December 12, 2019

By a vote of 230 to 192, the House of Representatives passed Speaker Nancy Pelosi's bill HR 3 to give the federal government the power to negotiate lower drug prices. Nearly all Democrats supported the measure and nearly all Republicans voted against it. The bill also includes provisions to create new vision, dental and hearing benefits, and caps out-of-pocket drug costs for Medicare beneficiaries at $2,000.

December 10, 2019

The Congressional Budget Office says that Speaker Nancy Pelosi's bill HR 3, which would give Medicare the power to negotiate lower drug prices, would save the government $456 billion over 10 years. The bill also includes provisions providing dental, vision, and hearing coverage under the Medicare program would raise spending by approximately $358 billion, but also improve public health. The House of Representatives is voting on the bill on Thursday.

December 05, 2019

Speaker Nancy Pelosi’s proposed bill to reduce prescription drug prices, the “Lower Drug Costs Now Act” ― H.R. 3 ― is scheduled for a vote this month. The bill allows Medicare to negotiate prices for a limited number of drugs, has a $2,000 out-of-pocket cap on what seniors pay, and forces companies that have raised prices beyond inflation since 2016 to either reverse the price or rebate the amount of the increase to the federal government. Pharmaceutical companies are attacking the bill, but their criticisms are deeply misleading and inaccurate.

November 22, 2019

Senators Chuck Grassley and Ron Wyden said that they are considering making changes to their bipartisan bill to lower drug prices. Wyden suggested that the updated bill may contain new measures to reform the pharmacy benefits management industry and to lower insulin costs. 

November 12, 2019

The American College of Physicians released a new position paper that offers additional recommendations to improve transparency in the PBM industry and highlights the need for reliable, timely, and relevant information on prescription drug pricing for physicians and patients.

November 02, 2019

The New York Times Editorial Board endorsed HR 3, Speaker Pelosi's bill to reduce drug prices. The Congressional Budget Office found that this proposal, which would give Medicare the power to negotiate lower prices for some drugs, could save $345 billion in federal spending over seven years. It could also reduce out of pocket costs by $158 billion over the next dcade.

October 17, 2019

The House Energy and Commerce Committee approved HR 3, the Lower Drug Costs Now Act. Written by Speaker Pelosi's office, this bill would give Medicare the power to negotiate lower prices for a number of drugs, impose penalties if drug companies refuse to negotiate, and provide investment for drug research and development. It was passed by the Committee by 30 to 22.

October 14, 2019

The Congressional Budget Office (CBO) estimates that House Speaker Nancy Pelosi’s bill to lower prescription drug prices (HR 3) would save Medicare $345 billion over 10 years. The savings would start in 2023.

September 30, 2019

A liberal champion among House Democrats on lowering drug prices is circulating a letter calling for “necessary improvements” to Speaker Pelosi's bill to lower drug price (HR 3). The letter from Rep. Lloyd Doggett lists changes that he says need to be made to the legislation Pelosi unveiled earlier this month, which is one of her most important priorities.

September 24, 2019

Delaware State Representative Andria Bennett (D-DE-32) will lead a new Pharmacy Reimbursement Task Force to hold pharmacy benefit managers (PBMs) accountable and ensure they lower drug prices. In an oped, she wrote that "we will be taking a deep dive into pharmacy benefit manager practices and reimbursements, where there have been concerns to both consumers and pharmacies."

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"As chair of the task force, I’ll be leading the efforts to study pharmacy reimbursement practices in Delaware, and across the country. We owe it to the residents of our state to fight for their best interests, increasing access and affordability to needed medications. Our residents deserve to pocket any savings, not over-bloated, under-regulated big pharma middle men. And our residents certainly don’t deserve to be taken advantage of. I look forward to our continued efforts and discussion to that end."

September 17, 2019

Nine Senators, concerned about the anticompetitive effects of the AbbVie-Allergan and Bristol-Myers Squibb mergers, sent a letter to the Federal Trade Commission urging that the mergers be thoroughly investigated. The letter was signed by Senators Amy Klobuchar, Richard Blumenthal, Cory Booker, Mazie Hirono, Kamala Harris, Elizabeth Warren, Tammy Baldwin, Tina Smith, and Bernie Sanders.

September 12, 2019

About a dozen advocacy groups and unions, including Public Citizen and the American Federation of Teachers, wrote the Federal Trade Commission on Thursday urging it to consider blocking drugmaker AbbVie Inc’s planned $63 billion purchase of Botox maker Allergan. The organizations stated that both companies have engaged in anticompetitive behavior, and the merger will harm consumers and lead to reduced competition  and higher drug prices.

September 11, 2019

New York Governor Andrew Cuomo intends to file a lawsuit against the overprescription of opioids that have defrauded New York out of billions of dollars. The New York Department of Financial Services is gathering evidence for a lawsuit that he said extends beyond the drugmakers to PBMs. Cuomo said the costs of the overuse of the opioids was passed on to insurance premium holders in the form of rate increases, and that some PBMs may have been paid rebates by opioid drug companies. In return the PBMs pushed the drug to patients by placing it on a list of drugs with lower co-pays.

September 10, 2019

Speaker Nancy Pelosi's draft plan to lower drug prices would empower the federal government to negotiate lower prices for hundreds of prescription drugs, not only for Medicare but for the private market as well. The government would bargain for lower prices for 250 drugs in Medicare, and if companies don't reach an agreement, they would have to pay 75 percent of the previous year’s sales of the drug.

September 03, 2019

Congress is currently considering many proposals to reduce prescription drug costs. To block these reforms, Pharma CEOS are giving big campaign contributions to a select group of Republican Senators, including Senate Majority Leader Mitch McConnell and John Cornyn.

August 21, 2019

Recent federal survey data indicate that high costs of diabetes drugs drive many patients to cut corners in their treatment regimens. The 2017-2018 National Health Interview Survey show that nearly one-quarter of adults with type 1 or type 2 diabetes (including those on Medicare) asked his or her doctor for a lower-priced diabetes medication. Even worse, 13% of adults of all ages diagnosed with diabetes reported they didn't take their prescription drugs in order to cut costs!

