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The initial fallout from the Valeant-Philidor kerfuffle has hit the pharmacy industry. Over the past few weeks, the major pharmacy benefit managers have begun dropping pharmacies from their networks. Some PBMs are also reminding retail pharmacies that they are prohibited from acting as mail pharmacies…I highlight the high-profile network pruning by the top three PBMs—Express Scripts, the Caremark PBM business of CVS Health, and the OptumRx business of UnitedHealthcare. I also speculate on the factors that would lead a PBM to clash with a pharmacy in its network…An as-yet-unanswered question: If PBMs routinely monitor their networks, why did it take a highly publicized pharmacy meltdown before PBMs finally cracked down?

Direct and indirect remuneration fees rise from preferred network drug plans offered by insurers and pharmacy benefit managers…fees…are causing financial hardship for many pharmacies…These fees may encompass “pay-to-play” fees for network participation, periodic reimbursement reconciliations, or non-compliance with quality measures…Many pharmacists feel that there is a lack of transparency regarding how DIR fees are calculated…the fees are retroactive, which can make it hard for pharmacy owners to run a business…Originally, DIRs were established to allow PBMs and Medicare to share in rebates that the insurers received from drug manufacturers under Medicare Part D coverage…cost imposed by the PBM on pharmacies that is not necessarily disclosed to Medicare officials…the financial realities associated with very high DIR may force many pharmacies to withdraw from networks…CMS has said in the past that the fees distort the real price of prescription drugs in the market.

..nation’s biggest pharmacy benefits manager has decided to cover two new drugs that lower…cholesterol but raise concern over prices that can top $14,000 a year…Express Scripts said…that it will pay for prescriptions of…Repatha as well as Praluent…under a few conditions designed to control costs…It will require prior approval…before any prescriptions are filled…will need to see a patient’s cholesterol levels first as well as proof that the older statins failed…is requiring the drugmakers to provide rebates if prices climb more than a set amount each year…Express Scripts also has agreed to cover any costs that exceed a certain amount per person, annually.

Express Scripts has been named the worst company to work for in the United States, while CVS ranked 12th on the same list.  24/7 Wall St. compiled the rankings using data from career website Glassdoor, which gathers ratings on more than 400,000 companies globally.

...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…The terminations come from payers who together manage drug benefits for more than 100 million Americans…Express Scripts, the nation's largest pharmacy benefits manager, has changed the algorithms it uses in its audits to find pharmacies focused heavily on one drug manufacturer and has cut ties with half a dozen such pharmacies...Independent pharmacies and their drugmaker partners counter that Express Scripts, CVS and OptumRx together control more than two-thirds of the market through their own mail-order operations. The specialty pharmacies say that the benefit managers are trying to curb the explosive growth of smaller, independent players.

..specialty pharmacy that fills prescriptions for Valeant Pharmaceuticals International Inc. has altered doctors’ orders to wring more reimbursements out of insurers, according to former employees and an internal document…Workers at the mail-order pharmacy, Philidor RX Services LLC, were given written instructions to change codes on prescriptions in some cases so it would appear that physicians required or patients desired Valeant’s brand-name drugs -- not less expensive generic versions -- be dispensed, the former employees said. Typically, pharmacists will sell a generic version if not precisely told to do otherwise by a “dispense as written” indication on a script. The more "dispense as written" orders, the more sales for the brand-name drugmaker.

pharmacy benefit manager jobs are relatively rare,..pharmacists employed by PBMs found the following job aspects..

• most appealing: client interaction, constantly changing issues and challenges, flexible schedule, researching and evaluating clinical studies and peer-reviewed literature, and the opportunity to change pharmacy to a provider profession.
• least appealing: sitting at a desk for 8 to 10 hours a day and day-to-day functions such as answering emails, statistics, and paper work…a lack of direct patient contact.

...latest fallout over the role that specialty pharmacies play in boosting prescription drug sales, Express Scripts has ended a contract with a company that is used by Horizon Pharma to distribute some of its medicines…Express Scripts cancelled its contract with Linden Care after determining the mail-order pharmacy was apparently dispensing drugs that are mostly made by Horizon, according to a spokesman. Express Scripts, which is the nation’s largest pharmacy benefits manager, is scrutinizing what it calls captive pharmacies. Those captive pharmacies appear to sell products for mostly one drug maker…In response, Linden filed a lawsuit accusing Express Scripts of making “a trumped-up charge that Linden Care is mailing drugs out of state purportedly in violation of [its] contract.” The pharmacy also maintains Express Scripts failed to provide adequate notice that the contract was ended. Express Scripts sent its termination notice yesterday, Nov. 10.

Some of the biggest customers of Philidor Rx, the consolidated specialty pharmacy tucked inside embattled drug giant Valeant Pharmaceuticals, are seeing red flags. Two of the nation’s biggest pharmacy benefits managers, CVS Health and Express Scripts, both said on Thursday they are cutting ties with Philidor Rx after finding the noncompliance with provider agreements…The terminations add a new headache to Valeant Pharmaceuticals as it tries to recover from an onslaught of scrutiny from lawmakers, regulators and investors into its business practices.

two largest pharmacy benefit managers —Express Scripts and CVS Caremark—have just released their 2016 formulary exclusion lists…CVS Caremark’s 2016 list has 124 products, including 31 new additions. Express Scripts, which is much more public about its strategy, has only 80 products and fewer additions to its list...