Content about Pharmacy Benefit Management

July 9, 2013

A nonprofit pharmacy advocacy group has launched a new project that it said was aimed at ensuring fair audit standards for prescription drug claims paid under the Medicare Part D program and protecting pharmacies and patients from what it called unfair audit and conduct practices by pharmacy benefit managers.

WASHINGTON — A nonprofit pharmacy advocacy group has launched a new project that it said was aimed at ensuring fair audit standards for prescription drug claims paid under the Medicare Part D program and protecting pharmacies and patients from what it called unfair audit and conduct practices by pharmacy benefit managers.

July 3, 2013

Oregon Gov. John Kitzhaber, a Democrat, has signed what the National Association of Community Pharmacy has characterized as groundbreaking reform legislation that applies reasonable standards to how pharmacy benefit managers audit community pharmacies, provides increased transparency into generic prescription drug reimbursement and ensures that PBM administrators of prescription drug claims are registered within the state.

ALEXANDRIA, Va. — Oregon Gov. John Kitzhaber, a Democrat, has signed what the National Association of Community Pharmacy has characterized as groundbreaking reform legislation that applies reasonable standards to how pharmacy benefit managers audit community pharmacies, provides increased transparency into generic prescription drug reimbursement and ensures that PBM administrators of prescription drug claims are registered within the state.

June 27, 2013

The U.S. healthcare system could avoid hundreds of millions of dollars in medical costs if medication adherence rates improved, according to the CVS Caremark "2013 State of the States: Adherence Report" released today.

WOONSOCKET, R.I. — The U.S. healthcare system could avoid hundreds of millions of dollars in medical costs if medication adherence rates improved, according to the CVS Caremark "2013 State of the States: Adherence Report" released today.

June 24, 2013

CVS Caremark has been awarded Mail Service Pharmacy accreditation from URAC, a Washington, D.C.-based healthcare accrediting organization that establishes quality standards for the healthcare industry, the company announced.

WOONSOCKET, R.I. — CVS Caremark has been awarded Mail Service Pharmacy accreditation from URAC, a Washington, D.C.-based healthcare accrediting organization that establishes quality standards for the healthcare industry, the company announced on Monday.

June 11, 2013

Catamaran will provide pharmacy benefit management services to Cigna Corp. for 10 years under a new deal between the PBM and the health insurer.

BLOOMFIELD, Conn. — Catamaran will provide pharmacy benefit management services to Cigna Corp. for 10 years under a new deal between the PBM and the health insurer.

May 31, 2013

The Pharmacy Quality Alliance has given one of its top awards to pharmacy benefit manager Catamaran Corp., the PBM said Friday.

LISLE, Ill. — The Pharmacy Quality Alliance has given one of its top awards to pharmacy benefit manager Catamaran Corp., the PBM said Friday.

Catamaran announced that it received a 2013 PQA Quality Award recognizing its five-star rating on all PQA measures in the Part D Star Ratings program. The PQA's stated goal is to improve patient health by championing clear performance measures for medication management, and the recognition program for prescription drug plans recognizes Medicare plans that have demonstrated outstanding performance in medication-related quality.

May 31, 2013

Antitrust attorney and pharmacy benefit management legal expert David Balto on Friday monitored a mini-summit helping supermarket pharmacy better navigate the PBM universe.

Antitrust attorney and pharmacy benefit management legal expert David Balto on Friday monitored a mini-summit helping supermarket pharmacy better navigate the PBM universe. And Balto updated attendees on the legislative landscape — three current bills pending in Congress; 29 states now regulate PBM activity; and 19 states have PBM legislation pending.

May 21, 2013

Spending on specialty drugs is likely to increase by 67% over the next couple of years, according to a new study by pharmacy benefit manager Express Scripts.

ST. LOUIS — Spending on specialty drugs is likely to increase by 67% over the next couple of years, according to a new study by pharmacy benefit manager Express Scripts.

May 20, 2013

A recent survey commissioned on behalf of a pharmacy benefit manager trade group found a high degree of satisfaction among Medicare Part D beneficiaries with preferred pharmacy plans.

WASHINGTON — A recent survey commissioned on behalf of a pharmacy benefit manager trade group found a high degree of satisfaction among Medicare Part D beneficiaries with preferred pharmacy plans.