August 07, 2019

The Lower Health Care Costs Act, which is sponsored by Senators Lamar Alexander and Patty Murray, contains provisions that would lower drug prices by regulating PBMs. It would prohibit PBMs from engaging in spread pricing tactics, which would be a critical step toward changing misaligned incentives, potentially lowering patient costs at the pharmacy counter. The legislation, through Section 306, would also require PBMs to pass 100 percent of negotiated rebates and other price concessions to employers (i.e., plan sponsors of group health plans) while also mandating bi-annual reports on the costs, fees and rebates in their contracts. 

August 06, 2019

The Trump administration announced it is working on a plan to import more affordable prescription drugs from Canada. Americans spend an average of about $1,200 per person, per year on prescription drugs, more than anywhere else in the world. Lowering those costs is one of the few topics uniting both Democrats and Republicans. The Washington Post takes a look at the proposal to import prescription drugs and how it would work.

July 30, 2019

The federal government's investigation into the generic drug industry has hit a bunch of obstacles. Over 40 state attorneys general have filed lawsuits claiming that generic companies conspired to work together to raise drug prices, and their lawsuits detail extensive telephone contacts and meetings where this happened. Two executives have been prosecuted, but cooperation from witnesses is proving hard to attain.

July 30, 2019

American patients desperately need a solution that lowers the costs of the medicines they need. Fortunately, there is a bipartisan effort moving forward in Congress co-sponsored by Connecticut’s U.S. Sen. Richard Blumenthal that would take important steps towards addressing this growing problem. This legislation would address the some of the tricks the big drug companies use to exploit loopholes in the U.S. patent process and extend indefinite monopolies on their medications. By gaming the patent system to their advantage, these companies can drive out competition. This anticompetitive behavior keeps drug prices soaring, leaving millions of patients struggling to afford the medicine they need to live.

July 23, 2019

The Senate Finance Committee released its bill to lower prescription drug prices. The The Prescription Drug Pricing Reduction Act of 2019 will penalize drug companies that raise drug prices higher than the rate of inflation and makes changes to Medicare by adding an out-of-pocket maximum for beneficiaries at $3,100 starting in 2022. It also bans PBM spread pricing in Medicare and requires information about PBM rebates and fees to be made public.

July 22, 2019

Wendell Primus, a senior aide to Speaker of the House Nancy Pelosi, said that House Democrats will unveil their long-awaited bill to lower drug prices in September. The proposal will give Medicare the power to negotiate lower drug prices, and the prices that are negotiated will apply to private insurers as well, bringing down costs for everyone. If Medicare and drug companies can't agree on a price, the drug companies will be taxed to encourage them to negotiate.

July 16, 2019

The Trump administration claims that prescription drug prices are decreasing. The consumer price index (CPI) has declined for prescription drugs, but several studies have also found that drug prices have not declined. And the administration's proposals to lower costs have run into trouble.

July 11, 2019

The Trump administration has abandoned a central component of its efforts to lowering drug prices, and stopped a proposal to eliminate safe harbor protection for most PBM rebates and require that those rebates be passed on to consumers. This reform would have lowered drug prices, and it is a bitter disappointment to consumer groups and advocates.

July 09, 2019

U.S. District Court Judge Amit Mehta has ruled that the Trump administration does not have the authority to force drug makers to disclose their sticker prices in TV ads. In order to require this, Congress will have to explicitly pass a law.

July 03, 2019

Trump is quite upset about rising drug prices, and is pushing Secretary of Health and Human Services Alex Azar to adopt tougher and bigger ideas, including importing cheaper drugs from Canada.

June 26, 2019

The leaders of the Senate Finance Committee are in bipartisan talks on a potentially sweeping deal to limit drug price increases in Medicare, according to sources familiar with the negotiations. Sen. Ron Wyden (D-OR) the ranking Democrat, is pushing to make drug companies pay back rebates to Medicare’s prescription drug program, called Part D, if their prices rise faster than inflation. Another measure would force drug companies to pay money back to Medicare if they launch a new drug with a high price. 

June 25, 2019

This week, the Senate Judiciary Committee will be marking up a number of patent bills on Thursday. And on Wednesday, The Senate Health, Education, Labor, and Pensions Committee is marking up its own bills, including the CREATES Act. And the Democratic presidential candidates will undoubtedly discuss drug prices at their debates.

June 16, 2019

In a new article, Katie Thomas of the New York Times lays out some of the most promising proposals to lower prescription drug costs. They include: giving Medicare or the Department of Health and Human Services the power to negotiate lower drug prices, lowering out of pocket costs for Medicare beneficiaries, international reference pricing, and stopping anticompetitive actions by drug companies.

June 13, 2019

Insulin prices have risen so much that people with diabetes are forced to resort to extreme measures, such as rationing their insulin, buying from strangers online, and relying on samples from doctors. The above video looks at how people are struggling with this crisis. Patent laws and existing regulations allow the top three companies that make insulin to continuously increase prices without consequences.

June 11, 2019

Judge Richard Leon recently held a two day hearing hearing on the final step needed to gain approval for the $70 billion merger: a so-called Tunney Act hearing to approve a consent decree between CVS (ticker: CVS) and the Justice Department. These decrees are normally fast and painless. This one was neither.

June 03, 2019

Beginning Tuesday, June 4th, Judge Richard Leon will hear three days of testimony, including from witnesses opposing the settlement agreement, testifying for friends of the court including the American Medical Association, the AIDS Healthcare Foundation, U.S. PIRG and Consumer Action. There are also witnesses testifying for CVS and the government.

May 21, 2019

The House Energy and Commerce Committee's Health Subcommittee held a hearing on seven specific bills to require transparency around drug prices. Most of the seven bills under consideration were aimed at getting manufacturers' justifications for their price hikes, or revealing the obscure negotiations between pharmacy benefit managers, insurers and drugmakers.

