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The Ohio Department of Insurance said...that pharmacy benefit managers and insurers would have to disclose the lowest price for a prescription drug for Ohio consumers, part of a move to prevent insured consumers potentially paying more than those without insurance...Two of the largest pharmacy benefit managers, Express Scripts Holding Co. and CVS Health Inc said their contracts include clauses by which members receive the lowest cost automatically...The agency said it would ban the practice in which some insurers and pharmacy benefit managers use contractual provisions to prevent pharmacists from discussing with consumers if low-cost options are available for prescriptions, effective immediately...It would also prohibit them from charging customers a higher amount for prescription drugs than what it would otherwise cost without insurance coverage

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.

...Anthem Inc said it had sued pharmacy benefit manager Express Scripts Holding Co to recover damages from drug pricing it believes was too high...latest development in a months-long dispute over Anthem's contract with Express Scripts...The lawsuit also seeks to recover damages from operational issues and for a declaration of Anthem's right to terminate its contract with Express Scripts…Anthem, which has been seeking $3 billion in annual cost savings through a repricing provision in its 10-year contract with Express Scripts, said it had not yet decided whether to end the contract...The latest news has taken a very unhealthy turn and we see it unlikely that Anthem renews its contract with Express Scripts past 2019, and is likely to leave sooner to the extent it can manage the transition for consumers smoothly...Express Scripts...said in a statement that it believed the lawsuit to be without merit. The company has consistently acted in good faith and in accordance with the terms of its agreement with Anthem…

..pharmacist Russell Reitz…agreed to sell his pharmacy (R&O Pharmacy), in a quiet suburban office park, to the group (East Coast investors) for $350,000…he continued as manager, Reitz began finding his store's name and his national pharmacy license number on an avalanche of prescriptions nationwide…a torrent of insurers' money started flowing to his small shop…on pace to equal $230 million a year…Reitz now finds himself at the center of the national scandal enveloping Valeant…In the last two months, Reitz has filed papers in two Los Angeles courthouses laying out details of what he and his lawyer call "a massive fraud."…Until Reitz's court filings…few people knew about Valeant's close ties to Philidor...Reitz detailed how he had discovered that Philidor was using his national pharmacy identification number on prescriptions being filled at other pharmacies — and even on some that were filled and billed before he signed the agreement to sell R&O…Reitz said he believes that Philidor had targeted his pharmacy because it needed access to his licenses, which he has in California and 33 other states, as well as to the contracts he had negotiated with insurers.

Jeff Bezos is teaming up with two fellow billionaires in what could be a prelude to bigger plans to undercut the dominance of intermediaries in the country’s complex health-care system. Pharma companies are trying to shift the blame onto them for soaring drug prices...In response, the middlemen known as pharmacy-benefit managers, or PBMs, are getting more aggressive with the tactics they use to control costs. Express Scripts Holding Co., CVS Health Corp. and UnitedHealth Group Inc.’s OptumRx are increasingly denying coverage of some drugs, negotiating discounts on others or requiring high co-pays for expensive treatments...“It’s becoming more common that we have to play the gatekeeper role,”...The strategy has had some success. Express Scripts said clients’ drug costs rose 1.5 percent last year, the slowest in more than two decades. For 2018, Express Scripts and CVS each refused to cover about 150 drugs -- typically in cases where they negotiated a better deal for alternatives...The tension between PBMs and drugmakers is likely to intensify for two sets of promising drugs coming soon: treatments that help prevent migraines, and drugs for a little-known but widespread liver disease called NASH...

Walgreens Boots Alliance Inc said it would partner with pharmacy benefit manager Prime Therapeutics to reduce drug procurement costs...The companies will combine their central specialty pharmacy and mail order service businesses and introduce a new retail pharmacy network that will give Prime Therapeutics' customers access to Walgreens' pharmacy network...Walgreens...already has partnerships with PBMs such as Express Scripts Holding Co...and UnitedHealth Group Inc's OptumRx...Walgreens is also in talks to acquire Rite Aid Corp, which will give it ownership of Rite Aid's PBM, EnvisionRx...

Express Scripts Holding Co. is carefully scrutinizing prescriptions for products made by Valeant Pharmaceuticals International Inc., making sure the pharmacy manager’s rules are being followed...We are looking at every single claim for their products...They are getting extra scrutiny...Valeant last year was accused of working with a network of pharmacies to boost sales of its drugs and get them reimbursed by health insurers and pharmacy benefit managers like Express Scripts, even when there were cheaper generics available...Express Scripts reviews prescription claims to ensure that the manufacturer and pharmacies are operating in a manner consistent with its contracts and in the best interests of its clients and patients...The reviews ensure that patients and payers aren’t spending more on the products than necessary...

Anthem Inc. plans to create its own pharmacy benefit manager in a move that will cut ties with the big insurer's current partner, Express Scripts Holding Co...The new PBM, dubbed IngenioRx...Anthem has also signed onto a five-year agreement with CVS Health Corp. that will provide prescription fulfillment and claims processing services, as well as other benefits like larger scale. The agreement is slated to begin on Jan. 1, 2020, after Anthem's contract with Express Scripts expires... Anthem leadership said the pivot will save an estimated $4 billion annually once IngenioRx becomes fully integrated…our new PBM will be focused on managing the total cost of healthcare to improve affordability for our members...

Pharmacy benefit manager Express Scripts Holding Co has accused Anthem Inc of negotiating their contract in bad faith and is seeking a court order that the health insurer has no right to demand lower drug prices...The allegations, made in a filing in federal court...in response to a lawsuit Anthem brought against Express Scripts last month seeking $13 billion in price cuts over the remaining four years of the companies' contract...Express Scripts said...the contract did not require it to offer any specific price cuts, but only to negotiate in good faith...Express Scripts said it had proposed five price cuts "within the range" of Swedish's projections last June, but that all were rejected, suggesting that Anthem was acting in bad faith when it brought its $13 billion lawsuit.

Valeant Pharmaceuticals International Inc sought to reassure doctors…that the company's decision to cut ties to a controversial specialty pharmacy would not disrupt doctors' ability to prescribe the company's drugs to patients…In a letter to healthcare professionals…Valeant would pay for the cost of its products through Nov. 8 and make sure patients could fill their prescriptions with no out-of-pocket expenses, wherever possible. Patients on government-run health plans such as Medicare are not eligible…Philidor Rx Services, will file no further insurance claims.