Results of a recent federal survey of Medicare Part D claims is again roiling the sometimes strained relationship between independent and smaller-chain community pharmacies and managed care, and could herald a growing threat to those pharmacies as health plan payers and pharmacy benefit managers abandon open pharmacy provider networks and shift more business to exclusive preferred pharmacy groups.
The Consumer Healthcare Products Association endorsed the Restoring Access to Medication Act (H.R. 2835), which would repeal a requirement enacted into law as part of the Patient Protection and Affordable Care Act of 2010 that requires consumers to obtain a prescription in order to utilize their flexible spending arrangements and health savings accounts to purchase over-the-counter medicines.
The creation of a clear approval pathway for biosimilar drugs remains a daunting task for the Food and Drug Administration, despite the fact that it's prescribed by law through the Patient Protection and Affordable Care Act. But when those lower-priced, generic versions of some staggeringly expensive bioengineered medicines do finally come to market, they're likely to have a profound effect on the nation's outlays for specialty pharmaceuticals.
A nonprofit pharmacy advocacy group has launched a new project that it said was aimed at ensuring fair audit standards for prescription drug claims paid under the Medicare Part D program and protecting pharmacies and patients from what it called unfair audit and conduct practices by pharmacy benefit managers.
Oregon Gov. John Kitzhaber, a Democrat, has signed what the National Association of Community Pharmacy has characterized as groundbreaking reform legislation that applies reasonable standards to how pharmacy benefit managers audit community pharmacies, provides increased transparency into generic prescription drug reimbursement and ensures that PBM administrators of prescription drug claims are registered within the state.
The U.S. healthcare system could avoid hundreds of millions of dollars in medical costs if medication adherence rates improved, according to the CVS Caremark "2013 State of the States: Adherence Report" released today.
CVS Caremark has been awarded Mail Service Pharmacy accreditation from URAC, a Washington, D.C.-based healthcare accrediting organization that establishes quality standards for the healthcare industry, the company announced.
Medicare Part D plans that create tiered networks of pharmacies for beneficiaries need more oversight amid reports that small and medium-sized pharmacies are being excluded from them, several senators wrote in a letter last week to the Centers for Medicare and Medicaid Services.
Bipartisan legislation that would let pharmacists devote more time to Medicare beneficiaries and less to adjudicating claims with pharmacy benefit management firms was introduced in the U.S. Senate and won the backing of the National Community Pharmacists Association earlier this week.
CareFirst BlueCross BlueShield has entered into a three-year agreement with CVS Caremark to provide pharmacy benefit and other related services to its commercial and Medicare Part D members, CareFirst announced earlier this week.
Unnecessary spending related to medications totaled nearly half a trillion dollars last year, and much of that was in the poorest states in the country, according to pharmacy benefit manager Express Scripts.
DSN spoke at length with two Catamaran executives — Albert Thigpen, SVP pharmacy operations and industry relations, and Sumit Dutta, SVP and chief medical officer — about the PBM’s new approach to managed pharmacy care and the changes driving that strategy.
The governor of North Dakota has signed into law a bill that would require pharmacy benefit managers to inform pharmacies about how reimbursement for generic prescription drugs is calculated under maximum allowable cost benchmarks and provide a more detailed appeals process to pharmacies to contest the MAC reimbursement caps that PBMs set up.