Latest From Leslie Small
Three-agency guidance, issued as Biden administration is hoping to emphasize reproductive rights in its reelection campaign, outlines the narrow set of circumstances in which a health plan doesn’t have to fully cover certain types of birth control.
While many IRA changes are seen as having an adverse effect on stand-alone PDPs, tweaks to the risk adjustment model, TrOOP calculation, and enhanced plan benefit designs rolled out by CMS make predicting how the market will shake out difficult.
Vigorous regulatory scrutiny is a given, but opinions vary about how much the companies’ respective PBM businesses present a major antitrust risk.
As legislation moves forward in Congress, an examination of high-utilization Part D-covered generic drugs concludes that other payers in the supply chain make almost as much money from spread pricing as PBMs do.
New coalition of smaller PBMs champions federal policies requiring ‘100% pass-through’ of rebates, with PBMs then paid by a flat, disclosed fee.
OWCP says that hiring a PBM will address overprescribing and cost concerns, but a consultant who participated in the audit is skeptical.