Policy & Sector Insights

Fox 25 Oklahoma – January 24, 2020 By Destiny Washington OKLAHOMA CITY (KOKH) — Oklahoma could soon join the growing number of states backing away from using Pharmacy Benefit Managers (PBM’s) to administer prescription-drug programs. A PBM is a third-party administrator of prescription drug programs for state and federal government employee plans, self-insured employer plans, commercial […]

Morning Consult– January 23, 2020  By B. Douglas Hoey Very few people know what pharmacy benefit managers do. The three biggest rival the largest corporations in the world in terms of market capitalization, revenue and profits. The CVS Health pharmacy service segment, for example, reported $134 billion in revenue last year. The PBMs exert enormous influence on […]

Inside Health Policy – January 08, 2020 By Emily Martin More than half of voters consider out-of-pocket costs for prescription drugs and other aspects of health care as top concerns ahead of the first primaries, according to a recent poll from Morning Consult and Bipartisan Policy Center. Nearly half also say use of illicit drugs and […]

Modern Healthcare– December 14, 2019 By Maria Castellucci About three years ago it became clear to the leadership team at RWJBarnabas Health that pharmacists were needed in its 68 ambulatory clinics. Its providers—and the system overall—are increasingly participating in value-based contracts with payers that involve metrics related to medication adherence, adverse drug events and other […]

Axios– November 24, 2019 The Trump administration is pushing for a monthly cap on what seniors pay out-of-pocket for drugs through Medicare’s pharmacy benefit to be added to a bipartisan drug pricing bill in the Senate, a senior administration official told Axios’ Caitlin Owens and me. The big picture: The cost of prescription drugs is still a […]

Axios — By Bob Herman, October 8, 2019 Michigan’s Medicaid program is proposing to fire the pharmacy benefit managers that handle its prescription drug claims and negotiate prices. The state would manage drug coverage itself, starting Dec. 1. The big picture: More state Medicaid agencies have determined that outsourcing all negotiations and operations of prescription drugs to PBMs has […]

The Hill  By Peter Sullivan– September 19, 2019 Speaker Nancy Pelosi (D-Calif.) on Thursday unveiled her long-awaited plan to lower prescription drug prices, one of the top priorities for Democrats this year. The plan would allow the secretary of Health and Human Services to negotiate the price of up to 250 drugs per year, and […]

Morning Consult BY TED OKON August 21, 2019 Democratic presidential candidates have devoted plenty of debate time to health care and pointed fingers at a familiar bogeyman: the all-powerful pharmaceutical industry. They are right to be outraged at high drug prices and the affordability crisis millions of Americans face every day, but they missed a huge problem […]

Roll Call One proposed change to Medicare prescription drug benefit is to help the program control costs it absorbs to keep premiums stable. (CQ Roll Call file photo) Congress this year could enact the biggest overhaul of Medicare’s prescription drug benefit since it was first established in 2003. If successful, seniors — and taxpayers — […]