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...“Why Pharmacies Overcharge,” an entertaining and provocative video on the pharmacy industry and its generic prescription pricing...It’s definitely worth your time...The video covers the history of pharmacy, from the “Soda Fountain Era” to “Lick, Stick, and Pour” to the rise of PBMs and GoodRx...READ MORE

The Department of Health and Human Services finalized a long-awaited rule that sets up a process to resolve disputes surrounding the controversial 340B drug discount program...The final rule...comes as several drugmakers have restricted access to drugs discounted under the program. The rule could weigh in on the center of the feud: contract pharmacies...The process will resolve claims by safety net hospitals and other entities in the 340B program that a drug company overcharged them. It also allows drug companies to appeal if a covered entity violated a part of the program such as getting duplicative discounts...READ MORE

As President Trump wrestles with trying to rein in the high cost of medicine in the United States, he is contemplating an executive order and a proposed rule from the Center for Medicare & Medicaid Services that would set Medicare Part B prescription drug costs based on an International Pricing Index (IPI). The problem is that the IPI includes countries that utilize socialized medicine and artificial price controls. Here, President Trump is mistakenly focused upon the symptom rather than the cause of the problem.  The symptom is the cost, the cause is the incredible barriers to approval and pernicious middle-men known as Pharmacy Benefit Managers which make medicines more expensive...READ MORE

...nearly half of U.S. pharmacies now participate in the 340B Drug Pricing Program...The four largest specialty pharmacies are owned by CVS Health, Cigna’s Express Scripts business, UnitedHealth Group’s OptumRx business, and Walgreens Boots Alliance/Prime Therapeutics...these specialty pharmacies have dramatically increased their participation in the 340B program. Hospitals are the primary 340B covered entities that engage with these specialty pharmacies...We estimate that specialty pharmacy dispensing accounted for nearly one-third of PBMs’ total gross profits in 2019...the 340B program is a significant and growing component of profitability for these large, for-profit, publicly traded companies...READ MORE

A new legislation recently passed by the Michigan’s House of Representatives would require reforms to many pharmacy benefit manager reimbursement practices in the state...The provisions listed in HB 4348 would prohibit PBMs from reimbursing pharmacies affiliated with the PBM more than non-affiliate pharmacies; prohibit patient steering to PBM-owned pharmacies; prohibit retroactive clawbacks; require reimbursement be based on the National Average Drug Acquisition Cost; and establish fair audit procedures for community pharmacies...READ MORE

Amazon is getting more serious about pharmacy...This announcement is much less disruptive than it appears to be. Amazon is copying the GoodRx discount card model—including GoodRx’s partnership with Express Scripts. At the same time, Amazon is launching a mail pharmacy that will accept insurance and be in PBM pharmacy networks...Amazon’s actions are another negative headwind for retail pharmacies, but not a fatal blow to the system. Perhaps Amazon will one day become a true disrupter...Amazon Pharmacy operates as a home delivery pharmacy. It is built on the backbone of PillPack, which Amazon acquired for $700 million in 2018...Just like any other pharmacy, Amazon relies on your pharmacy benefit plan to determine your out-of-pocket expenses. Nothing magical here...READ MORE

Gov. Brian Kemp signed legislation...tightening rules on third-party companies that play a role in negotiating pharmaceutical drug prices between insurers and local pharmacies in Georgia...The bill...requires...pharmacy benefits managers to set drug prices within a national average, a move aimed at reining in excessively high prescription prices...Senate Bill 313...also forces PBMs to offer up full rebates to health plans that are typically given by drugmakers, rather than pocketing a portion...And PBMs will need to submit to new audits by the state Department of Community Health as well as requirements for publishing data on prescription prices online...READ MORE

A federal judge in Minnesota has decided that Mylan must face a lawsuit accusing it of paying bribes and kickbacks to pharmacy benefit managers and of conspiring to fix prices on its EpiPen device...Drug wholesalers Rochester Drug CoOperative and Dakota Drug filed separate but similar lawsuits in March 2020 and June 2020, respectively, claiming that Mylan paid bribes and kickbacks to a group of pharmacy benefit managers —referred to collectively as CVS Caremark, Express Scripts, and OptumRx — to ensure that Mylan could raise the price of its EpiPen auto-injector with impunity while also keeping a monopoly share of the market...Mylan and the PBM defendants filed separate motions to dismiss for failure to state a claim...READ MORE

Pharmaceutical Care Management Association president and CEO JC Scott issued the following statement on today’s hearing in the House Committee on Oversight and Reform on pricing practices for prescription drugs: “We appreciate the House Oversight Committee keeping a spotlight on drug manufacturers’ pricing practices. While drug manufacturers are solely responsible for setting and increasing prescription drug prices, pharmacy benefit managers, PBMs, are the only entity reducing prescription drug costs. PBMs keep prescription drug costs and premiums in check by negotiating lower costs with drug makers and pharmacies...We share President Trump’s intention to keep Medicare premiums affordable...PBMs will continue working with policymakers to advance solutions that encourage greater competition to reduce drug costs for every consumer.”...READ MORE

The country’s leading pharmacy groups said that any action on a prescription drug rebate rule must address skyrocketing fees extracted by pharmacy benefit managers on behalf of plan sponsors in Medicare Part D...“We remind the Administration of the continuous and heightened impact of pharmacy DIR fees imposed by Medicare Part D plan sponsors and their pharmacy benefit managers (PBMs) on our members. Pharmacy DIR fees are growing beyond CMS’ projection of 10% year-over-year...“If pharmacy DIR fees are not addressed in a forthcoming rebate rule, the impact on our members and their ability to care for patients in such a system will prove detrimental...READ MORE