pharmacy benefit managers

Pennsylvania's state budget includes a provision requiring pharmacy benefit managers (PBMs) to allow pharmacies previously removed from their networks to reapply after 12 months, addressing concerns about arbitrary contract terminations. The measure, supported by pharmacists, does not resolve broader issues like low reimbursement rates but aids struggling pharmacies.

Novo Nordisk lists telehealth company LifeMD as a provider for GLP-1 drugs, but former employees allege the firm prioritizes prescription volume over patient safety. An Iowa Medicaid audit found pharmacy benefit managers overcharged taxpayers by over $100 million through complex billing practices.

A state audit of Iowa’s Medicaid records found pharmacy benefit managers (PBMs) using complex methods to obscure drug costs, resulting in over $100 million in unreturned savings to managed care plans. The audit highlighted creative accounting maneuvers that evaded prohibitions on a now-outlawed pricing practice.

The FTC settled a lawsuit with CVS Caremark, alleging it manipulated insulin prices and restricted access, resulting in up to $8.5 billion in patient savings over 10 years. The settlement requires CVS Caremark to change rebate practices and unlock $4.5 billion in pharmacy counter rebates.

Mark Cuban recommends using AI chatbots like ChatGPT and Claude to analyze healthcare contracts and identify where employers are overpaying or being taken advantage of by insurers. He criticizes health insurers and pharmacy benefit managers for driving up costs through opaque pricing and urges employers to contract directly with hospitals or clinics to gain control over healthcare spending.

A proposed $10 prescription fee aims to increase dispensing fees paid by pharmacy benefit managers to pharmacies, potentially affecting New Yorkers' medical bills. The bill's impact remains uncertain, with questions about whether it would support pharmacies or raise costs for patients.

States are attempting to reduce drug prices by regulating pharmacy benefit managers, which manage prescription coverage for health insurers. The move addresses consumer concerns about rising medication costs.

States are enacting laws to regulate pharmacy benefit managers (PBMs) like CVS to lower drug prices, requiring transparency and limiting their compensation. CVS and other PBMs are contesting these regulations through lawsuits and lobbying, arguing they help reduce costs by promoting generic drugs.

States are enacting laws to regulate pharmacy benefit managers (PBMs) like CVS to lower drug prices, with Tennessee banning PBMs from operating retail pharmacies by 2028. CVS and other PBMs are contesting these regulations through legal action and advertising campaigns, arguing they help reduce drug costs by promoting generic medications.

States are implementing laws to reduce drug prices by regulating pharmacy benefit managers (PBMs) like CVS, which oversee prescription coverage for insurers. Tennessee's law, set to take effect in 2028, prohibits PBMs from operating retail pharmacies, prompting a lawsuit from CVS. Over 60% of U.S. adults express concern about affording prescriptions, with states passing measures to limit PBM compensation and increase transparency.

States are enacting laws to regulate pharmacy benefit managers (PBMs) like CVS to lower drug prices, with Tennessee banning PBMs from operating retail pharmacies by 2028. CVS has sued to avoid closing its pharmacies and spent millions opposing regulations, while a KFF poll highlights widespread public concern over medication affordability.

States are enacting laws to regulate pharmacy benefit managers (PBMs) like CVS to lower drug prices, with Tennessee banning PBMs from operating retail pharmacies by 2028. CVS and other PBMs are contesting these regulations through lawsuits and advertising campaigns, arguing they help reduce drug costs by promoting generic medications.

Illinois Governor JB Pritzker announced the first $25 million distribution to 434 local pharmacies under the Prescription Drug Affordability Act, aimed at supporting at-risk pharmacies in rural and low-income areas by regulating pharmacy benefit managers (PBMs) and providing funds for operational support and expansion. The legislation requires PBMs to pay fees based on enrollment numbers and prohibits steering customers toward affiliated pharmacies, with funds enabling projects like new facilities and expanded services at pharmacies such as Sav-More in Virden, Illinois.

Pennsylvania lawmakers propose hiring a single pharmacy benefit manager (PBM) to manage Medicaid prescriptions, aiming to support struggling pharmacies and reduce costs, while a state official warns it could increase expenses and risks without guaranteed savings. Proponents cite Ohio's reported $140 million Medicaid savings under a similar model, but critics argue the approach may not address broader pharmacy closures.

The Trump administration is intensifying a fraud crackdown on health insurers and pharmacy benefit managers through the Office of Personnel Management (OPM) and the White House Task Force to Eliminate Fraud. New compliance measures target the Federal Employees Health Benefits and Postal Service Health Benefits programs, focusing on fraud prevention, payment reviews, and pharmacy oversight. The Government Accountability Office highlighted risks in the FEHB program, including benefit card sharing and improper inducements.

The Trump administration is intensifying a fraud crackdown on federal health benefits programs, directing insurance carriers to strengthen fraud prevention measures. The Office of Personnel Management (OPM) and the White House Task Force to Eliminate Fraud are targeting health insurers and pharmacy benefit managers, with the Federal Employees Health Benefits program costing $70 billion in 2024 and covering 8.2 million individuals. OPM is also forming a data science team to detect fraud proactively.

A new report by Pennsylvania's Insurance Department suggests requiring pharmacy benefit managers (PBMs) to pay higher fees to pharmacies could help reduce closures. Over 1,000 pharmacies have shut down in Pennsylvania since 2020, with pharmacists attributing the decline to low reimbursement rates from PBMs, which process 80% of U.S. prescription claims. The study found that increasing dispensing fees to $10.49 per prescription would cost insurers less than 1% of total spending while supporting independent pharmacies.

Mark Cuban, billionaire investor and owner of CostPlusDrugs.com, rejected a presidential bid and announced collaboration with the Trump administration's TrumpRx initiative to reduce healthcare costs. His platform aims to lower drug prices by eliminating middlemen and importing generic medications to Dallas, significantly benefiting patients with chronic illnesses.