Tag: Pharmacy Benefit Managers (PBMs)
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,...
NCPA urges CMS to implement PBM guardrails
September 5, 2024HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association is pushing CMS to issue fair and common-sense contracting guardrails between Medicare Part D plans/pharmacy benefit managers and pharmacies. Medicare Part D makes up 36% of the average independent pharmacy’s business and current contracting practices that reimburse pharmacies less than their costs to acquire medications, dispense prescriptions, and earn a reasonable profit are having a disproportionately negative effect...
In brief: FTC tackles PBMs, AAH surveys impact, Encore measures management
July 10, 2024HME News Staff
WASHINGTON – The Federal Trade Commission has published an interim report that underscores the negative impact pharmacy benefit managers have on accessibility and affordability of prescription drugs.
The FTC’s report, which is part of an ongoing inquiry launched in 2022, details how increasing vertical integration and concentration has enabled the six largest PBMs to manage nearly 95% of all prescriptions filled in the United States. This market structure has allowed PBMs to...
FTC scrutinizes PBMs in new report
July 9, 2024HME News Staff
WASHINGTON – The Federal Trade Commission has published an interim report that underscores the impact pharmacy benefit managers have on accessibility and affordability of prescription drugs.
The FTC’s report, which is part of an ongoing inquiry launched in 2022, details how increasing vertical integration and concentration has enabled the six largest PBMs to manage nearly 95% of all prescriptions filled in the United States. This market structure has allowed PBMs to profit at...