The New York Times reporters who wrote the scathing article last month on the traditional PBMs are back with a new piece that discusses how the FTC has now taken up the cause. The FTC just released a report that strongly criticizes the Big 3 PBMs for their anti-competitive practices that frequently drive up prescription drug costs instead of helping to lower them. Here are some key passages of today’s Times article: • The Federal Trade Commission on Tuesday sharply criticized pharmacy benefit managers, saying in a scathing 71-page report that “these powerful middlemen may be profiting by inflating drug costs and squeezing Main Street pharmacies.” • The regulator’s study signals a significant ramping up of its scrutiny of benefit managers under the agency’s chair, Lina Khan. It represents a remarkable turnabout for an agency that has long taken a hands-off approach to policing these companies. • Benefit managers are supposed to save everyone money. But in recent years, the industry has grown more consolidated and has taken more control over how patients get their medicines, in a shift that critics say contributes to driving up drug costs. If you would like to learn more about how EmpiRx Health’s clinically-driven pharmacy care solutions help you to keep your members healthy while substantially reducing costs, visit our website at www.empirxhealth.com. #NewYorkTimes #FTC #PBM
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Here we are again with another must read. Choosing one of the “Big 3” for your PBM is just “Different Same-ness” of higher costs year over year over year…Get a ClinicAlly driven PBM at a lower cost with better outcomes. Choose EmpiRx Health as your PBM partner.
The New York Times reporters who wrote the scathing article last month on the traditional PBMs are back with a new piece that discusses how the FTC has now taken up the cause. The FTC just released a report that strongly criticizes the Big 3 PBMs for their anti-competitive practices that frequently drive up prescription drug costs instead of helping to lower them. Here are some key passages of today’s Times article: • The Federal Trade Commission on Tuesday sharply criticized pharmacy benefit managers, saying in a scathing 71-page report that “these powerful middlemen may be profiting by inflating drug costs and squeezing Main Street pharmacies.” • The regulator’s study signals a significant ramping up of its scrutiny of benefit managers under the agency’s chair, Lina Khan. It represents a remarkable turnabout for an agency that has long taken a hands-off approach to policing these companies. • Benefit managers are supposed to save everyone money. But in recent years, the industry has grown more consolidated and has taken more control over how patients get their medicines, in a shift that critics say contributes to driving up drug costs. If you would like to learn more about how EmpiRx Health’s clinically-driven pharmacy care solutions help you to keep your members healthy while substantially reducing costs, visit our website at www.empirxhealth.com. #NewYorkTimes #FTC #PBM
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Beyond Frier Levitt’s contributions, the FTC report reveals other critical insights into PBM practices. The FTC finds that PBMs exert substantial influence over independent pharmacies who struggle with contract terms they find confusing, unfair, and harmful. The FTC study affirms that PBM dominance hurts independent pharmacies, as small pharmacies can’t negotiate fair terms, face unpredictable payments, and struggle with opaque contracts. The result? Uncertainty that threatens their very survival. Furthermore, the FTC report uncovers a concerning trend. PBMs and brand drug makers sometimes agree to exclude lower-cost generics from formularies for higher rebates. These deals may restrict patient access to affordable medications, and the FTC urges further scrutiny of this practice. Lastly, the FTC’s report confirms what we’ve long argued: PBMs use DIR fees to extract post-sale profits, often resulting in pharmacies being paid less than the cost of the drugs dispensed. This creates unpredictable and opaque financial conditions, particularly harming small, independent pharmacies struggling to stay afloat. Our research supports these findings, emphasizing the urgent need for reform. Access the FTC report here: https://lnkd.in/grcNSQqK #DIRfees #FTCreport #PBMpractices #IndependentPharmacies #FTCstudy #PharmacySurvival #DrugAccess
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The National Association of Chain Drug Stores (NACDS) is making it unmistakable: #PBMreform is must-pass legislation in the 118th Congress ❗️ NACDS President and CEO Steven C. Anderson 💬: It’s time for Congress to reduce patients’ drug costs, to stop PBMs from forcing pharmacies to fill prescriptions at a loss, and to ensure Americans can access the pharmacies and medications that are right for them.” “If the 118th Congress closes its doors without enacting these reforms, they’re closing the doors on Americans and pharmacies…Congress needs to stand strong and get this done.” NACDS emphasizes that all branches of government at the federal and state levels must act to bring about comprehensive PBM reform and that Congressional action in the 118th Congress is essential.
