Pharmacy Benefit Management

From Drug Benefit News - State and federal lawmakers focused heavily on the opioid abuse epidemic this year, enacting laws that give drug plans more tools to help addicts but also disallowing some methods of controlling costs on opioid prescriptions. Lawmakers also zeroed in on biologics and drug cost measures with a variety of new laws. Read more

From Drug Benefit News - Beginning in 2018, prescription drug utilization data could be used to improve the predictive ability of the public health insurance exchanges’ risk-adjustment program, CMS said in its 294-page proposed Notice of Benefit and Payment Parameters (NBPP), which outlines payments and requirements for the 2017 benefit year. While CMS proposes several changes to the risk-adjustment methodology for health plans sold through public insurance exchanges, the inclusion of pharmacy data for 11… Read more

Pharmacy Benefit Management Blog

By Lauren Flynn Kelly - April 14, 2016
In the latest squabble between drugstores and PBMs, the National Community Pharmacists Association (NCPA) on April 1 issued a letter to CMS Deputy Director Cynthia Tudor asserting that Medicare Part D plans and PBMs are not complying with a federal requirement to use drug pricing standards that “...
By Angela Maas - March 30, 2016
As high drug prices continue to make headlines and draw congressional ire, hepatitis C drugs and “Mr. Wu-Tang” Martin Shkreli seem to be getting a reprieve as focus turns to the prostate cancer drug Xtandi. On March 28, 12 members of Congress sent a letter to HHS Sec. Sylvia Burwell and Francis...
By Lauren Flynn Kelly - March 4, 2016
Since the introduction of direct-acting antivirals that in clinical trials demonstrated higher sustained virologic response (SVR) rates in hepatitis C patients than ever before, we’ve seen figures on sales, treatment costs, adherence levels, etc. For example, Harvoni (ledipasvir and sofosbuvir) and...

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