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News Items, by Subject (Headlines and Excerpts)

Health plan costs - prescription drugs


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Headlines

How Will the Medicare Part D Benefit Change Under Current Law and Leading Proposals?

"[P]olicymakers have expressed concerns about the absence of a hard cap on out-of-pocket spending for Part D enrollees, the significant increase in Medicare spending for enrollees with high drug costs, and the relatively weak financial incentives faced by Part D plan sponsors to control high drug costs.... This brief describes how the Medicare Part D benefit will change in 2020 under current law and proposed changes that would affect what beneficiaries, plans, manufacturers, and Medicare pay for drug costs under Part D in the future."

(Henry J. Kaiser Family Foundation)
Variation in U.S. Private Health Plans' Coverage of Orphan Drugs

"Health plans restrict access to orphan drugs approximately one-third of the time, and restrictions vary considerably across plans. Plans more often add restrictions for orphan drugs that are indicated for diseases with a higher prevalence and that have higher annual costs."

(American Journal of Managed Care)
[Opinion] Importing Lower-Cost Prescription Drugs to Support Public Health Services

"Biologic products, which include vaccines and insulins, cannot be imported, nor can narcotics, including suboxone and methadone for substance use disorder. From a public health spending perspective, these exclusions limit savings. The law also allows importation of drugs only from Canada. These constraints represent a serious limitation on the ability to import drugs."

(The Commonwealth Fund)
A Painful Pill to Swallow: U.S. vs. International Prescription Drug Prices (PDF)

77 pages. "The United States spent $457 billion in 2016 on combined retail (dispensed at the pharmacy) and non-retail (dispensed in physician offices) drugs.... In the five years between 2011 and 2016, drug spending nationwide grew by 27 percent -- more than 2.5 times the rate of growth in inflation.... This report examines patterns of drug pricing in the U.S. relative to other international comparator countries through a six-part analysis examining price differentials among 79 drugs sold in 11 countries and the U.S. in 2017 and 2018."

(Committee on Ways and Means, U.S. House of Representatives)
House Speaker Pelosi Unveils Bill to Lower Prescription Drug Prices

"House Speaker Nancy Pelosi unveiled her plan to lower drug prices by [1] giving the government the ability to negotiate prices for up to 250 of the costliest drugs, including insulin; [2] slapping pharmaceutical companies with penalties if they refuse to negotiate; and [3] seeking Medicare rebates from drug makers if they raise prices beyond inflation."

(American Journal of Managed Care)
Wasteful Drug Spending Contributes to High Prescription Costs

"[R]educing the use of high-cost, low-value drugs could lead to $63 million in annual savings among the 15 plan sponsors, which represents approximately 3% to 24% of overall pharmacy spending.... Wasteful prescriptions represented 3% to 12% of total claims per sponsor evaluated, with an average savings of $413 per script ... Brand-name drugs made up 42% of wasteful prescriptions, with an average savings of $682 per wasteful script."

(American Journal of Managed Care)
2020 Global Medical Trend Rates Report

38 pages. "Medical Trend is expected to remain stable in the US. This is driven mainly by moderate price and minimal utilization increases. Prices continue to drive trend while utilization of services remains relatively flat or decreasing.... [P]harmacy trends continue to have significant volatility[.]"

(Aon)
[Guidance Overview] Two Interesting New Rules Regarding Prescription Drugs -- What Is Really Going On?

"[T]hrough the PBM controlled formularies, the costs of many prescription drugs were ... hidden from participants because they were categorized as 'preventive care' and provided at no cost to participants. IRS Notice 2019-45 will change that practice.... [ACA FAQ Part 40 indicates] the Departments will not initiate an enforcement action if a [group health plan] excludes the value of drug manufacturers' coupons from the [out-of-pocket maximum] ... [T]his would not overrule any similar State Insurance law that has already passed."

