest U.S. managers of private prescription drug benefits have cut off at least eight pharmacies that work closely with drugmakers, intensifying scrutiny of a system that helps inflate drug prices, officials at the benefit managers told Reuters. The terminations come from payers who together manage drug benefits for… [Read More]
U.S. Insurers Often Limit Biosimilar Coverage
(Reuters Health)—U.S. commercial health plans only covered biosimilar treatments as preferred products in 14% of coverage decisions last year, according to an analysis of publicly available data on coverage decisions.1 Researchers examined records from the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database, which has information on coverage decisions made by 17 of… [Read More]
The Doctor Will See You Now: Legal & Regulatory Reforms Expand Telemedicine
In this time of COVID-19, you may be considering ways to deliver routine rheumatologic care via some form of telemedicine. Here are some of the legal considerations.... [Read More]
The Plight of the Retail Pharmacist
She wanted me to call in an antibiotic. My sister, a lawyer, often tells me how the ethics of her profession govern even her extra-professional acts. She feels that when she was sworn into the New York State bar, she lost the freedom to bend the truth. She would never, for example, attempt to smuggle… [Read More]
Copay Accumulator Programs Can Derail Rheumatologic Treatment Plans
As the medications for rheumatology become more expensive, the need for patient financial assistance becomes paramount. Unfortunately, commercially insured patients are finding it difficult to afford the exorbitant copays required by their plans, and the latest strategy of pharmacy benefit managers (PBMs) threatens to derail rheumatologic treatment goals. High deductible plans combined with copay accumulator… [Read More]
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