(Reuters)—Ohio’s attorney general on Monday said he had filed a lawsuit against UnitedHealth Group Inc’s OptumRx unit, saying the pharmacy benefit manager had overcharged the state nearly $16 million for prescription drugs. Ohio Attorney General Dave Yost’s lawsuit followed a probe into the extent pharmacy benefit managers (PBMs) like OptumRx had engaged in pricing practices…
Search results for: pharmacy benefit managers
Happiness in Rheumatology
A 2019 report says rheumatologists are the happiest medical specialists outside of work. Simon Helfgott, MD, says this finding shows “we have been able to blend an interesting, intellectually stimulating profession and practice with the ability to help people.”..
Early Activity Holds Signs of Hope for 2019 State Legislative Cycle
The 2019–2020 legislative cycle in the states holds real hope and opportunity for critical reforms to protect rheumatology practices and patients. It is important to note that because of the state legislative process, bill passage almost always comes later in the legislative session. Although the rheumatology community has not yet seen many official wins, early…
Eli Lilly Backs U.S. Proposal on Drug Rebates to Lower Costs
(Reuters)—Eli Lilly and Co. on Wednesday embraced a U.S. government proposal to end a decades-old system of rebates drugmakers make to industry middlemen, saying it could lower the cost of insulin and other prescription drugs for patients. Lilly, along with other major insulin makers, Sanofi SA and Novo Nordisk, has been under mounting pressure from…
U.S. Government Proposes Rule Overhauling Drug Industry Rebate System
NEW YORK (Reuters)—The U.S. government proposed a rule to end the industry-wide system of after-market discounts called rebates that pharmacy benefit managers receive from drugmakers, a practice that has been under scrutiny. If finalized, the rule would change a system that has been in place for decades and that increasingly has been criticized for obfuscating…
Rheumatology Advocacy in 2019
A belated Happy New Year to my fellow advocates! Here’s your first update for 2019 on what the rheumatology community should know is going on in Washington, D.C., right now. Current Climate On Jan. 3, the 116th Congress gaveled into session with Democrats in control of the House of Representatives and Republicans still the majority in the…
Medicare Changes Could Have Some Patients Paying More for Drugs
(Reuters Health)—A proposed shift in Medicare coverage for medicines administered by doctors may help reduce total drug spending, but a new study suggests it may also lead to higher out-of-pocket costs for some patients. Right now, drugs given by infusion or injection in outpatient settings are covered by Medicare Part B, which is part of…
Sen. Sanders, Rep. Cummings to Introduce Bill to Lower U.S. Drug Prices
WASHINGTON (Reuters)—U.S. Senator Bernie Sanders and Representative Elijah Cummings plan to introduce legislation on Thursday aimed at lowering the cost of prescription drugs for U.S. consumers. Democrats have been critical of efforts by the Trump administration to bring down drug prices after President Donald Trump promised to do so during his campaign and since being…
ACR Leaders Discuss E/M Coding Changes, Step Therapy & More
CHICAGO—ACR leaders described a series of looming legislative and regulatory threats to rheumatologists and their patients—including the proposed collapsing of evaluation and management (E/M) coding and potential changes to step therapy rules—and urged everyone in the field to make their voices heard to quash the proposals. They also recounted recent victories in the policy realm…
Year in Review: The Impact of Advocacy & RheumPAC in 2018
In 2018, did you interact with the Medicare payment system, receive payment for a consultation code or worry about the Centers for Medicaid & Medicare Services (CMS) reducing reimbursement through its proposal to combine evaluation and management codes in the Physician Fee Schedule? If your answer to any of those questions is yes, then you…
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