(Trucker Huss)
Eliminating Pharmacy Waste -- It's Not Easy

"An August 2019 study by the Commonwealth Fund looks at the use of low-value high-cost drugs and has concluded that correcting misaligned incentives can result in a potential 3% to 24% in savings.... Pharmacy Benefit Manager (PBM) contracts are part of the reason."

(Frenkel Benefits)
Pharma CEOs Shower GOP Senators with Campaign Cash

"Top pharmaceutical CEOs have targeted a small group of Republican senators with roughly $200,000 in campaign donations in the past year ... The focus on Congress comes as drug executives are holding back on donations to presidential candidates."

(STAT)
Reducing Wasteful Spending in Employers' Pharmacy Benefit Plans

"Formularies developed on their behalf by intermediaries like pharmacy benefit managers (PBMs) and health plans can ensure drug safety and support negotiating with manufacturers. But intermediaries can profit from these negotiations, creating financial incentives to include high-price drugs even if they offer little clinical value.... Plan sponsors could lower drug spending and out-of-pocket costs for enrollees by reducing the use of high-cost, low-value drugs on formularies. Savings could be achieved by improving pharmacy benefit design and management."

(The Commonwealth Fund)
Plans Need Not Count Drug Manufacturer Coupons Toward the ACA's Cost-Sharing Annual Limits

"The Departments acknowledged that interpreting the final rule to require drug manufacturer coupons to count toward the ACA's cost-sharing limits could conflict with prior IRS guidance on high deductible health plans (HDHPs) and health savings accounts (HSAs).... As a result, the final rule's provision on counting drug manufacturers' coupons could make it difficult for plans and insurers to comply with both the final rule and the prior HDHP rules."

(Thomson Reuters Practical Law)
[Guidance Overview] 2020 Drug Coupon Rule Dropped Due to Implementation Concerns

"Employer plans will still be able to exclude the value of drug manufacturer coupons from annual out-of-pocket maximums, even when no generic equivalent is available, under new guidance from the [DOL, HHS and Department of Treasury]. These exclusions, or copay accumulators, are built into many employer plans."

(Ogletree Deakins)
HHS Walks Back New Policy on Drug Coupons

"HHS will further clarify this policy in a forthcoming regulation for the 2021 plan year. In the meantime, the Departments will not enforce the new rule (which would have applied to plans beginning in 2020) and will allow states to adopt a similar nonenforcement stance. Thus, unless a state prohibits it, insurers and plans can likely continue to exclude drug manufacturer coupons from an enrollee’s annual limit on out-of-pocket costs."

(Katie Keith, in Health Affairs)
The New Hospital Price Disclosure Rule Is Important, But Only a First Step

"[As] the administration acknowledges, this regulation by itself will not fully address the opacity of today's market. Further disruptive changes will be necessary to give consumers usable pricing information. Among other things, meaningful transparency requires even stricter standardization of the services being priced and 'all in' pricing that matches how consumers think about the services they need."

(Health Affairs)
Administration Again Attempts to Lower Drug Prices

"The full impact of the proposed plan on all stakeholders has not been fully evaluated.... For PBMs, would the existence of pathways #1 and #2 alter how the PBMs negotiate formulary drugs with pharmaceutical manufacturers? Could the PBMs' push for manufacturers to use pathway #2 at some time in the future point to remaining on formulary drugs? Would importing drugs create shortages in foreign countries, potentially impacting U.S. diplomacy with them?"

(Wilson Sonsini Goodrich & Rosati)
Maximizing a Pharmacy Benefit Program: Innovative Solutions for Employers

"Once a plan sponsor has a deep understanding of their pharmacy program and PBM contract and has gone through industry benchmarking, they can begin to set and address goals to manage costs while still providing a reasonable and sustainable pharmacy benefit to their employees."

(CBIZ)
Shopping Abroad for Cheaper Medication? Here's What You Need To Know

"Americans routinely skirt federal law by crossing into Canada and Mexico or tapping online pharmacies abroad to buy prescription medications at a fraction of the price they would pay at home. In some cases, they do it out of desperation. It’s the only way they can afford the drugs they need to stay healthy — or alive."

