A young husband was diagnosed with advanced melanoma and tumors attached to his brain. Waiting on the other side of his oncology clinic’s pharmacy counter was a potentially life-prolonging drug. But his Pharmacy Benefit Manager pumped the brakes, instead requiring that he and his wife order the medication from the […]
Walgreens Boots Alliance said Monday that it had reached a deal to combine its mail-order pharmacy and specialty drug business with Prime Therapeutics, which will also distribute medicines through the drugstore chain’s retail pharmacies.
As the nation debates the policy framework that allowed — or even encouraged — drugmaker Mylan to hike the price […]
There is growing awareness of the problems and pitfalls with Pharmacy Benefit Managers (PBMs) in the United States’ health care system. Contracted by insurance carriers to negotiate on their behalf with pharmaceutical companies, these ‘middlemen’ corporations have quietly become an unavoidable part of our nation’s health care system. Controlling at […]
Express Scripts, the largest pharmacy benefit manager (PBM) in the nation, is discovering just how much customer service matters. It may also be discovering that suing your biggest customer in court is generally not considered good customer service.
Should Anthem Inc. withdraw its business from Express Scripts as it has indicated, […]
The 11Alive Investigators uncover claims of prescription drug price gouging, not from pharmacies, but from a little known industry known as “middlemen” drug suppliers.
Those middlemen companies are called pharmacy benefit managers (PBMs). While you may have never heard of them before, pharmacists say PBMs play a big role in the […]
Caterpillar’s lowered drug bills show why pharmacy benefit managers are under fire.
A decade ago, Caterpillar Inc. looked at its employee drug plan and sensed that money was evaporating. The bills for pills had increased inexorably, so the company started to rein in its pharmacy benefit manager, or PBM. […]
How pharmacy benefit managers morphed from processors to predators
Rob Frankil of Sellersville, Pennsylvania, followed his father into the family business after college. “My entire life,” he said, “I’ve been involved with managing and owning independent pharmacies.” He now owns two stores, a traditional community pharmacy and another that caters to […]
Another reason is the adverse impact PBMs have on drug costs. PBMs earn revenues, in part, by charging various fees to pharmacies. Some of these fees effectively require pharmacies to pay PBMs for the right to be compensated by the PBMs. If that sounds complicated, it’s because it is.
PBMs also […]
Eric Pusey has to bite his tongue when customers at his pharmacy cough up co-payments far higher than the cost of their low-cost generic drugs, thinking their insurance is getting them a good deal.
Pusey’s contracts with drug-benefit managers at his Medicap Pharmacy in Olyphant, Pennsylvania, bar him from volunteering the […]
Middlemen who manage drug benefits for employers and insurers should be under greater government oversight of their pricing and billing practices to make health care cheaper, an independent pharmacists’ group said.
President Donald Trump’s plans to lower prescription drug costs will only succeed if greater transparency is imposed on pharmacy benefit […]
For a professor of pharmaceutical ethics, John Jones’ recent Another Voice column, “Blame drugmakers for high-priced drugs,” is a disappointing example of the kind of ethical blindness that has left our health care system with the problem of insanely high drug costs.
There is no doubt that drugmakers share the blame […]
Consumer advocate groups are already engaged in an arms race of sorts, for what will likely devolve into a pitched battle in the 2018 legislative session against insurers and pharmacy benefit managers. Across the country, the inflated cost of prescription drugs has become a flashpoint in the ongoing national conversation about health care […]
Pharmacy benefit managers and health insurance companies, in theory, should be close partners.
But Anthem’s (ANTM) protracted litigation with its PBM, Express Scripts (ESRX) , and its decision in April not to renew their contract when the current one expires at the end of 2019 shows how fraught the relationship […]