May 16, 2019

The House of Representatives will be voting today on three bills to lower drug prices by promoting generic competition and ending regulatory abuses that brand name companies use to block competitor drugs from coming to market. And House Democrats are also seeking to reverse many of Trump administration's moves to undermine the Affordable Care Act.

May 15, 2019

The Centers for Medicare and Medicaid Services (CMS) is concerned that some Medicaid managed care plans are not accurately reporting "spread pricing," a tactic where pharmacy benefit managers (PBMs) charge a plan more for a drug than they reimburse pharmacies. The agency released a regulatory guidance on Wednesday intended to help states monitor and audit Medicaid and CHIP managed care plans to identify spread pricing when calculating their medical loss ratio (MLR). The guidance clarified that plans must include a PBM rebate in calculating an MLR if the PBM used a subcontractor.

May 07, 2019

The Senate Judiciary Committee held a hearing on proposals to promote competition in the prescription drug industry and end patent abuse that brand name companies use to block generic drugs. The four proposed bills share a common goal: avoiding some of the thorny issues around drug pricing, like whether the government will set drug prices or negotiate with manufacturers on what federal programs will pay. Instead, the patent reform proposals get at the ways branded drug manufacturers use patents, and the legal monopolies that are granted with patents, to keep lower-priced generic competitors from reaching patients.

April 29, 2019

In order for a major agreement to lower drug prices, President Trump will have to strike a deal with Speaker of the House Nancy Pelosi.

April 29, 2019

Pharmacy benefit managers, or PBMs, are getting increased attention as people realize how much they contribute to higher drug prices. According to the National Academy for State Health Policy, 101 PBM reform bills are being considered in 41 states this year, and state legislators are working to make sure that PBMs actually do their jobs.

April 23, 2019

The specialty drugs business is growing for the pharmacy benefit managers, and PBMs are earning an increasing share of their profits from specialty dispensing activities. In an interesting article, the Columbus Dispatch takes a look at this practice and what it means for consumers.

April 22, 2019

Ohio Attorney General Dave Yost, frustrated with PBM misbehavior, has released several proposal to toughen oversight of PBMs. These ideas include: requiring that state drug purchases are made through a master PBM contract administered through a single point of contact; giving the Ohio Auditor of State unrestricted authority to review all PBM contracts, purchases, and payments; requiring that PBMs be fiduciaries; and requiring that nondisclosure agreements on drug pricing with the state be prohibited.

April 22, 2019

U.S. District Judge Richard Leon in Washington, D.C., said earlier this month that he wanted to hear from witnesses before deciding whether to approve the CVS-Aetna merger.

Organizations that have been recognized as amicus curiae in the case had until Friday to name three proposed witnesses apiece to testify at a not-yet-scheduled hearing next month. Three groups named a total of seven people who want to testify on whether Leon should grant the DOJ's request for final judgment in favor of the transaction.

April 19, 2019

A trial into whether two giant pharmacy benefit managers can keep secret portions of an investigation into their pricing practices has again been delayed. Franklin County Common Pleas Judge Jenifer French this week pushed back the trial date in a case filed by CVS Caremark against the Ohio Department of Medicaid until Nov. 4. In the case, which was filed last August, the companies are seeking to keep secret portions of a report done last year by a Medicaid consultant. It found that the two pharmacy middlemen in 2017 charged taxpayers $224 million more for drugs than they paid the pharmacists who dispensed them. That was three to six times the going rate.

April 17, 2019

Rep. Elijah Cummings, Chair of the House Oversight and Government Reform Committee, accused his Republican colleagues of obstructing the committee's investigations into rising drug costs. GOP members sent letters to a dozen top drug company CEOs earlier this month warning them not to participate in Cummings' investigation, arguing the probe is strictly partisan and suggesting Cummings is likely to leak information drug companies turn over to the committee.

April 10, 2019

Senator Chuck Grassley and Ron Wyden of the Senate Finance Committee wrote to the Department of Health and Human Services, asking them to investigate PBM business practices, including 'spread pricing'. "Given the potential vulnerabilities created as a result of opaque drug pricing practices employed by entities like PBMs, we believe additional transparency and oversight in this space is warranted,” the Senators wrote. “We request your office conduct a federal-level analysis of PBM practices across state Medicaid programs, including practices that may allow for inappropriate profiteering and potential anti-competitive practices in state Medicaid programs.”

April 10, 2019

On Wednesday, April 10th, the House Energy and Commerce's Investigation Subcommittee held a hearing on rising insulin prices. Legislators lashed out at drug companies and PBMs, blaming them for skyrocketing costs. Rep. Jan Schakowsky (D-IL) told the CEOs that "I don't know how you people sleep at night."

April 09, 2019

In a powerful oped, Maris Kreizman, a writer who has Type 1 diabetes, wrote about the rising cost of insulin and how it affects her and other patients. She says that she "never imagined the current state of diabetes management would be dystopic, with so many patients in our rich nation rationing their doses, trying to make little glass vials of life blood last as long as possible while drug companies make a hefty profit."

April 09, 2019

At a hearing before the Senate Finance Committee, the CEOs of the huge PBMs CVS, Express Scripts, and Humana blamed pharmaceutical companies for rising drug costs and disclaimed any responsibility. The Senators, especially Senator Ron Wyden, asked pointed questions and were irritated by the witnesses' evasiveness.

April 09, 2019

When executives from the country's five biggest PBMS testify before the Senate Finance Committee on Tuesday, they’ll be staring down a group of Senators who have benefited from their businesses. Political action committees for the companies have donated nearly $1 million to the Senators’ campaign committees over the past 10 years, according to a Forbes analysis of Federal Election Commission filings.

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And some of the Senators have gotten personal donations from the PBMs.

April 08, 2019

The consumer groups Consumer Action, Consumer Federation of America, Consumer Reports, NETWORK Lobby for Catholic Social Justice, and U.S. PIRG submitted comments in support of the Department of Health and Human Services's proposal to lower drug prices by eliminating the safe harbor for most PBM rebates. The remaining rebates will be required to be passed on to consumers at the point of sale.

