pharmacy benefit managers
CEO of health company accused of bilking Ohio taxpayers stepping down
Six months after setting aside $1.25 billion to settle fraud claims with Ohio and 21 other states, the CEO of the nation’s largest Medicaid managed-care company has announced his retirement. Despite the scandal, Ohio continues to contract with the company. And although Centene denies it’s the case, the problems might have played into the CEO’s […]
Health companies accused of abuses even as they get giant government contracts
Even though two huge health care companies were accused of abusing Ohio taxpayers in the past, the Ohio Department of Medicaid this year awarded them historic contracts, anyway. Even as that’s happening, another form of abuse might be taking place, critics say. At issue is whether pharmacy middlemen owned by the companies are pocketing huge […]
Insurers slam critical drug-pricing research but can’t vouch for their own
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 […]
Congressional group takes up PBMs, strikes a partisan tone
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 […]
CVS sometimes forces people to use its pharmacies. Now the Supreme Court will weigh in
It’s a practice long complained of in Ohio. CVS Health and other massive corporations often use their pharmacy middleman subsidiaries to force people to get the most expensive class of drugs from the businesses’ own mail-order pharmacies. Some call the practice “patient steering.” CVS and companies such as UnitedHealth and ExpressScripts/Cigna say the arrangements save […]
Are companies still inflating the cost of Medicaid drugs?
Last week, Ohio Medicaid Director Maureen Corcoran revealed something with potentially far-reaching implications: When her department calculates how much to pay managed-care companies she’s not sure if it it knows the true cost of the prescription drugs for which it is shelling out billions. If the drug middlemen hired by Ohio’s Medicaid managed-care contractors are […]
After Ohio scandal, Medicaid managed-care giant to exit the pharmacy business
Centene, the nation’s largest Medicaid managed-care company, is planning to stop its work as a pharmacy middleman, or pharmacy benefit manager. Executives last week said the company is issuing a $30 billion request for proposals from an outside contractor to take over the work. The news comes after Ohio Attorney General Dave Yost sued the […]
Ohio’s Medicaid director owns the stock of some major contractors, but won’t say how much
Since she became director of the Ohio Department of Medicaid in January 2019, Maureen Corcoran has owned stock in some of the department’s biggest contractors. Given the size of those contracts, they could have increased the value of the stock Corcoran owned. But while she complied with one set of state disclosure requirements, Corcoran won’t […]
Biden administration announces “comprehensive” plan to fix high drug prices
The U.S. Department of Health and Human Services last week issued its plan to address high drug prices as part of President Joe Biden’s push to take on anticompetitive practices across the economy. But while it addressed in detail abusive practices by drugmakers, it was a lot more superficial about the practices of much-larger corporations […]
In court, drug middlemen fight to limit pharmacies insured patients can use
In the first test of a 2020 U.S. Supreme Court ruling, drug middlemen last week argued that federal law gives them a crucial right to limit what pharmacies patients with health insurance can use — or at least make it more expensive if patients get their medicine at a shop that isn’t preferred by the […]
Already concerned with drug costs, large employers, family pharmacists worry about more middlemen
There already were deep concerns among small pharmacists about drug middlemen known as "pharmacy benefit managers." Now the corporations that own them appear to be creating yet another layer of middlemen. That has even the largest employers in the country worried.
How info likely leading to massive settlement almost stayed hidden
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 […]