pharmacy benefit managers

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 […]

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, […]

Drugmakers, pharmacy middlemen sued over insulin prices

BY: - May 13, 2022

The companies that make prescription drugs and the pharmacy middlemen that buy them have been quick to blame each other for inflating prices. But now they’re being accused of conspiring to increase the cost of insulin, a lifesaving medicine for many with diabetes. Arkansas Attorney General Leslie Rutledge made the allegations in a lawsuit that […]

Ohio Medicaid preaches transparency, withholds watchdog reports

BY: - March 18, 2022

Ohio Medicaid director Maureen Corcoran often stresses the importance of transparency in delivering $35 billion worth of health care each year to Ohio’s poor and disabled. But in response to an open-records request, the department last week refused to provide copies of key, federally required reports meant to ensure that its biggest contractors aren’t gouging […]

Report: Medicare drug reforms would save seniors billions

BY: - March 10, 2022

A report published Monday says that another, less-sweeping (Medicare) change would save American seniors $18 billion a year, an annual average of about $281 for each senior getting drugs through Medicare Part D.

With big Medicaid changes looming, Ohio pharmacists complain of a lack of details

BY: - February 3, 2022

The Ohio Department of Medicaid plans to radically change the way it does business in July, but a group that helped motivate the reform effort says it hasn't provided some fundamental details. Some members of that group, the state's community pharmacists, say those details could determine whether they can stay in business — and whether some small towns become pharmacy deserts.

Basketball billionaire enters the no-insurance, no-middleman drug business

BY: - February 2, 2022

Mark Cuban, owner of the Dallas Mavericks, is getting into a business pioneered by independent pharmacists in Ohio and elsewhere. The idea is to radically reduce consumer costs for common generic drugs by cutting out insurance companies and the middlemen they hire to handle transactions with manufacturers and pharmacies. On Jan. 19, the Mark Cuban […]

CEO of health company accused of bilking Ohio taxpayers stepping down

BY: - December 15, 2021

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

BY: - December 14, 2021

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

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 […]

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 […]