Content about Pharmacy Benefit Management

May 28, 2013

Risk is everywhere in our lives. The trick, as Mr. Buffett says, is to manage it through knowledge. Your exposure to risk in the pharmacy businesses may come about from various sources.

“Risk comes from not knowing what you're doing.” — Warren Buffett

Risk is everywhere in our lives. The trick, as Mr. Buffett says, is to manage it through knowledge. Your exposure to risk in the pharmacy businesses may come about from various sources.

Theft, litigation, competition, financial risk, risk that you will see Emdeon’s VP of Pharmacy Sales, Richard Brook in a Harlem Shake video…. and audit risk.

April 14, 2014

AssistRx last week introduced a new technology that simplifies the prescribing of specialty therapies while streamlining communications between prescribers, pharmacies, patients and manufacturers. It’s smart technology that can lead to patients receiving specialty medications weeks earlier than ever before, the company claimed.

ORLANDO, Fla. — AssistRx last week introduced a new technology that simplifies the prescribing of specialty therapies while streamlining communications between prescribers, pharmacies, patients and manufacturers. It’s smart technology that can lead to patients receiving specialty medications weeks earlier than ever before, the company claimed.

April 9, 2014

As the cost for specialty medications continues to rise, implementing an effective "channel transition" approach — the process of moving prescriptions from the medical benefit to the pharmacy benefit — can produce significant savings for healthcare payers by improving management of these complex and costly drugs, according to a new report commissioned by CVS Caremark.

WOONSOCKET, R.I. — As the cost for specialty medications continues to rise, implementing an effective "channel transition" approach — the process of moving prescriptions from the medical benefit to the pharmacy benefit — can produce significant savings for healthcare payers by improving management of these complex and costly drugs, according to a new report commissioned by CVS Caremark.

March 18, 2014

Last year, $29.3 billion was spent on prescription drugs in Canada, but the annual growth rate was the second-lowest in more than 20 years, according to a new report by the Canadian Institute for Health Information released earlier this month.

OTTAWA, Ontario — Last year, $29.3 billion was spent on prescription drugs in Canada, but the annual growth rate was the second-lowest in more than 20 years, according to a new report by the Canadian Institute for Health Information released earlier this month. 

March 10, 2014

Although the United States is still waiting for final practical guidelines from the Food and Drug Administration about the launch of biosimilars and the standards required to meet the threshold of interchangeability, the rest of the world seems to be barreling forward with the development and launch of these important medicines.

Although the United States is still waiting for final practical guidelines from the Food and Drug Administration about the launch of biosimilars and the standards required to meet the threshold of interchangeability, the rest of the world seems to be barreling forward with the development and launch of these important medicines. By the end of this decade, a significant number of blockbuster drugs will go off patent, paving the way for biosimlar market entrance.

February 18, 2014

Now that most generics have declined in cost, plans will look for new ways to control health spend and ensure that generics are being used whenever possible.

Now that most generics have declined in cost, plans will look for new ways to control health spend and ensure that generics are being used whenever possible. Prescription drug spending is down, and generic drugs made up 77% of all 2012 prescriptions, according to the Centers for Medicare and Medicaid Services. Could this generic utilization percentage go even higher as a result of recent healthcare legislation?

Medicaid is increasingly becoming a managed care program, and states are looking to entities like pharmacy benefit managers to help them manage their drug spend.

February 18, 2014

The federal agency in charge of Medicare is pushing for a major overhaul of its Medicare Part D drug benefit program for seniors.

The federal agency in charge of Medicare is pushing for a major overhaul of its Medicare Part D drug benefit program for seniors. Those changes, if adopted, could help level the competitive playing field for pharmacy retailers in Part D plan networks, reduce competitive advantages for preferred pharmacy networks and mail-order pharmacies, and put a tighter squeeze on pharmacy benefit managers.

Thus, the proposals by the Centers for Medicare and Medicaid Services for the 2015 federal fiscal year could spell big changes for retail pharmacies. Among the most far-reaching are:

February 12, 2014

Members of Congress are contacting the U.S. Centers for Medicare and Medicaid Services in support of pro-patient improvements the agency proposed for Medicare Part D prescription drug plans in 2015, a development applauded today by the National Community Pharmacists Association.

ALEXANDRIA, Va. — Members of Congress are contacting the U.S. Centers for Medicare and Medicaid Services in support of pro-patient improvements the agency proposed for Medicare Part D prescription drug plans in 2015, a development applauded today by the National Community Pharmacists Association.

In response to problems with “preferred pharmacy” networks, CMS has proposed allowing any willing pharmacy to offer a plan’s lowest, or preferred, cost-sharing to give seniors more choice and to foster greater competition among pharmacies. 

