pharmacy benefit managers
Pharmacies file antitrust suit against massive drug middleman
A class-action suit has been filed in federal court on behalf of community pharmacies claiming that health giant CVS has used its dominance as a drug middleman to force pharmacies to pay large, after-the-fact fees in Medicare transactions. The suit was filed last week in Seattle on behalf of Osterhaus Pharmacy, which until last year […]
Congressional watchdog: Rebates increase drug costs for seniors
A system of kickbacks between drugmakers and drug middlemen is increasing costs for seniors on Medicare, the U.S. Government Accountability Office said in a fact sheet that was released Tuesday. The report by the congressional watchdog casts doubt on claims by the middlemen — known as pharmacy benefit managers or PBMs — that they save […]
Cancer drug shortages decried in congressional hearing
There's an acute shortage of injectable cancer drugs because manufacturers can't make money off of them, two experts told a U.S. House subcommittee Tuesday. But it's unclear whether chaos in the GOP Caucus that's supposed to be running the chamber will allow for action.
Policing prescription-drug middlemen’s middlemen
The Federal Trade Commission on Wednesday announced that it had added massive, new drug-purchasers to an investigation into the practices of powerful drug middlemen. Critics have described those businesses, created since 2019, as another layer of opacity in the already obscure world of drug pricing. The FTC — the federal agency tasked with policing monopolistic […]
Report: “Specialty” drugs are by far the most expensive, but classification seems arbitrary
The prescriptions with the most eye-popping price tags — like cancer meds that can cost more than $20,000 a month — are usually classified as “specialty” drugs. You’d think that since they’re so costly, there would be clear criteria for putting drugs in the specialty category. But, according to a new report, you’d be wrong. […]
Ohio AG files antitrust suit against Express Scripts, Humana, others
In a development that is likely shaking the world of health insurance, Ohio Attorney General Dave Yost on Monday sued six corporate entities over the way they facilitate drug transactions. Yost filed the suit under the Valentine Act — Ohio’s antitrust law — accusing the companies of improperly colluding to fix prices and other actions […]
Health care giant Centene settles with another state, California
Medicaid managed-care giant Centene has agreed to pay California $215 million to settle a drug-pricing scandal related to one that was initially detected in Ohio. In a press release last week, California Attorney General Rob Bonta said that two Centene-owned managed-care plans, California Health & Wellness and Health Net, ripped off the state’s Medicaid system, […]
Health care giant pays Iowa $44M to settle fraud claims with Iowa
The nation’s largest Medicaid managed-care company last week agreed to pay Iowa $44.4 million to settle claims that it defrauded the state’s Medicaid system. That makes it the latest state to settle claims that were originally raised in Ohio in 2021. St. Louis-based Centene agreed to pay the money over claims that its subsidiary, Iowa […]
Consumer groups want antitrust probe of hospital suppliers
The middlemen who buy things like medical equipment for hospitals have vastly consolidated their control of the marketplace in recent decades, nine consumer groups are saying. Now the groups want the Federal Trade Commission to mount a formal investigation to see if the companies are stifling competition among medical suppliers, artificially raising costs and unnecessarily […]
Newest federal regulator wants the little guy to be the focus of antitrust enforcement
From groceries to prescriptions to paychecks, the modern American business landscape makes it increasingly difficult for poorer Americans to get what they need to survive, Alvaro Bedoya, the newest member of the Federal Trade Commission, said in an interview late last month. The consequences have taken the form of food and pharmacy "deserts" and in a paucity of jobs that pay a living wage. "I want to focus on the folks at the bottom of the ladder and are trying to move up and not fall off," he said.
Tax-funded care provider in Ohio makes political donations — in Nevada
Medicaid managed-care provider Centene has already gotten in trouble in Ohio. Then on Friday came the news that its tax-funded Ohio subsidiary has been making political contributions 2,200 miles away in Nevada. Kaiser Health News reported that Centene’s Buckeye Health Plan and many other of its state-level Medicaid subsidiaries have each made $10,000 donations to […]
Health care giant confirms $15M settlement — two days after denying it
A prescription middleman on Friday confirmed that it has promised to pay Ohio $15 million to settle fraud claims against it. When the state announced the deal two days earlier, the company denied it had been finalized. Ohio Attorney General Dave Yost on Wednesday announced that pharmacy benefit manager OptumRx had agreed to pay $15 […]