#ICYMI: On Tuesday, the Federal Trade Commission issued a report criticizing #PBMs role in the rise in prescription drug costs and profiting at the expense of patients and rural pharmacies. Read more via The New York Times: https://bit.ly/4cYGjld
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Helping businesses make health insurance affordable by bringing business logic to benefits decisions.
The Federal Trade Commission (FTC) has launched a lawsuit against the "Big Three" Pharmacy Benefit Managers (PBMs) over their drug pricing tactics. PBMs play a crucial role in negotiating prices between insurers, pharmacies, and drug manufacturers. However, critics argue that their complex rebate and fee structures can lead to higher prices for consumers and less transparency in the market. The FTC's action aims to address these issues and promote a more transparent and fair pricing system for prescription medications. This lawsuit could have significant implications for the future of drug pricing and the role of PBMs in the healthcare industry. https://lnkd.in/gJiEKMWN
WSJ: FTC to sue PBMs over drug pricing tactics
fiercehealthcare.com
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Chief Operating Officer at Blue Shield of California. Transformational leader in redefining of health care.
Blue Shield of California, like other health plans and employers, pays billions of dollars for prescription drugs every year. While we may be considered a sophisticated purchaser, we are in the same position as many Americans: questioning whether we get good value for our money. Inflated prices, lack of transparency, and limited competition can all be partially attributed to the rebate process – an unfair process in dire need of reform. Read my perspective in HealthLeaders on rebates, alternative pricing methods, and how we can more equitably compensate manufacturers. #WellAhead #Pharmacy #DrugPricing https://lnkd.in/gx5Pf4Tc
Contributed Content: 2 Alternatives to Ineffective Prescription Drug Rebates
healthleadersmedia.com
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Owner of Forward Rx, a cost-plus pharmacy. Let’s bring transparency, affordability, and patient choice back to healthcare.
I could be wrong, but here's another example why I believe the government will not fix pharmacy reimbursement issues like many owners hope it will. From what I've seen, it costs a pharmacy at least $10 to dispense a prescription in addition to the drug cost to cover Drug Utilization Review by the pharmacist and other staff labor and overhead costs. Average gross profit per prescription below that is what has led to 2,200+ pharmacies closing across the country in the first 8 months of 2024. The pharmacies that have managed to remain open are continuing to be burdened by more work with less resources resulting in more negative experiences at the counter for both patients and pharmacy staff. Now CMS wants to put together a list of drugs to pay pharmacies $2 per prescription to fill and wants stakeholder input on what generic drugs to include. You won't see me signing up for that contract anytime soon.....or ever. https://lnkd.in/dybQHwMh
Medicare Two Dollar Drug List Model
cms.gov
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The drug pricing regulatory and legislative landscape is constantly changing. Stay up to date on the latest changes that could impact prescription benefits with our Q2 2024 State and Federal Regulatory and Legislative Activity Update https://lnkd.in/gX4tAX7F This update showcases major discussions and potential shifts being considered at both state and federal levels. Featured updates provide information on: · Drug shortages · PBM reform impacts · Recently implemented critical legislation #carelonrx #pbm #pharmacybenefits #brokers #consultants
CarelonRx | Q2 2024 State and Federal Regulatory Activity Report.pdf
file.carelon.com
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Health Rosetta advisor disrupting healthcare status-quo to lower cost & improved member health with independent data.
Employer health plan customers of PBMs & Ascent seemingly have a smoldering fiduciary liability problem. This lawsuit publically broadcasts “trust assets” of plan beneficiaries are being skimmed and violate ERISA’s requirement of plans exclusively benefiting plan members. Add that employers are under the advice of national consultants receiving per-claim kickbacks for keeping their plans under the heel of these PBMs? Class-action rocket fuel!
“Among the claims against the companies is that by working through Ascent, the companies effectively pool pricing information, allowing them to avoid competing with each other and to take advantage of pharmacies, with which Express Scripts directly competes in the specialty drug space. The effect, Dave Yost argues, is to make prescription drugs artificially expensive.”
