Three things drug manufacturers and CEs can do to build trust and enable effective collaboration

The post How Covered Entities and Pharma Companies Can Better Collaborate on Drug Discount Programs appeared first on MedCity News.

Singling out an industry segment won’t solve the underlying problem of healthcare costs.

The post The Senate Attacks on Pharma Put the Industry in Jeopardy and Consumers at Risk appeared first on MedCity News.

Dan Reedy, senior director of pricing and underwriting for Abarca, spoke recently with MedCity News about what payers should consider as they explore new models and press for greater transparency.

The post Unlocking Transparency in PBM Pricing appeared first on MedCity News.

Smart but easy tech upgrades can boost margins.

The post Don’t Let Inflation Bloat Your Drug Spending appeared first on MedCity News.

MedCity News is launching a new ongoing show called Debunked: Slaughtering Myths, Bad Practices and Sacred Cows in Healthcare. In this show, co-hosts Arundhati Parmar and Samir Batra will discuss healthcare news and call out things that seem utterly insane to us. The goal is to inspire change in the healthcare industry.

The post MedCity News Launches Debunked, A Show Where We Slaughter Myths, Bad Practices and Sacred Cows in Healthcare appeared first on MedCity News.

While pharmaceutical companies continue to raise list prices year-over-year, we work behind the scenes to fight the trend by driving competition, negotiating with drugmakers and incentivizing the use of less expensive medicines that deliver the same clinical value.

The post Pharma Just Increased the Price of Hundreds of Drugs. PBMs are Minimizing the Impact for Health Plans, Employers and Patients appeared first on MedCity News.

No matter the outcome, it’s certain that the cost of drugs will not be an issue easily resolved anytime soon even though several other states also have laws allowing for drug imports.

The post Healthcare Docket: Will Florida’s Plan to Import Drugs From Canada Open the Floodgates? appeared first on MedCity News.

Walgreens has agreed to pay Humana $360 million to settle a drug pricing dispute that has spanned nearly five years. The payout is roughly half of what Walgreens was originally ordered to pay when the issue was first resolved last year.

The post Walgreens to Pay Humana $360M to Settle Claims It Overcharged for Drugs appeared first on MedCity News.

The word has gained greater urgency in recent years as the consumer trend in healthcare has forced payers, providers and all other kinds of healthcare stakeholders to swear by it.

The post What Was the Most-Repeated Word in CVS Health CEO’s JPM Presentation? appeared first on MedCity News.

Healthcare has traditionally been built around the convenience of the provider and not the patient. Worse, it tends to treat all patients the same regardless of the condition they are trying to manage. If we want to improve medication compliance, we have to make access, support, and most importantly financial assistance a priority.

The post Rising Cost of New Medications, Will the People Who Need Them Most be able to Afford them? appeared first on MedCity News.

Proposals targeting misaligned financial incentives, price transparency, and pharmacy access are important and necessary reforms. But the consequences of failing to address pharmacy benefit managers’ use of market power to block competition and extract monopoly profits from payers and consumers will not be limited to drug costs – it will change all of healthcare for generations.

The post PBMs Are in Regulators’ Crosshairs But Are Regulators Missing the Point? appeared first on MedCity News.

Despite these wins for many patients, the new law is already impacting the discovery and development of new drugs for people living with orphan diseases. Not only are drugs that could treat more than one disease being disincentivized, small molecule medicines, which play an important role in treating neurological disorders, cancers, and other diseases, may also be disadvantaged by the law.

The post The Inflation Reduction Act’s Impact on Drug Development for Rare Diseases appeared first on MedCity News.

Pharmaceutical manufacturers say high U.S. prices support research and development and point out that Americans tend to get new treatments first. But recent research has shown that the price of a drug is related neither to the amount of research and development required to bring it to market nor its therapeutic value.

The post Here’s Why Many Americans Are Unable to Afford Their Drugs appeared first on MedCity News.

Lawsuits filed in opposition to the White House’s drug pricing negotiation program are beginning to mount, but legal experts agree that the plaintiffs’ arguments probably won’t hold up during a court battle. However, these lawsuits still could delay when the government’s ability to negotiate price goes into effect.

The post Lawsuits Against Medicare Drug Negotiations Are Mounting, But They Probably Won’t Be Able to Stop The Plan appeared first on MedCity News.

Merck recently became the first drugmaker to sue the federal government over its Medicare drug price negotiation program. The company’s lawsuit argues that the program violates the Constitution’s First and Fifth Amendments, but healthcare law expert Robin Feldman said the defense doesn’t have any legs.

The post Why One Healthcare Lawyer Thinks Merck’s Drug Pricing Lawsuit Defense ‘Makes No Sense’ appeared first on MedCity News.

