Cigna/Express Scripts

Newest federal regulator wants the little guy to be the focus of antitrust enforcement

BY: - November 14, 2022

From groceries to prescriptions to paychecks, the modern American business landscape makes it increasingly difficult for poorer Americans to get what they need to survive, Alvaro Bedoya, the newest member of the Federal Trade Commission, said in an interview late last month. The consequences have taken the form of food and pharmacy "deserts" and in a paucity of jobs that pay a living wage. "I want to focus on the folks at the bottom of the ladder and are trying to move up and not fall off," he said.

Pharmacy middleman agrees to pay Ohio Workers’ Comp $15M, attorney general says

BY: - October 27, 2022

OptumRx, a huge pharmacy middleman, has agreed to pay the Ohio Bureau of Workers Compensation $15 million to settle claims that it overbilled the system between 2015 and 2018, Attorney General Dave Yost announced Tuesday.

Antitrust regulator takes aim at drug middlemen

BY: - September 30, 2022

The newest member of the Federal Trade Commission last week said that for decades his agency hasn’t served the historical mission of the agency — fairness. And in decrying the rise of megacorporations that dominate vast ranges of services in some economic sectors, he cited pharmacy middlemen as exhibit A. Alvaro Bedoya in May was […]

Deep inside the gun bill: a break for drug middlemen

BY: - June 22, 2022

Many Americans across the political spectrum are clamoring for federal action on guns in the wake of a mass shooting at an Uvalde, Texas, elementary school, a Buffalo, N.Y., grocery store and hundreds of other mass shootings. But buried in a bipartisan compromise hashed out by the U.S. Senate on Tuesday is an unrelated provision they might not be so happy about. Apropos of nothing, the gun bill would enhance the exemption drug middlemen working with Medicare have from the federal "Anti-Kickback Statute." 

Feds to probe drug rebates

BY: - June 20, 2022

The Federal Trade Commission last week announced what some observers believe could be a game-changer when it comes to the rising cost of prescription drugs. The agency — which is meant to protect fair competition — said it would look into the murky practice by which drugmakers grant rebates and other fees to insurer-owned pharmacy […]

Federal Trade Commission to investigate pharmacy middlemen

BY: - June 9, 2022

After years of pleading, the Federal Trade Commission on Tuesday voted to investigate the practices of some of the nation’s largest companies. They’re accused of using their dominance in myriad sectors of the health care space to drive up costs, drive out competition and reap profits. Four of the six companies to be investigated have […]

After years, pharmacy-middleman suit might finally come to trial

BY: - May 16, 2022

Since at least 2016, Ohio pharmacists have been accusing large companies acting as pharmacy middlemen of abusive practices, which they deny. And since 2019, the state has been accusing them as well, in the form of lawsuits. Now, after years of wrangling in court, some of that litigation might be headed to trial. The middlemen, […]

Attorney General seeks financial info from Medicaid contractors

BY: - March 11, 2022

In the past month, Ohio Attorney General Dave Yost has sought financial information from the state’s five managed-care contractors, documents received in response to an open-records request show.  The AG won’t discuss ongoing investigations, but he might be looking into whether some practices by subcontractors who manage pharmacy benefits violate state law or federal regulations. […]

State employee pension fund to audit big PBM

BY: - March 11, 2022

The upcoming audit will be the fifth time in 10 years that the pharmacy benefit manager to the Ohio Employees Retirement System has been audited. An earlier version of this story said it had been audited more frequently. It’s been updated. The Ohio Employees Retirement System is seeking proposals for a firm to audit Express […]

Insurers slam critical drug-pricing research but can’t vouch for their own

BY: - December 9, 2021

A spokeswoman for a major health-insurance industry group on Wednesday questioned research cited in a story published Tuesday in the Capital Journal. In doing so, she cited a bit of purported research that she couldn’t vouch for herself. The story was about research showing that insurers working with Medicare are supposed to be lowering care […]

For one drug at least, biggest insurers force Medicare patients to buy the most expensive

BY: - December 7, 2021

In theory, the point of managed care is to save money by negotiating with providers for lower prices. So it would seem that the biggest managed-care providers would use their clout to negotiate the lowest prices from doctors and hospitals and for medicine. But for at least one drug, the largest Medicare managed-care companies are […]

Congressional group takes up PBMs, strikes a partisan tone

BY: - November 26, 2021

Members of Congress last week took up an issue potentially of great importance: What to do about powerful health conglomerates who play an increasingly powerful role in the drug-supply chain. But the event also demonstrated the harsh partisanship that increasingly paralyzes Congress in the face of difficult problems. Rep. James Comer, R-Ky, called the forum […]