CVS Caremark

How info likely leading to massive settlement almost stayed hidden

BY: - August 31, 2021

It seems to be an object lesson in the importance of government transparency. Revelations that quite possibly led to a lawsuit and a billion-dollar settlement by the nation’s largest Medicaid managed-care provider almost never came to light, according to court documents filed last month. Meanwhile, huge drug middlemen are fighting to keep sealed damning information […]

Drug-pricing practice could be banned to help pay for infrastructure bill

BY: - July 29, 2021

Drug-pricing practice could be banned to help pay for infrastructure bill.

Big PBM decision undergoes its first test

BY: - July 9, 2021

The stakes appear to be pretty high. After a unanimous ruling in a related case in December, the U.S. Supreme Court has reopened a case regarding sweeping regulations of powerful middlemen known as pharmacy benefit managers — and 30 state attorneys general and many others are joining the fray. Pharmacy benefit managers, or PBMs, are […]

Centene agrees to settle Medicaid claims with Ohio, Mississippi for $143 million

BY: - June 14, 2021

In what could be a harbinger of more settlements, Medicaid managed-care contractor Centene on Monday settled potential fraud claims by Ohio and Mississippi for $88.3 million and $55 million, respectively. Ohio is the only state to file suit so far alleging improper double billing through Centene’s pharmacy middlemen. But Mississippi, Kansas, Arkansas, Georgia, Oklahoma and […]

Antitrust concerns are increasing on Capitol Hill. Advocates say they should extend to drug pricing

BY: - June 1, 2021

Antitrust concerns are increasing on Capitol Hill. Advocates say they should extend to drug pricing.

Eleven generic versions of an HIV drug rush onto the market… and list prices go up

BY: - May 28, 2021

The health care system is supposed to incentivize the development of wonder drugs and then apply market forces to squeeze prices to a minimum. But a new report shows how at least for one drug, incentivizing is working a lot better than price-squeezing. At least when insurance is involved. For example, Blueberry Pharmacy in the […]

Reports: Drug manufacturers and middlemen both responsible for rising consumer costs

BY: - May 17, 2021

The world of prescription drug pricing can be bewildering — intentionally so, some critics of the industry claim.  Whether that’s true or not, several reports this year show that the supply chain’s alchemy of list prices, rebates and net prices hurts consumers. And a U.S. Senate report says drugmakers and middlemen share the blame. The […]

Additional corporations reported to be facing states’ drug-middleman probes

BY: - May 12, 2021

More states are investigating more companies regarding their conduct in the multi-billion dollar business of managing drug transactions, the Wall Street Journal reported Tuesday. The reporting comes after the Capital Journal in April reported that attorneys general in Ohio, Kansas, Mississippi and Arkansas were investigating health care giant Centene. Ohio Attorney General Dave Yost has […]

Federal probe of drug middlemen urged

BY: - May 10, 2021

After years of accusations in Ohio and elsewhere, a bipartisan group in the U.S. Senate wants federal regulators to investigate whether drug middlemen and their parent companies are rigging the system to raise prices and pad their pockets. Sens. Chuck Grassley, R-Iowa, and Maria Cantwell, D-Wash., last month filed legislation that would require the federal […]

Ohio hires Medicaid prescription drug watchdog

BY: - April 15, 2021

As it makes sweeping reforms to the way it handles managed care for the state’s $24 billion Medicaid program, Ohio on Wednesday announced that it had hired a company to monitor its progress.  The Department of Medicaid announced that it had hired the Medicaid and Medicare auditing firm Myers and Stauffer to be its pharmacy […]

Conflicting corporate claims at the heart of Ohio’s blockbuster Medicaid suit

BY: - April 12, 2021

Two mega-corporations appear to be claiming they did the same work for Medicaid — Ohio’s $24 billion-a-year program that provides health care to the poorest 25% of state residents.  Since the companies received at least $53 million for the work in 2017 alone, the conflicting claims could be a big problem — one with potential […]

Ohio suit against health care giant is sealed. Here’s why

BY: - March 16, 2021

Ohio Attorney General Dave Yost last week filed suit against the largest Medicaid managed-care provider in the United States.  The suit appears to accuse St. Louis-based Centene of improper billing, misrepresentation of its costs and other offenses. But it’s impossible to know for sure because the case was filed under seal. For the most part, […]