On Wednesday, President Trump signed bipartisan legislation that would ban so-called “gag clauses” and allow “pharmacists to tell consumers when they could actually save money by paying the full cash price for prescription drugs rather than using health insurance with large co-payments, deductibles and other out-of-pocket costs.” The New York Times reports. Pharmacists “say

Approximately 20 pharmacies across Ventura county filed a lawsuit against their Pharmacy Services Administrative Organizations (PSAOs) – Arete, Elevate, and Leadernet – for allegedly conspiring with OptumRx in reducing reimbursement rates.

The pharmacies allege that PSAOs owe fiduciary obligations to independent pharmacies to protect their interests against PBMs. PSAOs allegedly failed to negotiate acceptable rates

A new litigation is brewing up against OptumRx’s arbitrary MAC pricing. A recent case was filed by 29 pharmacies against OptumRx in Pennsylvania, arguing breach of contract and bad faith in carrying out its contractual obligations. OptumRx filed a motion to dismiss and to compel arbitration. As a result, 28 pharmacies were sent to arbitration,

Audits of healthcare providers are inevitable. Negative findings and allegations of overpayment are almost certain too. Because of voluminous records to be reviewed and scrutinized, auditors use extrapolation, reviewing only a snippet of all claims submitted. If any of the claims reviewed do not comply with applicable regulations and generally accepted practices – or contain

Last week, Express Scripts – a pharmacy benefit manager (PBM) – announced that it has reached an agreement to acquire eviCore – a medical benefit manager (MBM) – for $3.6 billion. eviCore manages medical benefits for 100 million people in areas of radiology, cardiology, musculoskeletal disorders, post-acute care and medical oncology.   Express Scripts is the

Oregon became another state to further increase its oversight over PBMs. Oregon has required PBM registration since 2013, however, it had no actual oversight over PBMs operating in the state. The new law – coming in effect on January 1, 2018 – grants Oregon Department of Consumer Services (DCS) the authority to deny, revoke, or

I’ve come across a very informative article written by William McConnell, “Behind the War Between HealthPlans and PBMs” that I want to share with you today. Click here to access the article.

Interestingly, the author predicts that despite the new administration’s pledge to reduce drug cost and spending, it’s unrealistic to expect that anything will

The bill would require PBMs to be licensed by the California State Board of Pharmacy and provides for greater transparency in PBMs’ dealings with health plans. The proponents of the bill argue that by allowing the Board to regulate PBMs would provide pharmacies with redress when wronged by aggressive PBM practices. In addition, the bill