(Kaiser Health News)
Amazon Mail-Order Pharmacy Faces Pushback

"Surescripts LLC, a provider of the technology widely used to route electronic prescriptions, accused Amazon’s mail-order pharmacy subsidiary PillPack of receiving patient data that it had fraudulently obtained through a third party.... The dispute with Surescripts is an example of the challenges that PillPack faces in disrupting the $424 billion U.S. prescription drug market: In many cases, PillPack's competitors are also gatekeepers that control access to patient data and payment rates from insurers."

(The Wall Street Journal; subscription may be required)
Follow the Scripts: Trends in ERISA Litigation Against PBMs

"[S]everal plaintiffs' law firms believe that the manner in which pharmacy benefit managers set cost-sharing amounts and receive rebates from network pharmacies is at least partly to blame [for rising drug costs], and have filed litigation against PBMs under [ERISA] in response. This article looks at recent ERISA lawsuits filed against PBMs, the success of those claims, and some issues those litigants have encountered along the way."

(Bloomberg Law)
Drug Pricing and Surprise Billing: Recent Actions and Outlook

"We expect a very active fall as House and Senate leadership attempt to find a path forward on drug pricing and surprise billing.... The drug pricing debate could be further complicated should the administration release the pending IPI Model proposed rule ... Also lurking in the background are potential court decisions around the [ACA] and a possible administration plan to replace the health law."

(Akin Gump)
Congress and Administration Consider Significant Drug Pricing Policy Changes

"In both chambers of Congress, passing legislation to bring down drug prices is a policy priority -- and the savings from such possible legislation is slated to offset other healthcare legislative proposals (such as addressing impending Medicaid Disproportionate Share Hospital (DSH) allotment reductions). Nonetheless, gaining traction on changes designed to bring down drug pricing is proving challenging, for Congress and the administration."

(Manatt, Phelps & Phillips)
Administration Announces Plan to Permit Drug Importation

"[T]he plan relies on others -- states, wholesalers, and manufacturers themselves -- to do the federal government’s work for it, to demonstrate the potential for importation to be done safely and effectively.... [T]he state-based importation programs would be only demonstration projects, which (in addition to only applying in a geographic subset of the country) would be time-limited and require renewal."

(Rachel Sachs, in Health Affairs)
Trump Administration 'Open for Business' on Drug Imports from Canada

"[M]anufacturers could import versions of any FDA-approved drugs from foreign countries -- including insulin -- and sell them at a lower cost than the same U.S. versions. This appears to be a way drugmakers could avoid some of the contracts they have with drug middlemen, known as pharmacy benefit managers."

