pharmacy benefit managers

Drug-pricing reform might fall victim to infrastructure negotiations

BY: - July 21, 2021

As lawmakers attempt to salvage a bipartisan infrastructure package, new rules intended to crack down on secretive prescription-drug transactions might fall by the wayside.

Ohio AG signs on to important pharmacy middleman case

BY: - July 20, 2021

Ohio Attorney General Dave Yost has joined a lawsuit testing states’ power to regulate powerful middlemen who control the way prescription drugs are managed. Yost last week notified the 8th U.S. Court of Appeals in St. Louis that Ohio was joining 30 other states who are urging the court to uphold North Dakota laws meant […]

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 […]

U.S. Supreme Court to hear HIV case with implications for Ohio, elsewhere

BY: - July 8, 2021

It’s a practice that’s already been called anti-competitive. Now the U.S. Supreme Court could rule on whether it discriminates against the disabled. The court last week agreed to review a case focused on whether actions of insurers and pharmacy middlemen discriminate against people with HIV, the virus that causes AIDS.  The case is on appeal […]

Court ruling could spotlight questionable practices by health care companies doing huge business with Ohio, other states

BY: - July 6, 2021

When you’re emailing about medical billing, it’s probably best not to write about using “dummy codes” to “bury” administrative fees. But two huge health care companies did just that between 2012 and 2016, and now it’s an issue that is poised to get new attention. Ohio is already suing one of the companies, claiming improper […]

Attempts to reform drug middlemen surge in nearly every state

BY: - July 1, 2021

Secretive companies that mediate between drug manufacturers, payers and pharmacies have been drawing heavy scrutiny for at least four years.  Now efforts to change the way those companies do business have resulted in 100 bills introduced in 42 separate states, according to a report published Wednesday by the influential Kaiser Health News. Ohio has been […]

Lavishly paid and unapologetic. Company at center of Medicaid scandal focuses on profits.

BY: - June 28, 2021

Coordinating government health care for poor people has been very, very good to Michael F. Neidorff. By one measure, he’s the country’s top-paid health care executive, making $25 million a year. That means the Centene chief makes as much in a year as 1,409 of the best paid of the 25 million Americans for whom his company […]

Proposed budget changes said to threaten Medicaid reforms

BY: - June 24, 2021

The Republican leadership of the Ohio Senate is attempting to give an Ohio-based Medicaid managed-care company a do-over after it failed badly in a competitive process to keep its business with the state. Critics say the do-over — which was apparently lobbied for by the previous Medicaid director — would at least delay a series […]

Chucking insurance

BY: - June 22, 2021

To a growing number of pharmacists, using insurance to pay for most generic drugs makes about as much sense as getting auto insurance to cover your oil changes. Problem is, if you try to buy generics without using your insurance card at the vast, vast majority of American pharmacies, you’re going to pay a “cash” […]

Analysis: Billion-dollar whitewash?

BY: - June 16, 2021

In the wake of a blockbuster settlement of fraud claims, the top executive at the nation’s biggest Medicaid contractor was eager Wednesday to put the matter behind the company, which derives most of its revenue from taxpayers. But even though executives repeatedly used some form of the word “transparency,” they seem to be trying to […]

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 […]

Ohio suits against drug middlemen headed for the long haul

BY: - June 7, 2021

Ohio has been one of the most active states litigating against drug middlemen, whom Attorney General Dave Yost accuses of bilking state agencies out of tens of millions of dollars. Other states also have been active in court against the healthcare giants. Notably, Arkansas last year squared off at the U.S. Supreme Court against the […]