Pharmacy Benefit Managers Improperly Reinterpret Medicare Rules for Financial Gain

A new White Paper from the Community Oncology Alliance (COA) looks at recent moves by Pharmacy Benefit Managers (PBMs) to increase corporate profits by declaring all physician dispensing to be out-of-network. Prepared for COA by attorneys at the law firm, Frier Levitt, LLC, the White Paper “Pharmacy Benefit Managers’ Attack on Physician Dispensing and Impact on Patient Care,” examines recent PBM actions, notably CVS Caremark’s announced intent to restrict patient access to physician dispensing, effective January 1, 2017.

After decades of classifying and paying claims for physician dispensing as “in-network,” the PBMs are playing a dangerous game with patient care in order to capture revenue in the growing specialty drug market. Despite a strong record and data showing positive patient outcomes from physician dispensing, the nation’s PBMs have begun a disturbing trend of systematically limiting patient access to outpatient medications from their dispensing physicians. Since 2011, PBMs have consolidated into just five major corporations that control 80% of the covered lives in the United States today; limitations, such as those proposed by CVS Caremark, would disrupt the care of tens of millions of patients.

Read the Full Whitepaper Here >>

By | 2017-06-26T13:04:26+00:00 June 26th, 2017|Resources|0 Comments