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The #Freedom #Caucus has caused fiscal instability. The stock market wants priedictability It is time for #Gaetz and #Byron #Donalds to come to the table, act, and behave like responsible adults. We hope to see urgent action on reforms that will lower American’s out-of-pocket costs for prescription drugs. Momentum is growing as more leaders come together to discuss #PBMreforms. Yesterday, the #White #House held a roundtable discussion with prominent figures such as #HHS Office of the Secretary, Federal Trade Commission's #Lisa #Khan, and #Mark #Cuban. Tomorrow, The Hill will host a panel of experts and leaders, including Reps. #Jake #Auchincloss and #James #Comer, #Antonio #Ciaccia, #Mariana #Socal, #James #Gelfand, and #Amy #Hinojosa, to discuss ways to reduce the out-of-pocket costs for prescription drugs for Americans. #PBMs #prescriptiondrugs #healthcarepolicy #drugpricing
Momentum is building as more leaders are coming together to discuss #PBMreforms! Yesterday, the White House held a roundtable discussion with leaders like HHS Office of the Secretary, Federal Trade Commission Lisa Khan, and Mark Cuban. Tomorrow, The Hill will host its own discussion on this critical issue with leaders and experts including Reps. Jake Auchincloss and James Comer, Antonio Ciaccia, Mariana Socal, James Gelfand, and Amy Hinojosa. We hope to see urgent action on reforms that will lower American’s out-of-pocket costs for prescription drugs. #PBMs #prescriptiondrugs #healthcarepolicy #drugpricing https://lnkd.in/gBXVHFd5
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Momentum is building as more leaders are coming together to discuss #PBMreforms! Yesterday, the White House held a roundtable discussion with leaders like HHS Office of the Secretary, Federal Trade Commission Lisa Khan, and Mark Cuban. Tomorrow, The Hill will host its own discussion on this critical issue with leaders and experts including Reps. Jake Auchincloss and James Comer, Antonio Ciaccia, Mariana Socal, James Gelfand, and Amy Hinojosa. We hope to see urgent action on reforms that will lower American’s out-of-pocket costs for prescription drugs. #PBMs #prescriptiondrugs #healthcarepolicy #drugpricing https://lnkd.in/gBXVHFd5
Prescribing PBM Reform: Accelerating Transparency with Bipartisan Action
prescribingpbmreform-thehill.splashthat.com
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Congratulations to James Comer (U.S. House of Representatives) and the House Oversight Committee for pushing this incredibly important piece of legislation through. In a significant move towards ensuring fairness and transparency in the pharmaceutical industry, The Delinking Revenue from Unfair Gouging (DRUG) Act seeks to redefine how pharmacy benefit managers (PBMs) operate within federal health benefits plans. This pivotal legislation requires PBMs to "de-link" their fees charged to insurers from the price of drugs, a step forward in dismantling the opaque pricing models that have long plagued our system. At AffirmedRx, we stand firmly in support of the DRUG Act's mission. We've always believed that the value we bring to our partners and their beneficiaries should not be tied to the costs of medications but rather to the quality and integrity of the service we provide. This legislation aligns with our core values and operational model. We've demonstrated that it's not only possible to offer comprehensive PBM services without relying on the traditional fee structures tied to drug prices, but it's also more effective in promoting health equity and access. The DRUG Act presents an opportunity for all PBMs to step up and embrace a model that prioritizes patients' health and financial well-being over profits. As discussions around the DRUG Act continue, we want to reassure our clients and their members that we remain committed to leading the way in transparent, ethical PBM practices. We see this not as a challenge to our business model but as a confirmation of its necessity and value. We call on our peers in the industry to join us in this pivotal moment. Let's work together to ensure that the