February 11, 2014

The Pharmacy Benefit Management Institute recently released its Specialty Drug Benefit Report, sponsored by Walgreens Specialty Pharmacy.

PLANO, Texas — The Pharmacy Benefit Management Institute recently released its Specialty Drug Benefit Report, sponsored by Walgreens Specialty Pharmacy. The 2014 edition highlights trends important to specialty pharmacy, including emerging cost-control strategies and challenges affecting benefit design and patient care. 

February 5, 2014

CVS Caremark was awarded the 2014 Rx Benefit Innovation Award by the Pharmacy Benefit Management Institute on Tuesday, the company reported.

WOONSOCKET, R.I. — CVS Caremark was awarded the 2014 Rx Benefit Innovation Award by the Pharmacy Benefit Management Institute on Tuesday, the company reported. The award recognizes the company's new Specialty Connect program, which was developed by CVS Caremark to improve access, quality of care and convenience for specialty pharmacy patients.

January 24, 2014

Legislative relief that would result in a more balanced business relationship between Ohio community pharmacists and PBMs is critical, according to the National Community Pharmacists Association.

ALEXANDRIA, Va. — Legislative relief that would result in a more balanced business relationship between Ohio community pharmacists and PBMs is critical, according to the National Community Pharmacists Association.

January 9, 2014

Administering high-touch, expensive and complex medications to patients intravenously in their homes — or in a setting other than a hospital — is essentially a large-scale bid to “reduce costs by transferring non-self-administered drugs to the most cost-effective and clinically appropriate site of care,” said pharmacist Michael Einodshofer, senior director of specialty strategy and innovation at Walgreens Specialty Pharmacy.

Administering high-touch, expensive and complex medications to patients intravenously in their homes — or in a setting other than a hospital — is essentially a large-scale bid to “reduce costs by transferring non-self-administered drugs to the most cost-effective and clinically appropriate site of care,” said pharmacist Michael Einodshofer, senior director of specialty strategy and innovation at Walgreens Specialty Pharmacy.

January 2, 2014

The number of new drugs approved by the Food and Drug Administration fell by more than 30% in 2013 compared with 2012, according to agency records.

NEW YORK — The number of new drugs approved by the Food and Drug Administration fell by more than 30% in 2013 compared with 2012, according to agency records.

December 19, 2013

The National Community Pharmacists Association on Thursday announced the need for legislation in Pennsylvania to protect independent pharmacy operators there.

ALEXANDRIA, Va. — The National Community Pharmacists Association on Thursday announced the need for legislation in Pennsylvania to protect independent pharmacy operators there. 

December 13, 2013

Pharmacy benefit manager Express Scripts hopes to drive down the cost of new drugs to treat hepatitis C by pitting their manufacturers against each other, according to published reports.

NEW YORK — Pharmacy benefit manager Express Scripts hopes to drive down the cost of new drugs to treat hepatitis C by pitting their manufacturers against each other, according to published reports.

Bloomberg News reported that ESI would pit companies like Gilead Sciences against others such as AbbVie when the new treatments become available in 2014 or 2015. The Food and Drug Administration announced last week the approval of Gilead's new drug, Sovaldi (sofosbuvir), which is designed to cut by three quarters the time needed for treatment.

December 9, 2013

A survey of more than 1,000 independent pharmacists finds that acquisition costs for generic drugs have spiked by as much as 1,000% this year.

ALEXANDRIA, Va. — A survey of more than 1,000 independent pharmacists finds that acquisition costs for generic drugs have spiked by as much as 1,000% this year.

December 4, 2013

Mail-order pharmacies frequently charge Medicare prescription drug plans more than community pharmacies do for filling prescriptions, a new analysis by the U.S. Centers for Medicare and Medicaid Services has concluded.

ALEXANDRIA, Va. — Mail-order pharmacies frequently charge Medicare prescription drug plans more — as much as 83% — than community pharmacies do for filling prescriptions, a new analysis by the U.S. Centers for Medicare and Medicaid Services has concluded.

CMS examined claims from March 2012 and found 21 drug plans that routinely paid more for prescriptions filled through the mail compared to a community pharmacy.

November 19, 2013

A pair of Congress leaders — Reps. Doug Collins, R-Ga., and Martha Roby, R-Ala. — on Tuesday advocated for community pharmacy with letters addressed to the leaders of the House Energy and Commerce Committee and Ways and Means Committee.

ALEXANDRIA, Va. — Reps. Doug Collins, R-Ga., and Martha Roby, R-Ala., on Tuesday advocated for community pharmacy with letters addressed to the leaders of the House Energy and Commerce Committee and Ways and Means Committee. 

