Pharmacy Benefit Management

From Drug Benefit News - According to predictions made by several PBMs and pharmacy benefit consultants in DBN’s last Outlook poll, 2011 was slated to be the year of the narrow network (DBN 1/7/11, p. 1). From incentive-driven networks to limited pharmacy panels, plan sponsors were supposedly chomping at the bit to achieve savings through these restrictive network designs. Read more

From Specialty Pharmacy News - Multiple sources tell SPN that the release of biosimilars guidance is imminent, but as of SPN’s Jan. 3 deadline, the expected guidance had not yet been issued. The FDA, though, last month released proposed recommendations for a biosimilars user fee program that echoed those under the Prescription Drug User Fee Act (PDUFA). Gillian Woollett, Ph.D., vice president at Avalere Health LLC, says the FDA “has promised to soon publish three draft… Read more

Pharmacy Benefit Management Blog

By Lauren Flynn Kelly - February 2, 2012
The comment period for responses to HHS’s Dec. 16 bulletin on essential health benefits packages has just closed, and a variety of stakeholders have expressed concerns over the agency’s intent to give states “flexibility” in choosing an existing health plan to define the benefits that must be...
By Angela Maas - January 27, 2012
With specialty drugs being adjudicated under both the pharmacy benefit and the medical benefit, health plans can run the risk of incentivizing members to choose a drug based on their out-of-pocket cost share. According to data from The Zitter Group, 35% of 40 payers that have a cost-sharing level...
By Lauren Flynn Kelly - January 19, 2012
Last month Drug Benefit News ran a story on PBM and insurer tactics to combat the growing use of copay cards among members. As you may already know, these copay offset programs are loathed by PBMs for their potential to undermine tiered benefit designs and increase overall cost share. Mason...