May 14, 2013

Medicare Part D plans that create tiered networks of pharmacies for beneficiaries need more oversight amid reports that small and medium-sized pharmacies are being excluded from them, several senators wrote in a letter last week to the Centers for Medicare and Medicaid Services.

WASHINGTON — Medicare Part D plans that create tiered networks of pharmacies for beneficiaries need more oversight amid reports that small and medium-sized pharmacies are being excluded from them, several senators wrote in a letter last week to the Centers for Medicare and Medicaid Services.

May 13, 2013

Walgreens extended its agreement as a network pharmacy provider in the CVS Caremark pharmacy benefit management national retail network.

 DEERFIELD, Ill. — Walgreens on Monday extended its agreement as a network pharmacy provider in the CVS Caremark pharmacy benefit management national retail network. The companies are not disclosing the financial and other confidential terms of the agreement.

May 9, 2013

Bipartisan legislation that would let pharmacists devote more time to Medicare beneficiaries and less to adjudicating claims with pharmacy benefit management firms was introduced in the U.S. Senate and won the backing of the National Community Pharmacists Association earlier this week.

ALEXANDRIA, Va. — Bipartisan legislation that would let pharmacists devote more time to Medicare beneficiaries and less to adjudicating claims with pharmacy benefit management firms was introduced in the U.S. Senate and won the backing of the National Community Pharmacists Association earlier this week.

May 7, 2013

The National Community Pharmacists Association is expecting its highest turnout in two years for the association's 2013 Legislative and Government Affairs conference being held Tuesday and Wednesday.

WASHINGTON — The National Community Pharmacists Association is expecting its highest turnout in two years for the association's 2013 Legislative and Government Affairs conference being held Tuesday and Wednesday. NCPA intends to address many key issues impacting community pharmacy with legislators during the two-day conference. 

May 2, 2013

CareFirst BlueCross BlueShield has entered into a three-year agreement with CVS Caremark to provide pharmacy benefit and other related services to its commercial and Medicare Part D members, CareFirst announced earlier this week.

BALTIMORE, Md. — CareFirst BlueCross BlueShield has entered into a three-year agreement with CVS Caremark to provide pharmacy benefit and other related services to its commercial and Medicare Part D members, CareFirst announced earlier this week.

April 23, 2013

Unnecessary spending related to medications totaled nearly half a trillion dollars last year, and much of that was in the poorest states in the country, according to pharmacy benefit manager Express Scripts.

ORLANDO, Fla. — Unnecessary spending related to medications totaled nearly half a trillion dollars last year, and much of that was in the poorest states in the country, according to pharmacy benefit manager Express Scripts.

ESI said the country wasted $418 billion on bad medication-related decisions, including $55.8 billion spent on higher-priced medications when cheaper alternatives were available; and $269.4 billion went to expenses related to poor medication adherence.

April 16, 2013

DSN spoke at length with two Catamaran executives — Albert Thigpen, SVP pharmacy operations and industry relations, and Sumit Dutta, SVP and chief medical officer — about the PBM’s new approach to managed pharmacy care and the changes driving that strategy.

The health and pharmacy marketplace is undergoing rapid and fundamental transformation. To navigate profitably in tomorrow’s complex and shifting healthcare system, the pharmacy benefit management industry — along with the pharmacies and health plan payers allied with PBMs — are going to have to change and adapt as well.

April 15, 2013

The governor of North Dakota has signed into law a bill that would require pharmacy benefit managers to inform pharmacies about how reimbursement for generic prescription drugs is calculated under maximum allowable cost benchmarks and provide a more detailed appeals process to pharmacies to contest the MAC reimbursement caps that PBMs set up.

ALEXANDRIA, Va. — The governor of North Dakota has signed into law a bill that would require pharmacy benefit managers to inform pharmacies about how reimbursement for generic prescription drugs is calculated under maximum allowable cost benchmarks and provide a more detailed appeals process to pharmacies to contest the MAC reimbursement caps that PBMs set up.

The bill, H.B. 1363, received unanimous support in both houses of the state's legislature, and Gov. Jack Dalrymple signed it into law Monday.

April 4, 2013

Washington-based accrediting organization URAC has accredited pharmacy benefit manager Catamaran Corp.'s specialty pharmacy brand, Catamaran said.

LISLE, Ill. — Washington-based accrediting organization URAC has accredited pharmacy benefit manager Catamaran Corp.'s specialty pharmacy brand, Catamaran said.