(Kaiser Health News)
[Official Guidance] HHS Announces New Action Plan to Lay Foundation for Safe Importation of Certain Prescription Drugs
"The Action Plan outlines the government's intention to pursue two pathways to allow safe drug importation from foreign markets: [1] Through a notice of proposed rulemaking (NPRM), HHS and FDA would propose to rely on the authority under current federal law ... that would ... authorize pilot (or demonstration) projects developed by states, wholesalers or pharmacists and submitted for HHS review, outlining how they would import certain drugs from Canada that are versions of FDA-approved drugs that are manufactured consistent with the FDA approval.... [2] FDA would provide recommendations to manufacturers of FDA-approved drugs who seek to import into the U.S. versions of those drugs they sell in foreign countries. Under this pathway, manufacturers would use a new National Drug Code (NDC) for those products, potentially allowing them to offer a lower price than what their current distribution contracts require.... This pathway could be particularly helpful to patients with significantly high cost prescription drugs." (U.S. Department of Health and Human Services [HHS])
Medicare Part D Prescription Drug Plan Costs to Decline Again in 2020
"Over the past three years, average Part D basic premiums have decreased by 13.5 percent, from $34.70 in 2017 to a projected $30 in 2020, saving beneficiaries about $1.9 billion in premium costs over that time. As a result, Part D continues to be an extremely popular program, with enrollment increasing 12.2 percent since 2017." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Policy Options for Addressing High Drug Prices
"[K]ey themes include: ... [1] Making drugs more affordable at the pharmacy, for instance by capping out-of-pocket spending in Medicare Part D.... [2] Shedding light on complex topics like the supply chain, price increases, how prescription benefits managers (PBMs) operate, and potential patent abuses.... [3] Incrementally curbing anticompetitive practices.... [4] Addressing loopholes in previously passed legislation, such as addressing misclassification of drugs by manufacturers to determine the size of the Medicaid rebate." (The Commonwealth Fund)
[Opinion] Drug Rebates Will Remain, But So Will Pressure to Reduce Drug Prices and Demonstrate Value
"While the rebate issue is now off the table, pressure to reduce prescription drug costs is not. But rather than waiting for the next round of regulations, ... the pharmaceutical industry should consider developing its own business models that address drug prices and demonstrate value." (Deloitte)
A Small Group of Patients Facing High Drug Costs Drive Health Care Spending
"Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year.... 'Persistently high spenders' are people who have accumulated big health care bills for at least 3 consecutive years. They often have HIV, MS, cystic fibrosis, rheumatoid arthritis, diabetes, cancer and other serious conditions requiring frequent and often costly care. Drugs are lifesavers for these patients, but also big offenders when it comes to costs." (Drew Altman, via Axios)
Prescription Drug Rebates, Explained
"This animation explains how rebates for prescription drugs work and why they matter in the debate about lowering drug costs. The video breaks down how prescription drug rebates are determined, who benefits from them, how they affect spending by insurers and consumers and the role of pharmacy benefit managers in the process." (Kaiser Family Foundation)
Understanding the Senate Finance Committee's Drug Pricing Package
"[This post summarizes] key provisions from the package, explaining how it aims to lower prescription drug prices. Next, [it situates] the Committee's package within the broader set of drug pricing reforms being considered by the federal government. Finally, [it explains] the key objections levied by Senators during Thursday's markup and how those objections might affect the development of the package going forward." (Health Affairs)
Is Prescription Drug Pricing the Cure for Partisanship?
"By limiting reimbursement and pulling back money as rebates, the Medicare provisions could result in substantial savings to the program. In addition, the [Prescription Drug Pricing Reduction Act of 2019] contains provisions addressing site-of-service reporting and impact on reimbursement." (Sheppard Mullin)
Senate Finance Committee Passes Drug Pricing Package
"The main components of the [Prescription Drug Pricing Reduction Act of 2019 are a] $3,100 cap on what Medicare beneficiaries pay out-of-pocket on prescription drugs, set to take place in 2022, and a limit on prescription drug price hikes under Medicare Part D.... [CBO projects] a $31 billion reduction in cost sharing and premiums by unsubsidized Part D enrollees." (HealthLeaders Media)
Senate Finance Committee Unveils Bipartisan Bill to Lower Drug Costs
"[The] Prescription Drug Pricing Reduction Act of 2019 includes an overhaul of parts of Medicare and Medicaid, including requiring drug manufacturers to pay a rebate to Medicare if their price hikes surpass the inflation rate. This, combined with a proposed restructuring of the Part D benefit, would save Medicare $85 billion over the next 10 years ... CBO also estimates that beneficiaries would save $27 million in OOP costs over the same period." (American Journal of Managed Care)