Ohio antitrust suit against drug middlemen hovers between courts - Ohio Capital Journal
ohiocapitaljournal.com
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Best Selling Author | Christ Follower | CEO | Consultant | Entrepreneur | Benefits Advisor | Speaker | Husband and Father
🚨 **Breaking News in Healthcare** 🚨 The Federal Trade Commission (FTC) is taking significant action against the largest pharmacy benefit managers (PBMs) over drug pricing tactics. Here are the key points: - **FTC Lawsuit**: The FTC is suing CVS Caremark, Express Scripts, and OptumRx for rebate practices that may increase drug costs and disadvantage independent pharmacies. - **Market Impact**: These PBMs handle around 80% of U.S. prescriptions and are integrated with major health insurers. - **Conflict of Interest**: The FTC report highlights how vertically integrated PBMs may prefer their affiliated businesses, potentially raising prescription drug costs. - **Consumer Impact**: The lawsuit aims to address how these practices affect consumers, particularly regarding the cost of essential medications like insulin. For more details, read the full article [here](https://lnkd.in/eCvzBTGq). #Healthcare #Pharmacy #DrugPricing #FTC #PBMs #LegalAction #Pharmaceuticals #RX 3PBM #FixHealthcare BenefitHelp : [Fierce Healthcare](https://lnkd.in/eCvzBTGq) : [BioSpace](https://lnkd.in/eJSb6Aqy)
WSJ: FTC to sue PBMs over drug pricing tactics
fiercehealthcare.com
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Express Scripts Sues FTC Over PBM Report In a recent turn of events, Express Scripts has filed a lawsuit against the Federal Trade Commission (FTC), demanding the withdrawal of what they describe as a "false and misleading" report on pharmacy benefit managers (PBMs). The report, which criticized PBM practices, was released after an in-depth study conducted by the FTC. Express Scripts claims the report fails to provide an accurate portrayal of the industry, potentially influencing policy based on flawed findings. This lawsuit highlights ongoing tensions between regulatory bodies and PBMs over transparency, pricing, and the role of PBMs in healthcare. As the battle over drug pricing reform continues, it's important to keep a close eye on how these developments might shape the future landscape for patients, healthcare providers, and pharmaceutical companies alike. https://lnkd.in/gm_QRtvy #Healthcare #Pharma #DrugPricing #PBMs #Regulation #MedMind
Express Scripts Sues FTC, Demands Withdrawal of ‘False and Misleading’ PBM Report
biospace.com
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🏥 The Federal Trade Commission (FTC) has criticized the business practices of pharmacy benefit managers (PBMs) and highlighted their role in inflating prescription drug prices. However, #drugmakers are also at fault for the high costs of medications. 💡 Insight - PBMs like Express Scripts, Caremark, and Optum Rx control 80% of U.S. prescriptions, using tactics that raise drug prices. Meanwhile, drugmakers set high prices and increase them over time, forcing patients to pay more or abandon treatment. Both sides blame each other, but the sanctimonious finger-pointing hasn't resolved the affordability issue. ❓ Key questions - How can regulatory measures like the #DRUGAct and the #MedicareDrugPriceNegotiationProgram effectively address these issues? What additional reforms are needed to ensure fair pricing and access to medications? #Pharma #PBMs #DrugPricing #HealthcareReform #FTC #PatientAccess
PBMs and Big Pharma Play Blame Game for Inflated Prescription Drug Prices
biospace.com
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NCPA joins NACDS to argue for pharmacy protections in new Medicare Part D $2 drug list model #PBM #PBMReform #Medicare #pharmacy #independentpharmacy Learn more https://lnkd.in/e5RrnieZ
NCPA joins NACDS to argue for pharmacy protections in new Medicare Part D $2 drug list model
ncpa.org
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NCPA joins NACDS to argue for pharmacy protections in new Medicare Part D $2 drug list model #PBM #PBMReform #Medicare #pharmacy #independentpharmacy Learn more https://lnkd.in/e5RrnieZ
NCPA joins NACDS to argue for pharmacy protections in new Medicare Part D $2 drug list model
ncpa.org
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