PBMs
Drug middlemen say Ohio law raises prices. Then they admit they don’t know
An industry organization representing powerful drug middlemen said that banning an industry practice would lead to “higher costs and fewer choices for America’s employers.” But to support it, the organization points to analysis that didn’t look at private insurance and didn’t reach the conclusion that it claimed. The Pharmaceutical Care Management Association represents pharmacy benefit […]
Federal authorities move to close mammoth drug-pricing loophole
Years after the potential for abuse was flagged in Ohio, the federal agency that oversees Medicaid is moving to close a loophole that likely is worth billions to prescription drug middlemen. The Centers for Medicare and Medicaid Services on Friday proposed a new rule that it said would help ensure compliance with a requirement under […]
PBMs are modern-day drug price gangsters and must be held accountable
In March, Ohio Attorney General Dave Yost filed a groundbreaking lawsuit challenging the coercive tactics of the shadowy, modern-day health care mafia known as pharmacy benefit managers (PBMs). You may not have heard of PBMs before, but they play a critical role in controlling which medications your insurer covers. While that may sound like a […]
Ending copay accumulator programs would make prescription drugs more affordable
There’s nothing more important than one’s health and the health of loved ones. All families have experienced a serious illness at one point or another — and many must deal with complex chronic illnesses. As someone who lives with a bleeding disorder, an autoimmune disorder, a child with a chronic respiratory condition, and a partner […]
Oncology patients at serious risk with Congress’ drug pricing plan
As Congress works to lower health care costs, we reach a critical point in our nation’s debate over what consumers must pay for prescription medicines. The current Senate budget reconciliation package is hyper-focused on bringing down drug prices. Unfortunately, the legislation is short-sighted, and ignores a key remedy that would help lower out-of-pocket costs for […]
Dangerous care delays ahead if more insurers implement “white bagging” policies
Consider the following scenario: A cancer patient comes into a community oncology clinic for their regularly scheduled chemotherapy treatment. After concluding the pre-treatment evaluation, the oncologist determines that the patient’s dose should be adjusted. Perhaps they need a higher dose than what we previously administered — a fairly common occurrence in the world of cancer […]
Pharmacy middlemen sue to stop rebate transparency
An industry group representing powerful drug middlemen has gone to court to stop a federal rule intended to bring transparency to rebates middlemen get from manufacturers. The middlemen are arguing that the rule, initiated by the Trump administration, will increase drug costs. But the group’s critics say that secretive rebates are a primary driver of […]
2+2=? Senate uses murky math as it shelves drug pricing rule to fund infrastructure
By Michael McAuliff, Kaiser Health News The Senate’s release of its bipartisan infrastructure plan signals that lawmakers are poised to throw former President Donald Trump’s belated bid to lower Medicare drug prices under the bus — not to mention trains, bridges, tunnels and broadband connections. That’s because the massive spending bill is the first of […]
To fix drug costs, stop Big Pharma price-gouging and tax-dodging
By Hannah Hendrix, American Medical Student Association I’m studying at The Ohio State University to become a doctor because I want to help people. Unfortunately, far too many Americans today are confronting skyrocketing prescription drug costs that prevent them from following their doctor’s advice because they can’t afford treatments they need. Drug prices are rising […]
Drugmaker on rising prices: Don’t look at us
A subsidiary of a leading U.S. drugmaker is reporting that the net cost of its products has been falling. If that’s true, it would appear that drug middlemen and insurers are driving increases in the overall cost of medicine and in consumers’ out-of-pocket costs at the counter. The report, by Johnson & Johnson subsidiary Janssen […]
U.S. Supreme Court deals big blow to pharmacy middlemen
The U.S. Supreme Court on Thursday ruled 8-0 that states have broad powers to regulate powerful pharmacy middlemen without being preempted by federal law. The case was brought by the $400-billion-a-year industry, known as “pharmacy benefit managers,” against the state of Arkansas over a 2015 law that set a minimum, market-based rate the middlemen had […]
Feds said to be investigating largest Medicaid provider in the U.S.
Federal officials are probing actions taken in Ohio in 2017 by the largest Medicaid managed care provider in the United States, a source familiar with the investigation has told Ohio Capital Journal. The U.S. Centers for Medicaid and Medicare Services declined to confirm or deny the existence of an investigation. But the source said the […]