Tag: Pharmacy Benefit Managers (PBMs)
In brief: No reimbursement relief, MGA Homecare deal, Henry Schein ‘Cheer’
December 20, 2024HME News Staff
WASHINGTON – Provisions to restore Medicare’s 75/25 blended reimbursement rates in non-bidding, non-rural areas are not a part of the end-of-year legislative package being considered by Congress, according to AAHomecare.
At press time, the measure to keep the government funded through mid-March 2025 was up in the air.
Industry stakeholders have been working all year to build support for its priority legislation, H.R. 5555 and S.1294, which would extend the blended...
NCPA says PBM reform provisions included in pending CR
December 18, 2024HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association says that a continuing resolution that Congress is readying includes provisions for two of its top priorities for reforming pharmacy benefit managers. The CR would require PBMs to reimburse pharmacies at national average drug acquisition cost plus the state’s fee-for-service dispensing fee for all Medicaid managed care programs in all 50 states; and it would require CMS to establish reasonable and relevant contract...
OneroRx bucks trend
December 6, 2024Theresa Flaherty, Managing Editor
WEST DES MOINES, Iowa – In an environment where both chain and independent pharmacies are exiting certain markets, OneroRx is building up its presence, most recently with two EverCare Pharmacy locations in Princeton and Trenton, Mo.
The company, a leading regional provider of pharmacy and telepharmacy services, now has 67 locations across seven states, including community, specialty and long-term care pharmacies and one DME company.
“We're finding that very...
NCPA applauds judge’s ruling in CVS case
November 18, 2024HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association applauds a decision by a federal judge in Arizona in a class action case against CVS that a court, not an arbitrator, should decide whether a plaintiff’s claims against the company must be sent to arbitration. Judge John J. Tuchi of the U.S. District Court for the District of Arizona agreed with Osterhaus Pharmacy that a provision in its contract with CVS that all disputes must be decided by an arbitrator is unconscionable,...
‘Unsustainable’ PBM model drives Lehan Drugs to drop pharmacy services
October 9, 2024Theresa Flaherty, Managing Editor
DEKALB, Ill. – Over the course of nearly eight decades, Lehan Drugs has adapted many times in response to change and competition, but the growing stranglehold of pharmacy benefit managers (PBMs) had fifth-generation owner Jim Lehan saying enough is enough.
Lehan Drugs in September stopped providing pharmacy services at its DeKalb, Ill., location, but it will continue to provide home equipment there and at multiple locations in the state.
“We’ve had reimbursement...
In brief: Geriatric Medical buys DDP, ResMed talks strategy, NCPA launches new PBM ad
October 2, 2024HME News Staff
WOBURN, Mass. – GMSS, the parent company of Geriatric Medical & Surgical Supply, has acquired DDP Medical Supply, significantly expanding its footprint and forming what it says is “the nation’s leading medical supply distribution networks focused on chronic, post-acute and home care providers.”
Both companies will maintain their unique brands and market-focused solutions, while benefiting from increased scale, enhanced distribution infrastructure and expanded service...
NCPA releases new PBM ad
September 30, 2024HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association has released a new digital ad as part of its ongoing campaign to push lawmakers to enact pharmacy benefit manager reform. In the ad, Bil and Shanon Schmidtknecht of Wisconsin speak out against PBMs after their 22-year-old son, Cole, went to get his Advair prescription refilled at a chain pharmacy early this year — a medicine he had been taking for a decade — and was told it was suddenly more than $500. He had to make...
In brief: DME’s value, FTC’s lawsuit, DMEscripts’ integration
September 25, 2024HME News Staff
WATERLOO, Iowa – The cost of treating injuries and illnesses due to lack of DME far exceeds the cost of providing the necessary equipment, according to a new report from Leitten Consulting.
For example, every dollar spent on mobility equipment can save Medicare $62.53 in treatment costs, the report found.
“An ounce of prevention is now worth several pounds of cure,” said Brian Leitten, CEO of Leitten Consulting, which specializes in health care policy analysis...
FTC sues PBMs
September 23, 2024HME News Staff
WASHINGTON – The Federal Trade Commission has sued the three largest prescription drug benefit managers (PBMs) – Caremark Rx, Express Scripts and OptumRx – and their affiliated group purchasing organizations for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs.
These practices have also impaired the ability of patients to access lower list price products and shifted the cost of high insulin list...
In brief: e-prescribe push, PBM guardrails & data collection efforts
September 6, 2024HME News Staff
WASHINGTON – AAHomecare is bringing together a group of e-prescribing vendors to develop resources, including an upcoming webinar, to educate suppliers and other key audiences.
In the group: Brightree, DMEscripts, Parachute Health and Tomorrow Health.
“Our board members and industry partners have invested heavily in e-prescribing transformation as a means to lower operating costs and to improve delivery of care and patient safety for all providers,” said John Brady,...