April 08, 2019

Tomorrow, the Senate Finance Committee will hear from five PBM executives about their role in drug prices. In this excellent introduction, STAT News looks at the five PBMs that will be testifying this week — and the strengths and vulnerabilities each will bring to the witness stand.

January 01, 2020

A federal judge said Friday that he wants to hear from witnesses opposed to a Justice Department ruling that approved a merger between CVS and health care company Aetna. Judge Richard Leon is reviewing a Justice Department settlement that permitted CVS's nearly $70 billion acquisition last year. These settlements are subject to federal court approval. 

April 04, 2019

The House Ways and Means Committee is poised to vote on a slate of as-yet-unintroduced drug pricing bills that would require sweeping disclosures from both drug middlemen and drug makers, according to summaries of the legislation obtained by STAT. One of these bills will require disclosure of aggregate PBM rebates.

April 03, 2019

On Wednesday, Ohio state legislators asked tough questions about pharmacy benefit managers (PBMs) and how they are harming community pharmacies. They grilled Ohio's Medicaid director Maureen Corcoran, asking her what she was doing to stop these abuses. Local pharmacists say they continue to be paid rates that often fail to cover costs, as PBMs short-charge them.

April 02, 2019

Senator Chuck Grassley (R-IA), Chairman of the Senate Finance Committee, and Senator Ron Wyden, (D-OR), ranking member of the Finance Committee, sent letters to the PBMs Express Scripts, CVS, and Optum demanding information and documents about their role in the skyrocketing costs of insulin in the United States.

April 03, 2019

Democrats and Republicans on the House Energy and Commerce Committee reached a bipartisan deal to advance the CREATES Act and other measures to lower prescription drug prices and promote generic competition. "The agreement between House Energy and Commerce Committee Chairman Frank Pallone Jr. and Rep. Greg Walden (Ore.), the panel’s top Republican, will allow the bills, aimed at increasing competition from cheaper generic drugs, to advance from the committee on a bipartisan vote expected later on Wednesday."

March 23, 2019

Drug manufacturers are charging consumers $100,000, $200,000 or even $500,000 per year for drugs, and claiming that these high prices are necessary because they need the money for research and development. But their claims don't add up. Instad, they spend a lot of money on television and advertising instead of innovation.

March 23, 2019

In the last couple of years dozens of states have passed bills to lower prescription drug costs. Since state government have to balance their budgets every year, rising drug prices can have a disproportionate and harmful impact on their budgets. States also know they need transparency in drug pricing and have proposed laws that require cost disclosure from manufacturers, health plans and PBMs. In 2017, California and Nevada were the first to pass transparency laws. And now other states are working to prohibit price gouging.

March 22, 2019

Kentucky Attorney General Andrew Beshear has opened an investigation into allegations that pharmacy benefit managers overcharged the state Medicaid program and discriminated against independent pharmacies. A recent report found that PBms are making substantial profits from spread pricing (the fees that PBMs pay pharmacies and then bill back to state Medicaid programs). In 2018 PBMs were paid $858 million, of which they kept $123.5 million, or 13 percent.

March 20, 2019

Democrats and Republicans in Congress agree that measures must be taken to make generic drugs more affordable and end manipulation of rules and regulations. But they disagree on other ways to lower drug costs, including Medicare negotiations and competitive licensing.

March 19, 2019

The Department of Health and Human Services has already received 18,000 comments on its proposal to end the system of rebates insurers and middlemen use to negotiate drug prices. That is six times more comments than HHS received on the entire drug pricing plan it released last May. The likely explanation is that a write-in campaign is being organized by a group that has some stake in the regulation

March 19, 2019

New survey data shows that 11.4 percent of U.S. adults did not take their medication as prescribed in an effort to reduce costs. The survey from the Centers for Disease Control and Prevention finds that those adults, aged 18 to 64, either skipped doses, took less medicine than prescribed or delayed filling a prescription because of the cost of the drugs in the past 12 months.

March 12, 2019

The Senate Finance Committee has invited five major pharmacy benefit managers (PBMs) to come testify at a hearing on rising prescription drug prices on April 3rd. Chairman Chuck Grassley (R-IA) and Senator Ron Wyden (D-OR) have asked Cigna, CVS, Humana, OptumRx, and Prime Therapeutics to appear before the Committee. “Middlemen in the health care industry owe patients and taxpayers an explanation of their role. There’s far too much bureaucracy and too little transparency getting in the way of affordable, quality health care,” Grassley and Wyden said in a joint statement Tuesday. “We’ve heard from pharmaceutical companies and it’s only fair that the committee has the opportunity to ask questions of other players in the health care supply chain.”

March 06, 2019

Senator Mike Braun (R-IN) has introduced a bill to end rebates negotiated between drug companies and pharmacy benefit managers (PBMs) in the private sector. The proposal would do for private health plans what the Trump administration has already proposed doing for government-sponsored health plans as the president has publicly taken aim at drug prices.

March 05, 2019

U.S. PIRG just released a report finding that Americans have access to some of the best medical care in the world, from life-saving drugs to cutting-edge surgical techniques. But spiraling costs force many Americans to spend more on care, even as the quality of that care remains the same. This is especially the case for prescription drug costs. Ongoing price increases, combined with the fact medications already cost much more than in many other countries, are leaving 1 in 4 Americans on medication struggling to afford their prescriptions.

March 04, 2019

The drug company Eli Lilly announced that it will sell a cheaper version of its most popular insulin, Humalog. It will sell an authorized generic of Humalog 100 for $137.35 per vial, a fifty percent discount off the list price. An authorized generic means that, except for the label, it is identical to the brand-name drug and manufactured in the same facilities.

February 27, 2019

A proposal to regulate an obscure but important player in the prescription drug industry divided Democrats and Republicans as it passed out of the state Senate today. It aims to regulate pharmacy benefit managers, PBMs, that negotiate deals between insurance companies, drug manufacturers, retail pharmacies and government health plans.

