The Weekly Roundup: PBM pricing practices (1.25.19)

January 25, 2019

This week, Stat News shared coverage of the “unchecked PBM industry” that is currently under scrutiny in New York by pharmacists concerned about spread pricing in the state’s Medicaid program. A Bloomberg analysis of the practice using Medicaid data reviewed the most common generics and found markups of approximately 32 percent. Of course, the practice is nothing new, but scrutiny seems to be on the rise, and some two dozen states passed attempts to weed out opaque pricing practices during the last legislative session. CVS was recently slapped for the practice when an audit in Ohio found that Ohio PBMs billed managed care payers $223 million more in 2017 than what they paid in pharmacy costs, prompting the state to move to a pass-through model

Here are a few other stories that might be of interest: 

  • There is optimism despite decline among independent pharmacies—particularly for those with multiple locations. 
  • Another study finds pharmacist intervention is key to preventing or reducing readmissions. 
  • No new drugs? FDA running on dwindling user-fee funding during government shutdown as agency “prioritizes approvals that impact the public safety,” according to FDA Commissioner Dr. Scott Gottlieb.
  • The lines have been drawn—again. Physician and patient advocacy groups lining up to battle proposed changes to CMS drug pricing approach in the court of public opinion. 
  • Put your money where your mouth is. Children’s Hospital in Pennsylvania opens “food pharmacy” to encourage better nutrition. 

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