Price transparency has come a long way over the past couple of years, with insurance companies and hospitals now required to publicly disclose their prices. The more pressing issue is that there is no mechanism in place to make this information easily digestible, personalized to each patient, and placed in context with competitors’ prices.

The post Free Prescription Drugs Are Often Available—If Only Your Doctor Can Find Them appeared first on MedCity News.

For the first time ever, CMS is preparing to negotiate prices for drugs paid for by Medicare. This has sparked a huge debate — will the creation of this taxpayer-funded drug negotiation infrastructure be a failed experiment, or will it become the standard for the future of drug pricing in this country? Jason Borschow, president and CEO of Abarca Health, says it’s the latter.

The post Medicare Drug Negotiation Is the Model for the Future of Drug Pricing, Abarca CEO Says appeared first on MedCity News.

Panelists at a recent pharmacy conference were optimistic about the future of value-based drug contracting. For example, one said that healthcare will be close to establishing a value-based formulary by 2030, and another said that longitudinal patient tracking will become a more important part the drug pricing process.

The post What Will Value-Based Drug Pricing Look Like By 2030? Experts Share 4 Predictions appeared first on MedCity News.

For anyone suffering from a debilitating or life-threatening disease, the experience of procuring specialty medications is like having a second job. You are your own advocate working in a draconian system that was developed as a business, not a care service. When you’re finally successful, after what can be weeks of delays, you’re met with […]

The post Specialty Pharmacy Needs a Shake Up to Help the Chronically Ill appeared first on MedCity News.

As pharma becomes part of the value-based revolution, there are several lessons that can be learned from the ongoing development of value-based care.

The post What Prescription Drug Pricing Can Learn From Value-Based Care Models appeared first on MedCity News.

2023 is shaping up to be a crucial year for everyone involved – and affected – by the pharmaceutical industry. It’s likely to be a year of experimentation for payers – and defensiveness for drug makers.

The post 2023 Likely To Be a Crucial Year for Pharma—and Insurers appeared first on MedCity News.

Requiring that PBMs bid on a per member per month guarantee would reduce the employer’s uncertainty by securing the actual per member per month cost to the employer.

The post Getting off the PBM Merry-go-Round: How Late-stage Offer Tricks Take Employers for a Ride appeared first on MedCity News.

A trade association for PBMs says that state PBM regulations in Oklahoma are preempted by federal ERISA and Medicare regulations.

The post States should be allowed to regulate PBMs, according to 35 state AGs advocating in Oklahoma case appeared first on MedCity News.

In a rapidly changing and expanding healthcare environment, the secure exchange of health information and price transparency enabled by real-time benefit tools is critical to improve patient safety, lower costs and ensure quality care.

The post How real-time benefit tools deliver meaningful savings appeared first on MedCity News.

Value-based pricing could have shown us with more certainty the real level of effectiveness of Aduhelm. Maybe it is worth paying something for; and value-based contracts are the only way to figure that out.

The post Aduhelm’s loss is a win for value-based drug pricing appeared first on MedCity News.

CVS Health intentionally prevented certain Medicare beneficiaries from accessing less expensive, generic prescriptions, according to a whistleblower lawsuit from a former senior CVS executive. Documents from the lawsuit were recently unsealed,. “In doing so, CVS Health has ensured astonishing profits for itself while passing the increased costs onto taxpayers and Part D beneficiaries,” the whistleblower […]

The post Report: Whistleblower accuses CVS of “calculated and widespread” drug pricing scheme targeting elderly patients appeared first on MedCity News.

Capital Rx recently closed a $106 million Series C funding round, bringing its overall funding to $175 million. The upstart pharmacy benefit manager will use the funds to enhance its digital pharmacy platform as well as grow its user base.

The post Capital Rx snags $106M to enhance digital platform, increase user base appeared first on MedCity News.

Pharma companies often take the blame for high prescription costs. But a new, industry-sponsored survey shifts attention to insurance industry practices.

The post Drug-industry survey blames insurer practices for barriers to care appeared first on MedCity News.

Congress must thoroughly investigate the anti-competitive behaviors of these conglomerates and act accordingly. Doing so will provide better outcomes both for patients and a more competitive marketplace for unaffiliated pharmacies.

The post Free market is at risk because of PBM titans’ anti-competitive behaviors appeared first on MedCity News.

A.J. Loiacono was speaking at MedCity INVEST in late March in Chicago when an audience member requested him to address whether it is sustainable to have a system where after insurance a drug costs $150 for consumers whereas with GoodRx the same drug is $6. Loiacono took aim at PBMs but also didn’t spare the federal government.

The post CEO of upstart PBM: What CVS, Cigna and other PBMs are doing in drug pricing is neither sustainable nor ethical appeared first on MedCity News.