Unbiased Analysis of Today's Healthcare Issues
From the FTC’s press release out today: Today, the Federal Trade Commission brought action against the three largest prescription drug benefit managers (PBMs)—Caremark Rx, Express Scripts (ESI), and OptumRx—and their affiliated group purchasing organizations (GPOs) for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’…
That is the news according to a report in Healthcare Dive. Blue Shield of California…will drop CVS Caremark as the sole manager of its pharmacy benefits. In Caremark’s place, Blue Shield of California will contract out the job to five separate companies…Blue Shield of California, or BSCA, expects to save $500 million a year from…
How do pharmacy benefit managers (PBM) claim they can reduce cost? A Health Affairs Forefront article by Brennan and Shrank (2023) identify 6 key pathways: Mail order. Mail order alternative is often cheaper than dispensing at the retail pharmaciesdue to greater scale and automation Negotiating power. PBMs leverage purchasing power to lower dispensing fees. PBMs…
That is the subtitle of an NBER working paper by Charles Gray, Abby E. Alpert & Neeraj Sood. The author examine recent mergers between pharmacy benefit managers (PBMs) and health insurers. On the one hand, integration may beneficial to consumers. It could: (i) improve operational efficiencies, and (ii) better align PBM incentives with those of…
An interesting news story from PBS Newshour on pharmacy benefits manager (PBM). Of particular interest is a clip of Alex Azar testifying that “We may need to move toward a system without rebates, where PBMs receive no compensation from the very pharma companies that they are supposed to be negotiating against.”
Value-based insurance design (VBID) is a simple concept. In short, interventions that provide high-value should be covered with little cost sharing; treatments with low-value should be covered with higher rates of cost sharing or in some cases perhaps not even covered at all. A paper by Cohen et al. (2017) aims to see how far…
CVS is the second largest pharmacy in the U.S. with over 7000 stores. Caremark Pharmacy Services is a pharmacy benefit management (PBM) company, providing benefit management services to health plans. In March of 2007 the two firms merged. The combined firm not only has $99 billion in sales, CVS Caremark also has the ability not to…