Pharmacy Benefit Management

From Specialty Pharmacy News - Starting 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 proposed Notice of Benefit and Payment Parameters, which outlines payments and requirements for the 2017 benefit year. The notice, released Aug. 29, proposes several changes to the risk-adjustment methodology, but the inclusion of pharmacy data for 11 conditions might be the most significant. Read more

From Drug Benefit News - As drug costs continue to rise, various efforts are underway to counter this health care trend. One such approach — Proposition 61, the California Drug Price Relief Act — will be voted on by California residents Nov. 8. The initiative calls for state agencies to pay no more for prescription drugs than does the U.S. Department of Veterans Affairs (VA). 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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