- Merck sues HHS to avoid fine over 340B contract pharmacy restrictions (fiercehealthcare.com)
Merck is suing the Biden administration to avoid potential fines for cutting off 340B contract pharmacies from getting discounted products...The pharmaceutical giant argues in a federal lawsuit filed Friday in the U.S. District Court for the District of Columbia that favorable rulings in similar cases make a warning letter from the federal government moot. The lawsuit is the latest in a feud between the federal government and drugmakers over the 340B program...In 2021, Merck became among nearly 20 drugmakers that cut off sales of 340B-discounted drugs to contract pharmacies, which dispense the products on behalf of covered entities. Merck told 340B entities that if they do not join the company’s integrity program and submit claims-level data then it will no longer provide the drugs to contract pharmacies...READ MORE
- CVS Health asks Gov. Scott to veto contentious pharmacy bill (vtdigger.org)H.353 (legislature.vermont.gov)
CVS Health has asked Gov. Phil Scott to veto H.353 — a last-ditch effort to block a bill it says would raise prescription drug costs for Vermonters with private insurance...H.353 started out as a bill to make drugs more affordable by regulating pharmacy benefits managers, third-party companies that negotiate medication coverage plans for consumers with private insurers. But revisions of the bill, as it worked its way through the House and Senate, would have all but guaranteed that specialty drug prescriptions given to patients in health care settings, including expensive cancer medication, would be filled at the University of Vermont Health Network’s pharmacy in Burlington, rather than through cheaper mail-order pharmacies that insurers prefer...READ MORE
- 2 new PBM launches aim to bring greater transparency to the market (fiercehealthcare.com)
Two new pharmacy benefit management startups are aiming to inject greater price transparency into the market...The Purchaser Business Group on Health has announced...EmsanaRx... As PBGH is a coalition of 40 large employers, the company says its PBM solution is "built by employers, for employers."...Emsana Health aims to serve as an "innovation studio" that will develop new products and solutions designed with input from PBGH's employer members...In addition...the Mark Cuban Cost Plus Drug Company PBC also launched its own PBM this week...Cuban's company aims to sell generic drugs at a transparent, fixed rate, and to achieve this united manufacturing, distribution and pharmacy services under one roof...READ MORE
- Community pharmacy makes goal line push to eliminate PBM spread pricing (chaindrugreview.com)
The National Community Pharmacists Association is using social media, digital advertising, and a grassroots effort to push congressional budget makers to include a provision eliminating pharmacy benefit manager spread pricing under the Medicaid program and reimburse pharmacies in a fairer and more transparent manner...“PBM spread pricing costs federal and state taxpayers hundreds of millions of dollars every year. It does nothing to reduce the cost of drugs for Medicaid patients, and it drives local pharmacies out of business,” said NCPA CEO B. Douglas Hoey...Spread pricing is what happens when pharmacy benefit managers, known as PBMs, charge insurance plans like Medicaid one price for prescription medications, reimburse pharmacies that dispense them a much lower price, and then keep a big chunk of the difference for themselves...READ MORE
- Hospitals and for-profit PBMs are diverting billions in 340B savings from patients in need (statnews.com)
America’s economically disadvantaged patients can point in two directions when talking about what is wrong with the 340B Drug Pricing Program, which is designed to help hospitals caring for underserved communities — and the patients they treat — keep necessary medicines reasonably priced: large supposedly “nonprofit” hospitals and for-profit pharmacy benefit managers that serve as 340B contract pharmacies, which together divert billions of dollars in savings that should be helping patients in need...The problem is that the 340B program has become a slush fund for its other participants, the large, supposedly nonprofit hospitals and health systems. They buy drugs at steep 340B discounts, then charge insurers, the uninsured, and cash-paying patients a huge markup. The profits pad the hospitals’ bottom lines and provide ample capital to take over and consolidate local markets, particularly in cancer care. And the result is shockingly little charity care...READ MORE
- Michigan signs PBM reform law with new transparency requirement (fiercehealthcare.com)FTC deadlocked on whether to study PBM contracting practices such as DIR fees (fiercehealthcare.com)
Michigan Gov. Gretchen Whitmer signed a series of pharmacy benefit management reforms into law...including bills that don’t discriminate against pharmacies they don’t have a relationship with...The signing of the three bills...comes less than a week after the Federal Trade Commission was deadlocked on whether to investigate PBM contracting practices...“For too long, unlicensed pharmacy benefit managers have been able to engage in practices that drive up costs for Michiganders whose lives and health depend on critical prescription drugs like insulin,” said Whitmer in a statement Wednesday. “This bill brings much-needed transparency to our healthcare system.”...READ MORE
- Payers, Providers and PBMs: Embrace Data Liquidity to Improve Medication Adherence (healthcareitnews.com)
Sharing real-time patient benefit and eligibility information with providers at the point of prescribing improves medication access and, ultimately, patient outcomes...To help patients access their prescribed medications during office closures due to the pandemic, many health plans relaxed or waived medication regulations, such as prior authorization and refill-too-soon orders...Despite this temporary relief, many patients still experienced delays getting their prescriptions filled...Solutions such as real-time prescription benefit, electronic prior authorization and intelligent pharmacy workflows can help reduce administrative and benefit barriers contributing to these delays – and improve medication adherence along the way...READ MORE
- National pharmacy board group can’t be sued as state actor – 3rd Circuit (reuters.com)
Two drug distributors cannot bring federal civil rights claims against UnitedHealthcare's pharmacy benefit manager Optum unit and an association of state pharmacy boards for allegedly shutting them out of the market by denying accreditation from state boards, a federal appeals court ruled...upheld a lower court judge's dismissal of a lawsuit by distributors PriMed Pharmaceuticals LLC and Oak Drugs Inc against Optum and the National Association of Boards of Pharmacy, finding the defendants could not be sued under the federal civil rights law because they were not state actors...According to the lawsuit, filed in federal court in Newark, PriMed and Oak Drugs, both of which operate in multiple states, were deprived of business because Optum, one of the nation's leading pharmacy benefit managers, requires pharmacies it works with to buy only from distributors accredited by NABP...The distributors said the NABP rejected their applications for accreditation without good reason, violating their due process rights...READ MORE
- NACDS praises Eighth Circuit decision upholding North Dakota law regulating PBMs (chaindrugreview.com)
The National Association of Chain Drug Stores is hailing a decision by the Eighth Circuit of the U.S. Court of Appeals...In the case — Pharmaceutical Care Management Association v. Wehbi — the Eighth Circuit relied on the U.S. Supreme Court’s unanimous ruling in Rutledge v. Pharmaceutical Care Management Association in determining that all provisions in the North Dakota statute, which seek to regulate the relationship between pharmacy benefits managers and pharmacies, were not preempted by the federal Employee Retirement Income Security Act...Importantly, the Court also found that most provisions in the North Dakota law were not preempted by Medicare Part D and outright rejected the PBMs’ argument that they could not be regulated in the federal or state arenas...READ MORE
- NCPA president urges comprehensive review of PBM consolidation (chaindrugreview.com)
National Community Pharmacists Association President Brian Caswell spoke to the Federal Trade Commission during its open meeting...about anticompetitive pharmacy benefit manager issues in the pharmaceutical supply chain...I have watched a steady increase of patients being forced or coerced into mail order which, more often than not, is owned by the (pharmacy benefit manager)...Also, a growing number of restricted medications which are classified as ‘specialty,’ with no clear clinical definition of why it is specialty, are contractually not allowed to be filled by the patient’s preferred pharmacist. Again, the prescription is steered towards the PBM’s own mail order....READ MORE