future of pharmacy benefits management is built on fairness, transparency and a commitment to the well-being of all patients. #AffirmedRx #PharmacyBenefits #PBM #PBC #DRUGAct #TransparencyInHealthcare #HealthcareReform Representative Jim Jordan Representative Michael Turner Representative Virginia Foxx Glenn Grothman @Representative Michael Cloud Representative Gary Palmer Representative Clay Higgins Representative Andy Biggs Nancy Mace @Representative Jake LaTurner patrick fallon @Representative Byron Donalds Scott Perry @Representative William Timmons @Representative Tim Burchett @Representative Lisa McCain Representative Lauren Boebert @Representative Anna Paulina Luna @Representative Mike Waltz @Representative Gerry Connolly Representative Raja Krishnamoorthi Representative Ro Khanna Representative Kweisi Mfume @Representative Katie Porter Representative Mike Garcia @Representative Maxwell Frost @Representative Rashnida Tlaib @Representative Jamie Raskin Pittsburgh Business Group on Health Ovation Healthcare Hospital Association of Southern California (HASC) Kentucky Hospital Association Kentucky Association of Manufacturers Mark Cuban Cost Plus Drug Company, PBC https://lnkd.in/d7SwYbFF
House panel passes PBM bill that bans spread pricing, only allows a flat service fee | BenefitsPRO
benefitspro.com
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🚨 PBMs Are Driving Up Your Prescription Costs! 🚨 Pharmacy Benefit Managers (PBMs) are inflating prescription prices while pocketing billions, and it's time to put a stop to it. These drug middlemen are raking in huge profits while you're left paying more. Let’s demand real reform that puts patients first. Tell Congress to take action NOW! Click the link below to join the fight against these "fat cats" and help pass PBM reform legislation. 👉 Take Action Now: https://lnkd.in/gh8RQ4EP #Fight4Rx #PBMReform #StopTheMiddlemen #SupportLocalPharmacies #HalifaxPharmacy #SouthBostonVA
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The industry is still a few years away from knowing the full impact that the Inflation Reduction Act will have on drug prices. But some critical provisions have already impacted drug plan sponsors for 2024. Our team has identified five areas that Medicare Advantage plans should consider when shaping their 2025 Part D strategy > https://owy.mn/47fU7EF #OWActuarial #Medicare #MedicareAdvantage
Positioning Part D Drug Plans For Success Under The IRA
oliverwyman.com
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Has your organization began looking at the 2024 PUF files to see how Part D sponsors have begun positioning themselves for IRA changes? The changes in the standalone PDP market are insightful. Check out this paper where our Oliver Wyman Medicare team has looked at this in detail. #medicareadvantage #medicare #OWActuarial #inflationreductionact
The industry is still a few years away from knowing the full impact that the Inflation Reduction Act will have on drug prices. But some critical provisions have already impacted drug plan sponsors for 2024. Our team has identified five areas that Medicare Advantage plans should consider when shaping their 2025 Part D strategy > https://owy.mn/47fU7EF #OWActuarial #Medicare #MedicareAdvantage
Positioning Part D Drug Plans For Success Under The IRA
oliverwyman.com
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Earlene Biggs, ICON Market Access, presented a Medicare Part D Price Negotiations poster at #AMCP2024. The Inflation Reduction Act and Medicare Part D Prescription Drug Price Negotiations are expected to have a long-term impact for the healthcare industry as it aims to control and lower prices, administrative costs, and resulting out-of-pocket expenses for patients. Specific ethnic groups have been identified as potentially prime beneficiaries of the legislative actions. Research reveals that while administrative purchase costs will be optimized, the real-world impact, specifically on the targeted groups, may be substantially less than suggested. Connect with us to learn more. https://ow.ly/izhy50RjAUS
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