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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.

Middlemen who manage drug benefits for employers and insurers should be under greater government oversight of their pricing and billing practices to make health care cheaper, an independent pharmacists’ group said (National Community Pharmacists Association)...plans to lower prescription drug costs will only succeed if greater transparency is imposed on pharmacy benefit managers...Benefit managers engage in price negotiations that are often kept secret for competitive reasons, with manufacturers on one end and pharmacies on the other. Pharmacists have criticized these discussions, as well as so-called clawbacks -- extra profit for the PBM after co-pays for cheap, generic medicines exceed the price of the drug itself...PBMs...continue to operate in a virtual black box...As the outcry over drug pricing intensifies, the middlemen have gained more attention...

Federal authorities are stepping up investigations at Department of Veterans Affairs medical centers due to a sharp increase in opioid theft, missing prescriptions or unauthorized drug use by VA employees since 2009…Doctors, nurses or pharmacy staff at federal hospitals — the vast majority within the VA system — siphoned away controlled substances for their own use or street sales, or drugs intended for patients simply disappeared...Aggravating the problem is that some VA hospitals have been lax in tracking drug supplies...Reported incidents of drug losses or theft at federal hospitals jumped from 272 in 2009 to 2,926 in 2015, before dipping to 2,457 last year, according to DEA data...The GAO review...found the most missed inspections at VA's hospital in Washington, D.C...Monthly checks were missed there more than 40 percent of the time, mostly in critical patient care areas, such as the operating room and intensive care units…Responding to the findings, the House Veterans Affairs Committee planned a hearing on the inspection issue. Its chairman, Rep. Phil Roe, a physician, said failing to follow protocol is serious and "should not be tolerated within VA."

Brian Haug, President of Pharmacy and Managed Markets, Pharmacy Times (PTNN) This weekly video program highlights the latest in pharmacy news, product news, and more.

Spending on prescription drugs for health plans created under the Affordable Care Act increased last year at a rate more than three times that of other commercial plans and most government-run plans managed by Express Scripts Holding Co...year-over-year spending per person for individual insurance plans sold on the Obamacare exchanges where it manages the pharmacy benefit rose 14 percent in 2016, driven by higher drug prices and utilization...Express Scripts said per-capita spending for other commercial plans it manages, mostly for employers, rose just 3.8 percent last year, despite an 11 percent increase in list prices for brand-name drugs...Drug spending for plans the company manages under Medicare...increased 4.1 percent last year while the rise for Medicaid...was 5.5 percent.

Pfizer Inc. said that it received two subpoenas from the U.S. Attorney’s office in Massachusetts related to charities that help Medicare patients afford co-payments for drugs, the latest company to disclose involvement in the probe...The...subpoenas...requesting documents related to the Patient Access Network Foundation and other organizations that provide financial assistance to Medicare patients. Pfizer donated more than $10 million to the PAN Foundation in 2016...including for funds related to kidney cancer and...acromegaly...A long list of drugmakers have now received subpoenas about their relationships with patient assistance charities, some related to how they help people in the Medicare drug program for the elderly afford the co-payments for drugs...As drug prices have surged, pharmaceutical companies’ large contributions to charities have given them a public-relations foil against backlash and helped keep patients from seeking lower-priced medicines. The seven biggest co-pay charities, which cover scores of diseases, reported combined contributions of $1.1 billion in 2014...

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

Eric Pusey has to bite his tongue when customers at his pharmacy cough up co-payments far higher than the cost of their low-cost generic drugs, thinking their insurance is getting them a good deal...Pusey’s contracts with drug-benefit managers at his Medicap Pharmacy in Olyphant, Pennsylvania, bar him from volunteering the fact that for many cheap, generic medicines, co-pays sometimes are more expensive than if patients simply pay out of pocket and bypass insurance. The extra money -- what the industry calls a clawback -- ends up with the benefit companies…Clawbacks, which can be as little as $2 a prescription or as much as $30, may boost profits by hundreds of millions for benefit managers and have prompted at least 16 lawsuits since October. The legal cases as well dozens of receipts obtained by Bloomberg and interviews with more than a dozen pharmacists and industry consultants show the growing importance of the clawbacks.

Nevada Gov. Brian Sandoval said Saturday he would take his concerns about the overhaul of the Affordable Care Act to Capitol Hill where lawmakers are mulling over various proposals to replace Obamacare...The nation’s governors, in town for their annual meeting, are expected to spend Monday talking with Republican leaders and members of Congress about repeal and replacement of the health care act...Many states, including Nevada, broadened Medicaid programs to take advantage of federal funds to help insure more elderly and poor. Officials in those states are concerned about how the federal government will continue its funding commitment for the expanded programs...Sandoval said congressional overhaul of the ACA is a top concern for governors and that the “conversation is ongoing.”...

As high pharmaceutical prices strain budgets of payers and patients alike, Harvard Pilgrim is betting so-called pay-for-performance deals will help lower drug costs and improve patient outcomes...The...health insurer announced...it had inked two separate agreements with Amgen and Eli Lilly that tie the costs of Amgen's Enbrel (etanercept) and Lilly's Forteo (teriparatide) with either performance or patient adherence...a number of large drugmakers have begun pushing value- or outcomes-based payments as a potential solution to blowback on rising drug prices. Under these types of deals, insurers and other payers would pay less for drugs that fail to meet specified benchmarks. Drugmakers, on the other hand, would be rewarded for innovative medicines that improve outcomes.