The PBM said BriovaRx had been awarded URAC's Specialty Pharmacy Accreditation. Catamaran said URAC offered the only third-party, voluntary accreditation program of this scope for the pharmacy benefit management and prescription services industry.

April 2, 2013

Specialty drugs are expected to account for 50% of all drug costs by 2018, according to two new studies.

SAN DIEGO — Specialty drugs are expected to account for 50% of all drug costs by 2018, according to two new studies.

By contrast, specialty drugs accounted for 20% of all drug costs in 2009, but increased to 28.7% by 2012. Pharmacy benefit manager Prime Therapeutics and Blue Cross and Blue Shield of Minnesota conducted the studies, and Prime is presenting them Tuesday at the Academy of Managed Care Pharmacy's 25th annual meeting and expo in San Diego.

March 25, 2013

Kentucky became the first state to enact legislation that provides pharmacists with transparency into how health plans determine pharmacy reimbursements for generic drugs, and establishes an appeals process when a dispute arises over those payment levels.

FRANKFORT, Ky. — Kentucky on Friday became the first state to enact legislation that provides pharmacists with transparency into how health plans determine pharmacy reimbursements for generic drugs, and establishes an appeals process when a dispute arises over those payment levels. 

Specifically, the new law creates a set of standards with relation to categorizations and formularies for how pharmacy benefit managers craft their MAC lists, requires more frequent updates and streamlines the process for pharmacy reimbursement appeals.

March 15, 2013

The National Community Pharmacists Association endorsed H.R. 1188, legislation introduced by U.S. Reps. Tom Marino, R-Pa., and Judy Chu, D-Calif., that would allow independent community pharmacies to collectively negotiate.

ALEXANDRIA, Va. — The National Community Pharmacists Association on Friday endorsed H.R. 1188, legislation introduced by U.S. Reps. Tom Marino, R-Pa., and Judy Chu, D-Calif. The bill will allow independent community pharmacies to collectively negotiate the terms and conditions of insurance contracts they must sign, typically with pharmacy benefit managers that administer prescription drug plans. 

March 13, 2013

Bills introduced in Oregon's state legislature would allow employers and other health plan sponsors to have greater knowledge about how pharmacy benefit managers determine the rates at which they pay pharmacies for dispensing generic drugs; establish new standards for pharmacy audits while requiring PBMs to register in the state and be licensed by the state board of pharmacy; and prevent health plans from requiring residents of the state to use mail-order pharmacies.

NEW YORK — Bills introduced in Oregon's state legislature would allow employers and other health plan sponsors to have greater knowledge about how pharmacy benefit managers determine the rates at which they pay pharmacies for dispensing generic drugs; establish new standards for pharmacy audits while requiring PBMs to register in the state and be licensed by the state board of pharmacy; and prevent health plans from requiring residents of the state to use mail-order pharmacies.

March 8, 2013

While the country's spending on specialty drugs increased by 18.4% in 2012, spending on traditional drugs fell for the first time in 20 years, according to a report by Express Scripts.

ST. LOUIS — While the country's spending on specialty drugs increased by 18.4% in 2012, spending on traditional drugs fell for the first time in 20 years, according to a report by Express Scripts.

March 7, 2013

Employers that use multiple cost-management programs have a 50% lower specialty drug trend than those that don't use them, according to a new study by pharmacy benefit manager Express Scripts.

WASHINGTON — Employers that use multiple cost-management programs have a 50% lower specialty drug trend than those that don't use them, according to a new study by pharmacy benefit manager Express Scripts.

The study, presented Thursday at the National Business Group on Health's Business Health Agenda 2013 conference in Washington, was described as one of the first to examine the effect of multiple utilization management programs on the cost of specialty medications, which is expected to account for $1 out of every $4 spent on prescription drugs by 2014.

March 6, 2013

The National Community Pharmacists Association joined the North Dakota Pharmacy Association in support of a pharmacy benefit manager transparency bill that was passed by the state assembly by a vote of 93-0 on Feb. 25.

ALEXANDRIA, Va. — The National Community Pharmacists Association on Wednesday joined the North Dakota Pharmacy Association in support of a pharmacy benefit manager transparency bill that was passed by the state assembly by a vote of 93-0 on Feb. 25.