February 26, 2019

During the second Senate Finance Committee hearing on drug prices, Senators criticized the CEOs of seven gigantic drug companies and blamed them for skyrocketing drug costs. The executives defended their business practices and acknowledged that drug costs were too high, but they insisted they were not to blame.

February 20, 2019

Members of Congress are debating proposals to lower drug costs, and they are focusing on insulin prices. Democrats, Republicans, and the Trump administration all want a victory on drug prices, and pharma companies are under a lot of pressure. Insulin is a prime target-the drug was first developed 100 years ago, and three companies control the vast majority of the world's supply. Lawmakers are demanding they explain their pricing.

February 19, 2019

Ohio Attorney General Dave Yost is seeking $16 million in repayment from the PBM Optum Rx, after the company overcharged Yost intends to take OptumRx to nonbinding mediation, which is required under the contract between the bureau and OptumRx. If it fails, the dispute will go to court. OptumRx violated its contract by failing to timely pass along savings as prices of generic drugs dropped.

February 19, 2019

Kentucky's Medicaid program released a new report on pharmacy benefit managers (PBMs) and their impact and role. PBMs serve as intermediaries between Medicaid Managed Care Organizations (MCOs) and pharmacies. The report provides recommendations to help create transparency, control the pricing of medications for Medicaid beneficiaries, and improve the care provided by pharmacies within the state. The report also concluded that direct and indirect remuneration (DIR) ees are not captured accurately. Pharmacies have reported that these retroactive fees assessed by PBMs to independent pharmacies are hurting their current practices.

February 14, 2019

The Department of Health and Human Services has unveiled a bold, sweeping policy proposal aimed at addressing one of the most critically broken elements of our prescription drug distribution system: pharmacy benefit manager and insurers’ practices regarding prescription drug rebates. HHS is looking to eliminate a legal exemption used by PBMs to pad their pockets with rebates from drugmakers created to help patients at the pharmacy counter.

February 11, 2019

Recently Optum Rx, one of America's largest pharmacy benefit managers, sent letters to a number of drug companies demanding a warning of seven calendar quarters before reducing drug list prices and maintaining rebates at the same level as a current list price. The drug companies were not pleased with this, and it shows that PBMs care more about their profits than lowering drug costs.

February 11, 2019

States and the federal government are closely examining pharmacy benefit managers — the go-betweens in the prescription drug supply chain — in their efforts to bring down the cost of prescription drugs. There are questions the extent to which patients benefit from the rebates that pharmacy benefit managers secure from drug companies. PBMs’ operations are largely hidden from public view and from regulators. Without transparency, many federal and state officials think (accurately) that PBMs are pocketing too much of the money and not passing the savings on to consumers.

February 07, 2019

House and Senate Democrats introduced a bill to allow Medicare to negotiate with drug companies for lower prices, and it would authorize generic competition if those negotiations failed. The proposal was introduced by Rep. Lloyd Doggett and Senator Sherrod Brown, and it has over 100 cosponsors.

February 06, 2019

Demcrats are divided over whether Trump is serious in his desire to lower drug prices. Some Democrats are prepared to cross the aisle and work with him, others think his proposals are just a trick, and still others are waiting for additional information. The challenge for Trump is to see if he can get Democrats to support some of his ideas, and the challenge for Democrats is if they can get Trump to support some of their ideas.

February 06, 2019

Pharmacy benefit managers are hitting back against critics who blame them for rising drug prices, as the system they use to negotiate rebates on drugs hangs in the balance. The Pharmaceutical Care Management Association (PCMA) this week launched a campaign called #OnYourRxSide, which aims to educate consumers about the role PBMs play in their health benefits, and claims that PBMs lower drug prices.

February 05, 2019

Democrats do not believe President Trump is serious about striking a bipartisan deal to lower drug prices. They are introducing a number of bills that would take sweeping action to ensure access to affordable medicines. Chief among them is a proposal to allow Medicare to negotiate lower drug prices, which was introduced today by Representative Lloyd Doggett and Senator Sherrod Brown. Should these negotiations fail, the bill would authorize generic competition.

February 01, 2019

Ohio Governor Mike DeWine, frustrated by PBM ripoffs of taxpayers, has directed Ohio's Medicaid program to provide information to Attorney General Dave Yost for a possible lawsuit against PBMs. In a statement, he told reporters, "We require openness in regard to this whole PBM process. I think the thing the public should find very irritating and very alarming is the secrecy surrounding the PBM process."

February 01, 2019

Montana's Insurance Commissioner pitched a bill to state legislators Friday to root out what he calls shady practices by middlemen in the prescription drug industry that he said would lower the cost of medications for Montanans.

Instead of directly going after pharmacy benefit managers (PBMs), which sit at the nexus of interactions between pharmacies that sell drugs, health insurance companies that cover patients and the manufacturers that make medications, the legislation tries to dictate what sort of contracts insurance companies can enter with those middlemen.

The bill would require that rebates not go to the PBMs, but instead go to the insurance companies so they could use the money to lower premiums.

February 01, 2019

HHS just proposed a rule to lower drug prices by encouraging drug manufacturers to pass discounts directly on to consumers, and to promote transparency in prescription drug markets. It would exclude from safe harbor protection under the Anti-Kickback Statute rebates on prescription drugs paid by drug manufacturers to PBMs.

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Eliminating the safe harbor is a critical first step in reining in escalating drug costs.  The PBM rebates were just a shady form of payola which ended up padding PBM profits and jacking up the price of drugs. Because of a lack of competition and transparency, PBMs pocket the rebates, essentially stealing from consumers' pocketbooks.  It is time for this multi-billion dollar rip off to end.

January 31, 2019

There has been a lot of talk in academic and policy circles recently about the failure of antitrust law to put the brakes on a decades-long merger wave that has consolidated industry after industry into a handful of dominant players, in the process deterring innovation and entrepreneurship, slowing economic growth, and widening the income gap between the rich and everyone else. The merger of CVS and Aetna, which will greatly reduce competition, is a perfect example of this-the Department of Justice under Makan Delrahim approved the merger without taking steps to protect consumers.

