Merith Basey’s Post

The Federal Trade Commission (FTC) has launched a lawsuit against the "Big Three" Pharmacy Benefit Managers (PBMs) over their drug pricing tactics. PBMs play a crucial role in negotiating prices between insurers, pharmacies, and drug manufacturers. However, critics argue that their complex rebate and fee structures can lead to higher prices for consumers and less transparency in the market. The FTC's action aims to address these issues and promote a more transparent and fair pricing system for prescription medications. This lawsuit could have significant implications for the future of drug pricing and the role of PBMs in the healthcare industry. https://lnkd.in/gJiEKMWN

Employer health plan customers of PBMs & Ascent seemingly have a smoldering fiduciary liability problem. This lawsuit publically broadcasts “trust assets” of plan beneficiaries are being skimmed and violate ERISA’s requirement of plans exclusively benefiting plan members. Add that employers are under the advice of national consultants receiving per-claim kickbacks for keeping their plans under the heel of these PBMs? Class-action rocket fuel!

🚨 **Breaking News in Healthcare** 🚨 The Federal Trade Commission (FTC) is taking significant action against the largest pharmacy benefit managers (PBMs) over drug pricing tactics. Here are the key points: - **FTC Lawsuit**: The FTC is suing CVS Caremark, Express Scripts, and OptumRx for rebate practices that may increase drug costs and disadvantage independent pharmacies. - **Market Impact**: These PBMs handle around 80% of U.S. prescriptions and are integrated with major health insurers. - **Conflict of Interest**: The FTC report highlights how vertically integrated PBMs may prefer their affiliated businesses, potentially raising prescription drug costs. - **Consumer Impact**: The lawsuit aims to address how these practices affect consumers, particularly regarding the cost of essential medications like insulin. For more details, read the full article [here](https://lnkd.in/eCvzBTGq). #Healthcare #Pharmacy #DrugPricing #FTC #PBMs #LegalAction #Pharmaceuticals #RX 3PBM #FixHealthcare BenefitHelp : [Fierce Healthcare](https://lnkd.in/eCvzBTGq) : [BioSpace](https://lnkd.in/eJSb6Aqy)

"The 6 largest #PBMs (pharmacy benefit managers) in the US manage ~95% of all prescriptions filled in the US, a “concentrated market structure” that has allowed them to “profit at the expense of patients and independent pharmacists”. The Federal Trade Commission’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs – including overcharging patients for cancer drugs.” Here are some strategies to mitigate these issues: 1. Require #PBMs to disclose the rebates they receive from drug manufacturers and how much of these rebates are passed on to insurers and patients. 2. Encourage or mandate the use of transparent pricing models where #PBMs provide clear information on how drug prices are set and what patients will pay out-of-pocket. 3. Federal and state legislation that increases oversight and regulation of #PBMs, such as laws that require #PBMs to act in the best interest of patients. 4. Strengthen regulations to prevent PBMs from engaging in practices that may lead to conflicts of interest, such as accepting kickbacks from drug manufacturers. 5. Support the development and use of alternative models, such as transparent #PBMs that operate on a flat fee rather than a percentage of drug costs. 6. Ensure that #PBM formularies are based on clinical efficacy and cost-effectiveness rather than on the size of rebates from manufacturers. 7. Expand access to patient assistance programs to help those who are struggling with high out-of-pocket costs. 8. Allow government programs like #medicare to negotiate drug prices directly with manufacturers, potentially bypassing #PBMs. 9. Encourage large employers and insurers to negotiate directly with drug manufacturers or use purchasing coalitions to increase their bargaining power. 10. Implement performance metrics and accountability standards to ensure that #PBMs are providing value to patients.

Expensive medicines can wreak havoc in a family budget. So when price controls are brought up, the concept of those price controls sound nice on the surface. There’s another side to price controls though. Merrill Matthews sheds light on price controls in this article from The Hill. #healthcare #medicine #pharmaceuticals

The Federal Trade Commission (FTC) has released an interim report on its investigation into pharmacy benefit managers (PBMs), revealing concerning practices that may harm patients, pharmacies, and employers. The report highlights issues such as PBMs steering patients to affiliated pharmacies, potentially limiting patient choice and raising costs. The investigation found that PBMs often engage in complex and opaque contracting practices, making it difficult for employers to understand the true costs of prescription drugs. Additionally, PBMs were found to use their market power to squeeze independent pharmacies through unfavorable reimbursement rates and fees. The FTC's report also raises concerns about vertical integration in the healthcare industry, with PBMs increasingly owning or being owned by insurance companies and pharmacies. This integration may create conflicts of interest and reduce competition. The interim findings suggest that PBM practices could lead to higher drug prices, reduced access to medications, and decreased competition in the pharmaceutical market. The FTC plans to continue its investigation and may consider policy recommendations or enforcement actions to address these issues. #healthcare #PBMs #BigPharma #HealthcareCosts #FTC #HealthcareCosts https://lnkd.in/eHBa2GjH

New York State wants to shake up PBM rules, with newly proposed regulations promising to prohibit "abusive contract terms that raise drug costs for consumers and strain small pharmacies." But PBMs claim newly proposed regulations would cost New Yorkers billions. A cost analysis released yesterday by the Pharmaceutical Care Management Association (PCMA), which represents PBMs, claims the proposed regulations would cost New York residents $3.1 billion in excess drug spending in the first year, and $40 billion over 10 years. Read more: #PBMs #PBM #health #healthcare

Medicare and CMS is taking on Pharma industry to lower the drug prices. Great for consumers. For some of the prescriptions the out-of-pocket cost are insane like ten thousand a month and could go as high as fifty thousand a month. We know that Healthcare is biggest cause of bankruptcy in America, We can say in some cases, prescription price can lead to bankruptcy as well.

This week the Biden Administration will announce the first 10 drugs the federal government will negotiate for lower prices in Medicare. Several legal challenges are pending, but for now, the government is moving forward. Whether one agrees that the feds should negotiate drug prices or not, one thing is clear: prescription drug misuse is a major -- and costly -- problem in this country. Too many prescribed medicines are ineffectively utilized and poorly managed. Medication misuse results in unnecessary medical treatments, hospital visits, and -- according to some estimates -- as much as $500 billion in added costs per year!  Yes, drug prices are high, and actions should be taken to make them more affordable. But policymakers in Washington also need to make sure that prescription medicines are used more effectively. When I was with the drug store association in the early 2000s, we successfully lobbied Congress for “medication therapy management” in Medicare. But, given the depth and persistence of this problem, obviously much more needs to be done. It’s not just the cost of the product. It’s also how that product is used!  #politics #prescription #medicare #pharmacy #medicine #lobbying https://lnkd.in/g2K696JT

Anyone able to decipher this? -- CVS is going to be 'transparent' with insurers and PBMS? Since when does a PBM or insurer listen or care about the cost of drugs sold to patients? Is it because its "CVS" --or is this just nonsense marketing to help their brand?? ANYONE? #pbms #pbm #pharmacy #pharmacist #pharmacysoftware #pharmacylife #pharmacists