Senate Hearings On Drug Prices: Many Questions, Few (Useful) Answers
"The first congressional inquiries on drug prices date back to 1959 and 1960, and similar hearings have been held every decade since then.... In the current landscape, ... in which confidential rebates are a major reason behind rising drug prices, congressional hearings could serve a key role -- that of data collection." (Health Affairs)
Rising Generic Prices Help Drive Up Cost of WHO List of Essential Medicines in US
"Of the 265 essential medicines, 197 (74%) were generic. Medicare Part D spending on those drugs were $87.2 billion, with annual spending increasing from $11.9 billion in 2011 to $25.8 billion in 2015 (116%).... Total annual OOP spending increased from $2 billion to $2.9 billion (47%), and annual per beneficiary OOP spending on these drugs increased from $20.42 to $21.17 (4%)." (American Journal of Managed Care)
[Opinion] There Is No Single, Best Policy for Drug Prices
"A majority of Americans prefer greater regulation of prescription drug prices, meaning government intervention to lower them. But don't count on a single policy to address a nuanced problem.... Outside of a few government programs ... low-priced drugs are alike in that competition is the sole source of downward pressure on prices.... In contrast, high-priced drugs lack competition for various reasons[.]" (Austin Frakt via The New York Times; subscription may be required)
How Blockchain Technology Will Disrupt the PBM-Payer-Pharmacy Relationship
"Blockchain could potentially transform the relationship between payers, pharmaceutical manufacturers, wholesalers, and pharmacies by offering an alternative, transparent mechanism for processing, pricing, and validating prescription transactions. This approach could lead to less waste, reduced pricing variations between pharmacies, and a better app-based purchasing experience for consumers, through transparency of the true cost of prescription drugs." (Milliman)
Administration Drops Plan to Curb Drug Rebates
"The plan had been to curtail the rebates worked out between drugmakers and third parties that manage benefits for Medicare as well as Medicaid managed care, where states contract with insurers to deliver benefits. The government sought instead to redirect those discounts toward patients. The effort could have disrupted the U.S. pharmaceutical industry." (The Wall Street Journal; subscription may be required)
Will Prescription Drug Price Disclosures Have an Impact?
"The Colorado General Assembly recently passed new statute ... which would require pharmaceutical manufacturer marketing employees or agents to present, at the time of marketing a drug to a Colorado prescriber, the wholesale acquisition cost of any discussed products.... [T]he stated objective is better-informed physicians who can 'consider lower-cost alternatives,' which could in turn help to 'contain prescription drug costs.' " (Faegre Baker Daniels)
How to Get a Cheaper Prescription Before Leaving the Doctor's Office
"[A] growing number of health systems and insurers [provide] real-time drug pricing information to physicians so they can help patients avoid 'sticker shock' at the pharmacy. The pricing tool, which is embedded in physicians' electronic health record and prescribing system, shows how much patients will pay out-of-pocket based on their insurance and the pharmacy. It allows the doctor to find a cheaper alternative when possible and start the process of getting authorization for a drug, if the insurer requires that." (Kaiser Health News)
Drug Price Disclosures and the First Amendment
"On July 8, 2019, the U.S. District Court for the District of Columbia held that [HHS] exceeded its statutory authority in promulgating its new rule on drug list price disclosures.... The court ultimately vacated the rule.... [but] did not evaluate whether the rule violated the First Amendment.... This Sidebar investigates [that] question[.]" (Congressional Research Service [CRS])
District Court Vacates HHS Rule That Would Require Drug Price Disclosure in TV Ads
"The plaintiffs in the case included three large drugmakers: Merck & Co., Eli Lilly and Co., Amgen Inc., as well as the Association of National Advertisers, Inc, challenging the [HHS] requirement that drugmakers post the list prices of prescription drugs equal to or greater than $35 for a month's supply.... The decision came one day before the rule ... was set to go into effect." [Merck v. HHS, No. 19-1738 (D.D.C. Jul. 8, 2019)] (HealthLeaders Media)
Supreme Court Seeks Solicitor General's Input on ERISA Preemption of State Regulation of Pharmacy Benefit Managers
"The [Arkansas] statute created an appeals process through which pharmacies could challenge the reimbursement rates offered by PBMs.... The law applied to both ERISA and non-ERISA health plans.... The Circuits are split on whether ERISA preempts all regulation of PBMs, or whether ERISA preempts no regulations of PBMs. " [Pharmaceutical Care Mgmt. Assoc. v. Rutledge, Nos. 17-1609 and 17-1629 (8th Cir. June 8, 2018; cert. pet. filed Oct. 22, 2018)] (Seyfarth Shaw LLP)
[Opinion] Maryland's Path to a Prescription Drug Affordability Board