January 29, 2019

On Tuesday, January 29th, the House Committee on Oversight and Reform and the Senate Finance Committee held hearing on rising prescription drugs and what can be done to lower them. Lawmakers from both parties attacked drug companies and PBMs, and stated they were considering a number of proposals to bring drug prices down. Among them were Medicare negotiations, drug importation, drug price and PBM transparency, and measures to promote generic drug competition and end patent abuse.

January 26, 2019

When a pharmaceutical company sold its patent rights for a blockbuster drug to an Indian tribe 16 months ago, stymied competitors and consumer groups condemned the move as a flagrant abuse of the patent system. This month, the company, Allergan, doubled down, asking the Supreme Court to rule that the Saint Regis Mohawk Tribe can use its sovereign immunity to fend off challenges by makers of low-cost generic copies of the best-selling prescription eyedrops, Restasis.

January 24, 2019

An analysis of New York's Medicaid and pharmacy data suggests that PBMs are increasingly marking up generic drugs, raising questions about the extent to which the profits are passed back to the state health program. At issue is a contentious topic known as spread pricing, which is increasingly factoring into the national debate about the cost of medicines at the state level and the opaque pharmaceutical supply chain. And pharmacy benefit managers, or PBMs, play a crucial, but largely hidden role

January 24, 2019

Democratic presidential candidates are already trying to bolster their support by releasing proposals to lower drug prices. Senator Elizabeth Warren has endorsed a public option for generic drugs and Senators Sherrod Brown and Bernie Sanders have proposals to give Medicare the power to negotiate drug prices. Other candidates have signed onto bills to penalize price gouging and allow importation of cheaper drugs.

January 24, 2019

Massachusetts Governor Charlie Baker has outlined a plan to lower drug prices for a small number of very expensive medicines. Last year Massachusetts spent $1.9 billion on drugs prescribed to patients covered by MassHealth, and this proposal would begin with direct price negotiations. If no agreement is reached, the state could take additional steps, including possible prosecution of the company using state consumer protection laws. 

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January 18, 2019

In a practice that policy experts say smothers competition and keeps prices high, drug companies routinely make hidden pacts with middlemen that effectively block patients from getting cheaper generic drugs. Makers of established brands give volume-based rebates to insurers or intermediaries called pharmacy benefit managers. In return, those middlemen often leave competing generics off the menu of drugs they cover, called a formulary, or they increase the price for patients. The result is that many can’t get the cheaper drugs unless they shoulder a bigger copay or buy them with no help from insurance.

January 14, 2019

Americans have been saying for years that they’re frustrated with the price of medicine and it should be near the top of lawmakers’ to-do list. Now congressional Democrats are starting to put together an extensive menu of ideas for reducing prescription drug costs.

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Democrats have made drug prices a top priority for their new House majority and they might be able to find common ground with Republicans.

January 14, 2019

CVS claims that its rebates do not prompt drug manufacturers to increase their list prices, and that it returns all but 2% of the rebates it collects to its health plans. But these claims are questionable at best. Both reports supporting these assertions were done by industry funded groups and have not been peer reviewed.

January 11, 2019

New York State Senator James Skoufis plans to investigate rising drug prices and pharmacy benefit managers (PBMs). He has been named head of the Investigations and Government Operations Committee, and said lst week that pharmacy benefit managers are one of the first matters his seven-member panel will explore.

January 09, 2019

As Congress reconvenes, Senator Chuck Grassley, the Republican chair of the Senate Finance Committee, is supporting three bills. They are the CREATES Act, which aims to crack down on anticompetitive behavior from brand-name manufacturers, a bill that would ban "pay for delay" schemes, and a bill to allow importation of drugs from Canada for personal use.

January 07, 2019

A new study published in Health Affairs concludes that the skyrocketing cost of many prescription drugs in the U.S. can be blamed primarily on price increases, not expensive new therapies or improvements in existing medications as drug companies frequently claim. It found that the cost of brand-name oral prescription drugs rose more than 9 percent a year from 2008 and 2016, while the annual cost of injectable drugs rose more than 15 percent

January 04, 2019

Prescription drug companies and their legions of Washington lobbyists are strapping in for their rockiest year on Capitol Hill in at least a decade, as newly empowered House Democrats prepare a raft of bills to check U.S. drug prices.

Democrats surged to power in the 2018 midterm House elections promising to protect Americans from ever-increasing prescription costs. They are buoyed by populist anger in individual states and a potential — if unpredictable — ally on the issue in Trump.

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The biggest idea in the House to reduce drug costs is to require Medicare to exercise its enormous leverage as the nation’s largest payer for health care and negotiate lower prices with drug companies.

Other Democratic proposals include: ending industry strategies that delay generics; requiring price transparency for drugs discovered with taxpayer money; curbing lucrative industry rebates to insurance companies (which critics call kickbacks); and allowing the import of drugs from Canada.

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January 04, 2019

A Bloomberg investigation found that Medicaid is paying much prices for generic drugs in certain states, due to PBM business practices. Independent pharmacies, state lawmakers and state officials have pointed at pharmacy benefit managers, or PBMs, as one possible reason for big differences in price. They’ve complained that PBMs, which have the contracts to run drug benefits in many state programs, operate with little transparency, making it hard to know whether health plans are getting a good deal.

January 01, 2019

Over three dozen drug companies began the new year of 2019 by raising prices on hundreds of medicines. The average increases was 6.3%, well above the rate of inflation. Drug pricing remains a hot topic that is expected to draw increased attention from Democrats when they take control of the House this week. Pharmaceutical companies are under the spotlight over the cost of their drugs, with pressure coming from patients, insurers and the Trump administration.

