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
From Drug Benefit News - Hiding the identity of pharmacy and therapeutics (P&T) committee members is a common practice for most PBMs and insurers. But because these unidentified members are equipped with the immense power of making drug formulary recommendations, Express Scripts Holding Co. is taking heat for the practice, with critics questioning whether the anonymity is a transparency concern or a necessity for the practicing physicians and nurses who serve on these committees. Read more
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