"[T]his year Maryland became the first state in the nation to create a Prescription Drug Affordability Board. The law's July 1st enactment marked the culmination of a multi-year, grassroots effort based on the recognition of a simple truth that pharmaceutical manufacturers have long ignored: drugs don't work if people can't afford them."

(Families USA)
Rebalancing High Prescription Drug Prices with Innovation Incentives
"[This post reviews] the previously published literature on the relationship between high drug prices and innovation incentives.... While high prices and innovation do not necessarily move in lockstep, it is undeniable that innovators develop new drugs in response to economic incentives.... The major barrier thus far to developing effective policy in this area is our lack of empirical evidence for how fungible price and non-price innovation drivers are and how best to deploy each to optimally address unmet medical needs. Finally, to help resolve this impasse, [the authors] propose a three-pronged approach." (Health Affairs)
Pelosi Aims for Feds to Negotiate Drug Prices, Even for Private Insurers
"A draft plan spearheaded, but not yet released, by [House Speaker Nancy Pelosi] and other House Democratic leaders would ensure that prices negotiated on the most expensive drugs would apply not only to the government but to all payers, including employers and insurers ... But first, Democrats must agree on how best to muscle drug companies to the negotiating table, as well as how to prevent Americans from paying more or even losing access to the other drugs they take." (Kaiser Health News)
New Texas Law Mandating Drug Price Transparency Considered Among Strongest in Nation
"HB 2536 requires pharmaceutical manufacturers to disclose to the Texas Health and Human Services Commission (HHSC) when a drug's price increases 15% or more compared to the previous year, or 40% or more over three calendar years. The new law also requires annual reporting of detailed price information by manufacturers, pharmacy benefit managers, and health benefit plans, and charges the HHSC with making this information available online to the public." (Morgan Lewis)
[Opinion] A Simple Solution to Lower Drug Prices for All Americans
"There's a simple solution for lowering prices of both old and new drugs for all Americans, not just for seniors under Medicare: a windfall profits tax that takes back surplus profits derived from excessive prices. This tax would be equal to the difference between a drug's list price -- the price that is used for patient payments -- and the drug's justified price, multiplied by the number of units sold." (Center for American Progress)
[Guidance Overview] Oklahoma Enacts Regulation of Pharmacy Benefit Managers
"[T]he Governor of Oklahoma recently signed [the Patient's Right to Pharmacy Choice Act (HB 2632)] into law. The purpose of the Act is to establish minimum and uniform access to providers, and standards and prohibitions on restrictions of patient's rights to choose pharmacy providers.... By regulating PBMs instead of health plans, the Act will impact self-insured health plans, but does not attempt to regulate such plans directly. This approach may ultimately help the Act avoid challenges by self-insured health plans on ERISA preemption grounds." (HUB International)
Senate Committee Hearing: The Complex Web of Prescription Drug Prices -- Examining Agency Efforts to Further Competition and Increase Affordability
June 19 hearing; page includes video and links to testimony of witnesses: [1] Demetrios Kouzoukas, Center for Medicare, Centers for Medicare & Medicaid Services; [2] Janet Woodcock, MD, Center for Drug Evaluation and Research, Food and Drug Administration; and [3] Vicki L. Robinson, Office of Inspector General, U.S. Department of Health and Human Services. (Special Committee on Aging, U.S. Senate)
Senate Package Targets Healthcare Costs, Surprise Medical Bills
"A broad array of proposed reforms aims to lower drug prices, increase transparency, foster greater electronic exchange of health information and improve public health. The provisions targeting surprise medical bills and drug prices join a growing list of similar proposals in Congress." (Mercer)
[Opinion] Transparency, Regulation Needed to Rein in Pharmacy Benefit
