Pharmacy Benefit Management

From Specialty Pharmacy News - On Feb. 12, CMS unveiled a multipayer initiative aimed at providing better oncology care and care coordination for Medicare fee-for-service beneficiaries but at a lower cost to the program. Developed by the CMS Innovation Center, the Oncology Care Model (OCM) will reimburse providers for episodes of care in the administration of chemotherapy. “Nearly all cancers” will be included in the initiative, which also will allow beneficiaries to have 24-hour access to providers. Read more

From Drug Benefit News - Retail generic drug prices experienced record rates of inflation in 2014, putting pressure on drugstores’ profit margins and raising costs for plan sponsors. With several market factors such as the consolidation of generic manufacturers and an FDA backlog of generic drugs awaiting approval likely to remain in play, generic drug inflation may not abate any time soon, agreed industry insiders at a recent AIS webinar. Although health plans can’t manipulate the… Read more

Pharmacy Benefit Management Blog

By Angela Maas - February 25, 2015
In the midst of continuing conversations over high drug prices, a California state assemblyman has introduced a bill to find out the reasons for them. David Chiu (D) recently introduced AB 463, which would require the manufacturer of a drug with a wholesale acquisition cost (WAC) of more than $10,...
By Lauren Flynn Kelly - February 13, 2015
A new lawsuit brought by a coalition of independent pharmacies points the finger at Catamaran Corp. for allegedly setting unsustainable reimbursement rates that the pharmacies aren’t made aware of until the time of claims adjudication. The complaint, filed Feb. 9 in the U.S. District Court for the...
By Angela Maas - January 30, 2015
Ever since the approval of hepatitis C drug Sovaldi in late 2013, manufacturer Gilead Sciences has been under attack by payers and payer associations over the drug’s $84,000 price. Even though clinical trials showed the drug to be tremendously more effective and have less side effects than previous...

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