In serving Medicare seniors, community pharmacies should be subject to the same three-year audit review period as hospitals, and not forced to document 10-year-old claims, the Representatives suggested.  

November 6, 2013

U.S. Sens. Pat Roberts, R-Kan., and Mary Landrieu, D-La., on Tuesday introduced legislation that repeals a portion of Obamacare that prohibits people from using their medical savings account funds to buy over-the-counter medications.

WASHINGTON — U.S. Sens. Pat Roberts, R-Kan., and Mary Landrieu, D-La., on Tuesday introduced legislation that repeals a portion of Obamacare that prohibits people from using their medical savings account funds to buy over-the-counter medications. Under current law, plan participants may no longer use funds from these accounts to purchase OTC medications, unless they have a prescription for the medication.

October 24, 2013

CVS Caremark has been awarded Pharmacy Benefit Management and Drug Therapy Management accreditation from URAC, a Washington, D.C.-based healthcare accrediting organization that establishes quality standards for the healthcare industry, the pharmacy retailer has announced.

WOONSOCKET, R.I. — CVS Caremark has been awarded Pharmacy Benefit Management and Drug Therapy Management accreditation from URAC, a Washington, D.C.-based healthcare accrediting organization that establishes quality standards for the healthcare industry, the pharmacy retailer has announced.

August 8, 2013

Results of a recent federal survey of Medicare Part D claims is again roiling the sometimes strained relationship between independent and smaller-chain community pharmacies and managed care, and could herald a growing threat to those pharmacies as health plan payers and pharmacy benefit managers abandon open pharmacy provider networks and shift more business to exclusive preferred pharmacy groups.

Results of a recent federal survey of Medicare Part D claims is again roiling the sometimes strained relationship between independent and smaller-chain community pharmacies and managed care, and could herald a growing threat to those pharmacies as health plan payers and pharmacy benefit managers abandon open pharmacy provider networks and shift more business to exclusive preferred pharmacy groups.

August 8, 2013

The world is turning generic. That's the takeaway from the latest trends in the drug industry, according to IMS Health.

The world is turning generic. That's the takeaway from the latest trends in the drug industry, according to IMS Health. In 2012, according to the healthcare industry analytics firm, dollar sales of drugs fell by 1% to $325.7 billion, but prescriptions grew by 1.2% as generic drugs' share of total drugs dispensed grew to nearly 83%.

August 2, 2013

Pharmacy benefit manager Catamaran Corp. had $3.4 billion in revenues in second quarter 2013, the company said.

LISLE, Ill. — Pharmacy benefit manager Catamaran Corp. had $3.4 billion in revenues in second quarter 2013, the company said.

That figure represented a 101% increase in the PBM's revenues in second quarter 2012 and resulted in a profit of $63.4 million, 132% higher than last year.

"During the second quarter of 2013, we continued to successfully execute our growth strategy, driving new customer wins by leveraging our flexibility and customizable model to deliver more control and savings to our clients," Catamaran chairman and CEO Mark Thierer said.

July 29, 2013

The Consumer Healthcare Products Association endorsed the Restoring Access to Medication Act (H.R. 2835), which would repeal a requirement enacted into law as part of the Patient Protection and Affordable Care Act of 2010 that requires consumers to obtain a prescription in order to utilize their flexible spending arrangements and health savings accounts to purchase over-the-counter medicines.

WASHINGTON — The Consumer Healthcare Products Association on Friday endorsed the Restoring Access to Medication Act (H.R. 2835) introduced by Reps. Lynn Jenkins, R-Kan., and John Barrow, D-Ga., which would repeal a requirement enacted into law as part of the Patient Protection and Affordable Care Act of 2010 that requires consumers to obtain a prescription in order to utilize their flexible spending arrangements and health savings accounts to purchase over-the-counter medicines.

July 12, 2013

The creation of a clear approval pathway for biosimilar drugs remains a daunting task for the Food and Drug Administration, despite the fact that it's prescribed by law through the Patient Protection and Affordable Care Act. But when those lower-priced, generic versions of some staggeringly expensive bioengineered medicines do finally come to market, they're likely to have a profound effect on the nation's outlays for specialty pharmaceuticals.

The creation of a clear approval pathway for biosimilar drugs remains a daunting task for the Food and Drug Administration, despite the fact that it's prescribed by law through the Patient Protection and Affordable Care Act. But when those lower-priced, generic versions of some staggeringly expensive bioengineered medicines do finally come to market, they're likely to have a profound effect on the nation's outlays for specialty pharmaceuticals.