December 20, 2018

The American people, an incoming Democratic-controlled House of Representatives, and a Republican-controlled White House and Senate are all concerned about rising drug prices. Out-of-pocket spending on prescription drugs totaled $46.7 billion in 2017, surpassing out-of-pocket hospital spending by $12.8 billion. The average American spends $1,208 annually on prescription drugs. And there are many proposals to address the problem, ranging from reference pricing to Medicare negotiations to eliminating incentives for high list prices.

December 18, 2018

At a hearing today, Judge Richard Leon asked CVS and Aetna to steps to keep their operations while he reviews the merger and comes to a final decision. He has criticized the Department of Justice for not adequately addressing concerns about competition and consumers. During this hearing, he scolded DOJ for being “hostile to the role of the federal courts” in reviewing the merger and guarding the public interest.

December 17, 2018

The consumer groups Consumer Reports, U.S. PIRG, Consumer Action, and the Universal Health Care Foundation of Connecticut submitted comments opposing the merger of CVS and Aetna. They argue that the merger is harmful to competition and consumers, and urge the Court to carefully review the final judgment to determine if it is in the public interest and that it preserves competition. Currently the final judgment is neither of those things, and it does not resolve the major harm resulting from the merger.

December 16, 2018

The Columbus Dispatch, an Ohio newspaper, has been an in-depth series on drug prices and pharmacy benefit managers (PBMs). In a recent editorial, the newspaper criticized the glaring lack of transparency in the PBM market and called for major reforms. Ohio commissioned an audit of Medicaid's pharmacy benefit, and found that CVS Caremark and Optum Rx, the two PBMs used in the program, charged taxpayers $224 million more for prescriptions than they paid to pharmacies in reimbursement. Under new contracts the state now is requiring between the managed-care companies and PBMs, the middlemen must pay pharmacists exactly what they charge taxpayers for each drug, eliminating so-called “spread pricing.” Their compensation for filling the prescription will be a set fee. PBMs also will be required to disclose other payments they receive through the contracts, such as participation fees from pharmacies and rebates from drug manufacturers.

December 10, 2018

Investigators from multiple states say that over a dozen generic drug companies engaged in illegal price fixing on a massive scale. The case involves at least 16 companies and over 300 drugs, and the victims include American consumers and taxpayers, hospitals, pharmacists, and health insurance companies. In just one instance of extraordinary cost spikes, the price of a decades-old drug to ease asthma symptoms, Albuterol, sold by generic manufacturers Mylan and Sun, jumped more than 3,400 percent, from 13 cents a tablet to more than $4.70. The example is documented in a lawsuit brought against the generic industry by grocery chains including Kroger. And since the generic industry had sales of around $104 billion in 2017, excessive billings of even a small fraction of annual sales over several years would equal billions of dollars in added costs to consumers, according to investigators.

December 07, 2018

State officials are now investigating pharmacy benefit managers (PBMs), the middlemen who are supposed to lower drug prices. They are increasingly finding that the rebates helped PBMs maintain an opaque system. Within that system, pricing data typically has been shielded by contract or law, allowing for drug prices to be easily manipulated without scrutiny. Drug prices continue to rise while the middlemen — whose main purpose was to help control costs — reap billions in profit from taxpayer dollars meant to care for the poor

December 04, 2018

The Columbus Dispatch reported that in their haste to get the deal approved, CVS and Aetna are making promises to Georgia that they seem unwilling to make to other states. In November 2018 Georgia said it would approve the merger f the two companies only if they made guarantees regarding competition and transparency. A spokesman for CVS Health last week declined to say that a merged company would make similar guarantees in other states.

December 04, 2018

Antitrust lawyer David Balto writes about how drug companies use bundled rebates to erect rebate walls that stifle competition and block more affordable drugs, and why the Federal Trade Commission should investigate these anticompetitive practices and if necessary, bring enforcement actions against them.

November 30, 2018

In a new oped, antitrust lawyer David Balto writes that federal antitrust enforcement must make a real difference for consumers and taxpayers, and that House Democrats now have a golden opportunity to promote health care competition. Health care is one of the most important issues that Americans think Congress should deal with, and antitrust enforcement should focus on reducing health care costs and prescription drug prices.

November 28, 2018

A new report by the American Medical Association shows that competition in health insurance markets is shrinking for half of the country. Half of all states had commercial health insurance markets that were less competitive in 2017 than in 2016. The majority of health insurance markets are highly concentrated, which indicates that when coupled with, and when combined with "evidence of their anticompetitive behavior" shows that insurers have substantial market power in many parts of the country, harming consumers and healthcare providers.

November 28, 2018

On Monday the Open Markets Institute released new evidence of increased corporate consolidation in many different industries. Across the American economy, a few large companies dominate many market areas, including health insurance, PBMs, cellphone providers, peanut butter, washers and dryers, and cat food. Almost every industry studies has become more concentrated over the past few decades. But 76% of Americans are very or somewhat concerned that "big corporations have too much power over your family and your community." And by a 65-19% margin, Americans think the federal government should do more to break up monopolies.

November 28, 2018

After gaining approval from the New York Department of Financial Services, CVS and Aetna officially closed their acquisition on Wednesday, creating a gigantic new company. The merger combines CVS's pharmacies and pharmacy benefit manager with Aetna's insurance business. The companies claim that this deal will lower costs, but consumer groups and independent analysts are skeptical.

November 26, 2018

Senator Chuck Grassley (R-IA) is returning to chair the Senate Finance Committee, and this could open an opportunity for bipartisan cooperation to reduce drug prices. He will be replacing Senator Orrin Hatch, who opposed efforts to promote transparency and lower drug prices, and he has backed the Trump administration's proposal to link some Medicare drug prices to the drug prices paid in other countries.

November 25, 2018

New York Times reporter David Leonhardt writes about a grave problem: the growing monopolization of American industries. In recent years, big companies have become more dominant in almost all U.S. industries, from hardware stores to pharmacies. The results have been quite harmful for consumers-higher prices and lower wages, and the companies have used their increased power to sway governments policies and stifle entrepreneurship. To counter this, we need a strong anti-monopoly movement.