"With pharmacy benefit managers playing an increasingly pivotal role not only in drug pricing but also in administering patient drug benefits, the American Medical Association (AMA) [[on June 10] called for oversight and transparency for the lightly regulated industry. The new policy ... responds to pharmacy benefit managers (PBMs) -- middlemen -- operating in a 'black box' with limited transparency to show what goes on behind closed doors.... [T]he AMA is concerned that the rebate process results in list prices above what they would be absent rebates, as neither PBMs nor manufacturers have an incentive to lower list prices." (American Medical Association [AMA])
How External Reference Pricing Could Address Price Disparities Between Drugs in the U.S. and Other Nations
"American taxpayers pay three times as much for prescription drugs as citizens in other wealthy nations, many of which use external reference pricing, a mechanism that benchmarks drug prices to those paid in other countries. The U.S. has yet to embrace this practice to keep prices affordable for consumers -- perhaps because we are often the first adopter of drugs." (Arnold Ventures)
Witnesses Testify in Review of CVS-Aetna Merger
"The nearly $70 billion transaction closed last fall, but [Judge Richard Leon of the U.S. district court for the District of Columbia] has been thoroughly scrutinizing the DOJ-approved deal.... This isn't a trial; it's merely an opportunity for Leon to gather additional perspective on the acquisition as part of his Tunney Act review process.... The hearings will last up to three days, with three witnesses put forward by amici curiae expected to speak first, followed by three witnesses put forward by CVS and the DOJ." (HealthLeaders Media)
[Opinion] Transparency Is Just One Piece of the Drug Pricing Puzzle
"Public reporting can provide valuable information ... public around excessive launch prices and price increases, but on its own, transparency will not solve the drug pricing problem.... A common refrain from the drug industry is that high prices are necessary to cover the cost of researching and developing new drugs. But industry experts are not buying it." (Arnold Ventures)
Arbitration Approach Favored in Pending Surprise-Bill Legislation
"An arbitration approach -- backed by hospitals -- to resolve surprise medical bills remains most popular among various options in Congress. Hospital advocates wrote Congress this week to criticize legislation that uses a rate-setting approach. Researchers have found positive effects from one state's arbitration approach." (Healthcare Financial Management Association [HFMA])
Policy Options to Help Self-Insured Employers Improve PBM Contracting Efficiency
"The Lower Health Care Costs Act ... includes three key components that address PBM contracting inefficiencies for self-insured employers. [1] PBMs would be mandated to report to employers drug-specific and aggregated pricing, utilization, and spending details for all drugs they contract for on behalf of employers ... [2] PBMs would be prohibited from practicing 'spread pricing' ... [3] PBMs would be mandated to pass-through all price concessions to employers, including rebates, fees, alternative discounts, and other remunerations received from drug companies." (Ge Bai, Mariana P. Socal, and Gerard F. Anderson, in Health Affairs)
Oklahoma Governor Signs Law Regulating PBMs

"Oklahoma Gov. Kevin Stitt ... signed into law HB 2632, which protects patient access to pharmacy services by establishing network adequacy and 'any willing pharmacy' requirements, minimizes pharmacy benefit manager conflicts of interest by prohibiting higher reimbursement rates for PBM-owned pharmacies, and limits PBM abuses by prohibiting retroactive claim adjustments and denials."

(National Community Pharmacists Association [NCPA])
Bipartisan Support for New Attempts to Control Prescription Drug Costs
"Lawmakers on both sides of the aisle are applauding two recent developments in the ever-raging battle to contain the cost of American healthcare. On May 8, 2019, [HHS] announced a final rule ... that will soon begin requiring pharmaceutical manufacturers to disclose the list price of prescription drugs in television advertisements.... In an unrelated move just a few days later, 43 states and Puerto Rico filed a lawsuit in federal court in Connecticut, alleging that at least 20 drug manufacturers conspired to artificially inflate and manipulate prices for more than 100 different generic medications." (ERISAPros)
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