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CVS Health Corp. and Walgreens Boots Alliance Inc. were sued by California customers who accused the drugstore operators of charging co-payments for certain prescription drugs that exceed the cost of medicines...CVS...overbilled consumers who used insurance to pay for some generic drugs and wrongfully hid the fact that the medicines’ cash price was cheaper...Walgreens...used the same clawback tactic...The lawsuits follow at least 16 other cases...targeting drugstore chains’ alleged co-pay clawback practices. The clawback occurs when patients hand over co-payments set by a pharmacy benefit manager that exceed the actual cash cost of the drug. The benefit managers pocket the difference…Most patients never realize there’s a cheaper cash price because of clauses in contracts between pharmacies and benefit managers that bar the drugstore from telling people there’s a lower-cost way to pay...Schultz (Megan Schultz v. CVS Health Corporation, 17-cv-359, U.S. District Court for the District of Rhode Island)...contends that CVS’s clawback agreements with benefit managers such as Express Scripts, CVS Caremark and OptumRx violate federal racketeering and insurance laws and works to artificially inflate prescription costs...

Nicole Crisano, PTNN. This weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

Express Scripts, a top-three pharmacy benefit manager in the U.S., will exclude an additional 64 drugs from its national listing of preferred drugs next year, sending shares in several biotechs affected spinning...Notably, the PBM's 2018 formulary leaves off Amgen's neutropenia blockbuster Neupogen (filgrastim) in favor of Novartis' biosimilar medicine Zarxio (filgrastim-sndz) and drops Lilly's osteoporosis drug Forteo (teriparatide)...Forty-six other brand-name drugs with generic competitors already on the market were also excluded, potentially accelerating uptake of cheaper copies. Valeant Pharmaceuticals, in particular, could see an impact as two of its top-three best-selling drugs were shut out from Express Script's preferred list...Express Scripts has been an outspoken critic of drugmakers' pricing practices, frequently pushing back against the pharma industry's attempt to pin the blame for rising costs on the rising power of PBMs...Express Scripts' newly released formulary for next year substantially increases the number of drugs excluded by the PBM to a total of 159. The PBM was quick to highlight, however, that the new exclusions would only affect 0.67% of its members while saving cash overall...

Laura Joszt, assistant managing editor at The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

The largest U.S. retail pharmacies, including Wal-Mart Stores Inc and Walgreens Boots Alliance Inc, are wielding more leverage when buying generic drugs, accelerating a decline in prices likely to affect drug companies for some time...That pressure is exacerbated by efforts from U.S. health regulators to speed approval of copycat drugs...The extent of the shift became clearer this week, when wholesale drug distributors Cardinal Health Inc and AmerisourceBergen Corp, as well as top global generic drugmaker Teva Pharmaceutical Industries Ltd, warned of generic price declines of as much as 9 percent through the end of the year…Walgreens formed a drug-buying partnership with AmerisourceBergen in 2013, and earlier this year partnered with pharmacy benefit manager Express Scripts Holdings Co. Retailer CVS Health Corp has tied up with Cardinal Health and, more recently, Wal-Mart has joined with McKesson Corp to source generic drugs. Industry analysts said the alliances took some time to become effective, but their power over negotiations is becoming clear.

Retail prices for commonly prescribed drugs are often absent from state prescription drug price websites, but when reported, can vary substantially...Objectives: To examine how often retail prices for prescription drugs are available on state public reporting websites, the variability of these reported prices, and zip code characteristics associated with greater price variation...Takeaway Points: Across state government websites reporting retail prices for medications commonly prescribed for chronic conditions, price information is often deficient. However, when retail prices for prescription medications are publicly reported, these prices vary significantly.

• This is the first study to document variation in publicly reported retail prices for prescription medications across different classes and different states.
• More consistent reporting of such prices could potentially yield substantial savings for consumers who face high out-of-pocket expenditures.
• Policy makers should work to ensure retail prices for prescription drugs are reported consistently and strive to develop new strategies to facilitate consumers’ use of this information.

Nicole Crisano, PTNN. This weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

The Washoe County Health District says a North Valleys resident has tested positive for West Nile Virus. It is the first human case this year in Washoe County...Although this resident had traveled outside of Washoe County and may have been exposed elsewhere, the presence of positive mosquito pools locally means that a local exposure cannot be ruled out and residents should take appropriate precautions. The announcement coincides with the identification of three positive mosquito collections in Gerlach, although the incidents are not related..."We have been expecting this to be a very active season for both mosquitoes and West Nile Virus in Washoe County due to the heavy precipitation we got this year and because of the extremely warm weather in the area," said Washoe County District Health Officer Kevin Dick. "Although we are monitoring mosquito activity, conducting monthly larvicide treatments, and fogging areas of known activity, this is a reminder that people must be vigilant and take personal measures to keep mosquitoes at bay" said Dick.

CVS Health...put out its standard control formulary for 2018, days after competitor Express Scripts announced its own drug coverage list for next year...Last year, CVS made biosimilars preferable over their reference product on its formulary, while this year the PBM expects to expand value-based deals to add further benefit for its customers...last year...it opted to include the highly touted, but still very new class of biosimilar products over longer-used reference products...This year, CVS Health looks set to change the game once again with an outcomes-based management program that will specifically target drugs for breast cancer, non-small cell lung cancer, obesity and chronic obstructive pulmonary disease...In each of these cases, manufacturers will have to cover costs over a pre-specified threshold if patients don't reach certain outcomes...Outcomes-based strategies have long been talked about as a means to control drug pricing. But there have only been a handful of such agreements put into practice and usually with specific drugmakers for specific products...CVS Health will remove 17 drugs from the 2018 formulary list across 10 drug classes...

Trump vs. Big Pharma: Can He Bring Drug Prices Down?...U.S. Food and Drug Administration Commissioner Scott Gottlieb spoke with Bloomberg News about drug pricing, new medicine and regulations. This transcript of the interview has been edited for clarity and length.

• What’s the FDA’s role to play in drug pricing and what can the agency do, given that it hasn’t traditionally had a mandate to address the issue?
• Is it just small, opportunistic drug companies that are "gaming" the system, or is this something bigger companies do as well?
• What about the rest of the administration? Trump talked a lot about drug pricing on the campaign trail and after, yet we haven’t seen much action other than yours.
• What about an executive order on drug pricing -- there was talk that Trump was going to come out with something. Is that still being worked on?
• What about drugs like EpiPen, would you come out with new rules there to create more competition? [EpiPen, made by Mylan NV, is what’s known as a drug-device combination, where both the medicine and the device that administers it can have patent protections.
• But is it reasonable to assume you’re looking at doing something like this, on these types of devices?
• One of the things we’ve seen from the administration is, get rid of regulation, get rid of regulation, get rid of regulation. How does your philosophy as a regulator –- one of the biggest regulators in the U.S. government –- how does that line up with what the Trump administration has called for?
• Some of the things you’re doing to create more competition among drugs, people could interpret as a loosening of standards. I wonder if you think that’s the case?
• Through the years we’ve seen the agency go through cycles, of pushing drugs out into the market faster, versus being much more conservative about safety. Is the balance at the FDA changing?
• How broadly can you apply new standards or guidelines for drug approval? There’s been talk about it in cancer, but what about other diseases?