2021 Outlook: Chaotic Transition Complicates Regulatory Landscape for PBMs
In the year ahead, Trump administration drug pricing policies are likely to be changed or revoked by the incoming Biden administration and court challenges, although which policies will be affected — and to what e...
CMS Greenlights Tennessee’s Closed Medicaid Formulary Demo
When CMS on Jan. 8 approved Tennessee’s Section 1115 Medicaid waiver — making it the first state to try an “aggregate cap” approach to Medicaid financing — the agency also took the unprecedented step of au...
Centene Expands Further Into Pharmacy With Magellan Deal
In addition to creating “one of the nation’s largest behavioral health platforms,” Centene Corp. will add another pharmacy-related asset to its portfolio with its recently announced $2.2 billion proposed purch...
Prices for COVID-19 Vaccines, Drugs Could Consider Value
Payers shouldn’t write off the idea of value-based pricing for COVID-19 vaccines and therapeutics, even though the ongoing coronavirus pandemic makes it imperative to develop and release those products as quickly ...
Hike in Drug List Prices Has Downstream Effect on Patient, Payer Costs
Even though drug manufacturer discounts and rebates have been rising, when wholesale list prices for prescription drugs more than doubled over a period of seven years, that still triggered large increases in patient...
News Briefs
✦ The Trump administration is shifting gears with its COVID-19 vaccine rollout strategy amid increasing frustration over the slow pace of vaccine distribution, multiple news outlets reported. HHS Secretary Alex Az...
Supreme Court Deals Surprise Blow to PBMs in Rutledge Ruling
In a unanimous, earlier-than-expected decision that surprised some observers, the U.S. Supreme Court on Dec. 10 unanimously rejected a trade group’s challenge to a 2015 Arkansas law regulating PBMs. The rule paves...
2020 Year in Review: PBMs Integrated, Expanded Offerings in ’20 Amid Uncertainty
In 2020, the PBM industry continued to deepen its integration with other industry players, a trend that experts say is likely to continue in coming years. Meanwhile, PBMs faced rising regulatory scrutiny and saw the...
With Rare Exceptions, Plans Stick With Generics for Epilepsy With Chart: Current Market Access to Epilepsy Medications
Pharmaceutical treatment for different types of epilepsy generally still relies on tried-and-true generics, despite recent efforts by drug manufacturers to introduce new branded medications into the mix, PBM insider...
Prime Inks Trio of Value-Based Pacts for Migraine Drugs
In recent weeks, Prime Therapeutics LLC has entered into not one, not two, but three value-based contracts with drug manufacturers for a trio of migraine medicines. The PBM owned by 18 Blue Cross and Blue Shield pla...