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Ire over pharmacy middlemen fuels lobbying blitz
While there is little agreement among PBM opponents about what actions Congress should take, industry lobbyists are offering a menu of options for Democrats to consider, such as requiring [Pharmacy Benefit Managers] PBMs to pass on more of the rebates they negotiate with drugmakers to consumers or employers. They could also ban a common practice called spread pricing in which PBMs charge health plans [insurance carriers] more than they pay to the a pharmacy corporation dispensing a drug, and pocket the difference.
[...]
JC Scott, who leads the Pharmaceutical Care Management Association, the trade group for PBMs, said targeting his members might be good politics and take the focus off drugmakers during a critical moment in the debate, but it would not lower drug costs.
[...]
Although dozens of PBMs exist, the industry is consolidated, with three of them -- CVS Caremark, Express Scripts and OptumRx -- controlling nearly 80 percent of the prescription market. Health insurers, employers and [federal and states'] government hire PBMs to manage prescription benefits for their health [employees' commercial medical insurance group] plans -- putting them at the center of a supply chain consisting of drugmakers, insurers and pharmacies.

reference
WHO.int, "Medicines Reimbursement Policies in Europe" (2018), 200pp

An increasing number of countries in the WHO European Region have concluded managed entry agreement (MEAs). These are contractual arrangements between a pharmaceutical company and a public payer that enable reimbursement of a medicine, subject to specified conditions. A variety of different types of MEAs exist, which can be classified, in principle, as either finance-based (such as simple discounts or price-volume agreements) or performance-based (linked to health outcomes); the former are applied more frequently. Common indications covered by an MEA are oncology, rheumatology, hepatitis C and diabetes. In general, MEAs tend to be confidential - at least those aspects relating to the prices and discount arrangements.
Federal and states' HHS agencies underwrite expense of CMS price schedules for Medicare and Medicaid beneficiares enrolled public insurance plans, administered by commercial insurers licensed by the states.
archived Tue Jan 30th, 2018
by Cat on Sun Dec 5th, 2021 at 06:57:46 PM EST
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