Tag: Pharmacy Benefit Managers (PBMs)
Alabama passes PBM reform bill
April 10, 2025HME News Staff
BIRMINGHAM, Ala. – The Alabama House of Representatives has unanimously passed SB252, a bill that would support independent pharmacies statewide by creating more transparency and limiting the power of pharmacy benefit managers. The “Community Pharmacy Relief Act,” which was already approved by the Senate on March 20, was introduced by Sen. Billy Beasley, D-Clayton, and Rep. Phillip Rigsby, R-Huntsville, a pharmacist. Rigsby told the Alabama Political Reporter that the bill addresses...
Optum Rx says it’s looking to ‘correct imbalances’
March 24, 2025HME News Staff
EDEN PRAIRIE, Minn. – Optum Rx will align payment models more closely to the costs pharmacies may face due to manufacturing pricing actions effective immediately and with full implementation by January 2028.
The company says the change will positively impact its non-affiliated network pharmacies, including the more than 24,000 independent, community pharmacies it serves.
“Pharmacies and pharmacists provide important care to patients, and we recognize that increasing...
Senators move to protect indie pharmacies
March 13, 2025HME News Staff
WASHINGTON – Sen. Peter Welch, D-Vt., along with Sens. Roger Marshal, R-Kan., Mark Warner, D-Va., and Bill Cassidy, R-La., has introduced legislation to limit what they say are abusive pricing practices by pharmacy benefit managers.
The “Protecting Pharmacies in Medicaid Act” cracks down on what they call “spread pricing” - charging Medicaid more than PBMs charge pharmacies for a drug, driving up costs for Medicaid and short-changing pharmacies. The legislation...
Indie pharmacy hosts FTC chair
March 10, 2025HME News Staff
REMINGTON, Va. – Al Roberts and Travis Hale, the owners of Remington Drug Company in Remington, Va., hosted Andrew Ferguson, chair of the Federal Trade Commission, to illustrate the challenges posed by pharmacy benefit managers and emphasize the significant role independent pharmacies play in their communities.
Also present: B. Douglas Hoey, pharmacist, CEO of the National Community Pharmacists Association; Matthew Seiler, general counsel for NCPA; and Anne Cassity, senior vice president...
Former NCPA president urges action on PBM reform
February 27, 2025HME News Staff
WASHINGTON - Hugh Chancy, former president of the National Community Pharmacists Association and a co-owner of Chancy Drugs in Georgia, urged members of Congress to take immediate action and pass common-sense pharmacy benefit manager reforms during a recent House Energy and Commerce Subcommittee on Health hearing that examined PBM reform policies. Emphasizing the important role of pharmacies like his in providing essential health care services to patients, he said this work is jeopardized by the...
NCPA joins price-fixing lawsuit
January 27, 2025HME News Staff
ALEXANDRIA, Va. – The National Community Pharmacists Association has joined a class action lawsuit against GoodRx, as well as CVS Caremark, Express Scripts, MedImpact Healthcare Systems and Navitus Health Solutions, that accuses them of colluding in a scheme to fix reimbursement rates to independent pharmacies. The lawsuit, brought by Community Care Rx, an independent pharmacy in Michigan, alleges that GoodRx and several PBMs are violating federal antitrust law by sharing competitively sensitive...
In brief: FTC scrutinizes PBMs – again, Lincare settles, Cardinal breaks ground
January 17, 2025HME News Staff
WASHINGTON – The Federal Trade Commission has published a report that found pharmacy benefit managers Caremark Rx LLC (CVS), Express Scripts and OptumRx marked up numerous specialty generic drugs by hundreds or thousands of percent.
The report, the second produced by the FTC, focused on PBMs influence over specialty generic drugs, including significant price markups by PBMs for cancer, HIV and a variety of other critical drugs.
“The FTC staff’s second interim...
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...