Pharmacy Benefit Management

From Report on Medicare Compliance - In a new fraud alert, the HHS Office of Inspector General (OIG) lets physicians know they’re on the hook for contracts that don’t comply with fraud and abuse laws. The one-page fraud alert, released June 9, makes it clear that OIG will throw the book at the takers of payments for referrals and not just the givers, lawyers say. It’s not an academic exercise; OIG already made its move in 12 civil monetary penalty settlements last year with physicians stemming from a Department of Justice false claims settlement with a diagnostic imaging company that allegedly paid them kickbacks disguised as compensation… Read more

From Drug Benefit News - Three years after SXC Health Solutions Corp. purchased Catalyst Health Solutions, Inc. to create what it hoped would be a viable contender with major PBMs CVS/caremark and Express Scripts Holding Co., Catamaran Corp. will soon secure itself positioning as the third largest PBM when it is acquired by UnitedHealth Group and merged with its in-house PBM, OptumRx (DBN 4/3/15, p. 1). Read more

Pharmacy Benefit Management Blog

By Lauren Flynn Kelly - June 18, 2015
The big news in the retail pharmacy space this week was that CVS Health plans to purchase 1,660 Target Corp. pharmacies that it will rent from the big-box retailer and rebrand as CVS/pharmacy. This may create some confusion and dismay among former CVS/pharmacy customers who’ve consciously chosen to...
By Lauren Flynn Kelly - June 4, 2015
Ever heard the Jonathan Richman song, “That Summer Feeling”? It’s a strange song that gets into my head this time of year and features one of many bizarre lyrics, “When the Oldsmobile has got the top down on it/When the catamaran has got the drop down on it.” I know nothing of sailing, so this...
By Angela Maas - May 18, 2015
It should come as really no surprise that the multiple sclerosis (MS) category is a tremendous driver of specialty drug costs for health plans. After all, that therapeutic class consistently ranks in the top three specialty categories — along with inflammatory conditions and cancer — among PBMs’...

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