November 26, 2018

Professor Robin Feldman wrote an article in the Washington Post on high drug prices and how pharmacy benefit managers (PBMs) contribute to the problem. She states that, "The answer can be found in this country’s shadowy and byzantine system for negotiating drug prices and rebate deals. The system contains odd and perverse incentives, with the result that higher-priced drugs can receive more favorable health-plan coverage, channeling patients toward more expensive drugs."

November 17, 2018

In a new segment, Axios looks at drug prices in the United States, why they are rising, and what can be done to reduce them. The system for setting drug prices is very complicated and frustrating, and both drug companies and PBMs contribute to higher costs.

November 16, 2018

The drug company Pfizer has announced that it will raise prices on 41 prescription drugs beginning in January 2019, after holding off on price increases due to pressure from President Trump. The drug giant will increase the list price of about 10 percent of its drugs Jan. 15, the company announced Friday. Most of the increases will be 5 percent, though Pfizer will raise three drugs' list prices by 3 percent and one drug's by 9 percent.

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November 09, 2018

Democratic Representative Elijah Cummings has been a fierce critic of drug companies and a strong advocate of lowering drug prices. He scolded Martin Shkreli during hearings, called out Biogen for charging egregious prices, and accused Valeant of obstructing an investigation into its pricing practices. Come January 2019, he will chair the House Oversight and Government Reform Committee.

November 07, 2018

Democrats took control of the House on Tuesday night, a victory that will transform a Republican-controlled chamber that supported and protected President Trump into a legislative body ready to challenge and investigate him. House Democrats have declared that lowering drug prices will be one of their most important agenda items.

November 06, 2018

In its third quarter earning report, CVS stated that it expects its $69 billion acquisition of Aetna is close before Thanksgiving. The Department of Justice has approved the merger, and the company has approvals from state Insurance Departments in 23 states. Aetna is divesting its Medicare Part B prescription drug business to a subsidiary of WellCare health plans.

October 30, 2018

Drug companies are preparing for the likely scenario that Democrats will win a majority in the House of Representatives and enact measures to reduce drug prices, including direct negotiating authority for Medicare and possible price controls.

October 28, 2018

Humira, a patent protected drug with no generic alternatives, now costs $38,000 per year. This makes the drug unaffordable for many Americans suffering from various conditions, especially seniors who are living on retirement savings and Social Security. And one of the reasons Humira is so costly is because the company that makes it, AbbVie, has filed 247 patents on the drug to prolong the company's monopoly, stifle competition, and block generic versions of the drug.

October 25, 2018

President Trump proposed that Medicare Part B pay for certain prescription drugs based on the prices that other developed countries pay for these drugs, a substantial change that could save money for the government and for millions of Medicare beneficiaries. As part of a demonstration project covering half the country, Medicare would establish an “international pricing index” and use it as a benchmark in deciding how much to pay for drugs covered by Part B.

October 23, 2018

New York state regulators are investigating CVS's fluctuations in pricing for medicine, which have been harming local pharmacies and causing them to often lose money per prescription. CVS Caremark has implemented big cuts to reimbursements for medicines in multiple states, and this may impact New York's review of the proposed merger of CVS and Aetna. Superintendent Maria Vullo is debating whether to block the deal to protect New Yorkers from price gouging.

October 22, 2018

Washington law firms are preparing for a boom in business from a project Democratic takeover of the House in the November 2018 election, especially regarding drug companies. Democrats have criticized high drug prices and sent letters to the companies Amgen, AbbieVie, Eli Lilly, Merek, and Pfizer demanding answers about these rising costs. The chief executives of these companies have until November 12th, six days after the election, to respond. 

October 10, 2019

Justice Department Requires CVS and Aetna to Divest Aetna’s Medicare Individual Part D Prescription Drug Plan Business to Proceed With Merger. Divestiture Will Preserve Competition in Medicare Part D Individual Prescription Drug Plans throughout the United States.

September 26, 2019

This article lays out the current Administration's position on using trade deals to protect manufacturers. The article claims this position can lower the cost of drugs domestically if done right. 

October 04, 2018

With the renegotiation of NAFTA (now USMCA), Trump hoped to protect exclusivity for biomedical drug manufacturers in North America. The administration's hope is that the incumbent pharmaceutical companies will decide to share their new profits by lowering drug prices within the US. This article tackles that assumption claiming that while it could be a step in a larger plan, as is, the treaty does not help lower drug prices domestically.

August 21, 2018

CPPC filed comments at the Federal Trade Commission as part of the FTC’s Competition and Consumer Protection in the 21st Century Hearing, along with Patients for Affordable Drugs, U.S. PIRG, Consumers Union, Consumer Action, Institute for Liberty, America’s Health Insurance Plans, and James Rickertt, MD for Society for Patient Centered Orthopedics.

The letter discusses abuses of the patent system by brand name drug companies that can extend government-granted monopolies illegitimately for years. 

The letter identifies evasive maneuvers to avoid patent challenges; non innovation patenting; product hopping; REMS program abuse, and the filing of sham citizen petitions as anticompetitive strategies that the FTC must monitor and take appropriate action when necessary to vigorously protect consumers.  The letter recommends that the FTC investigate and take action against these anticompetitive strategies and to assist Congress in developing strong legislation.

July 16, 2018

PBMs and payers have gone for too long with too little transparency. Small adjustments to change this opaque market can have an enormous effect for patients and the broader prescription drug market.

Through regulation we can ensure affordability, provide access to preventative treatments to manage costly chronic conditions, reduce emergency intervention, and ultimately drive down costs for everyone participating in the health-care market.

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Shedding a light on PBMs and payer practices is the medicine our healthcare needs right now to return drugs to an affordable price. 

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June 06, 2018

The Trump Administration has taken an important first step in bringing down and monitoring the sky-rocketing price of drugs for American Patients. By submitting a request for information, the Department of Health and Human Services is giving stake holders an opportunity to voice their concerns and solutions to the Administration by July 16th. "Returning more control to consumers [...] improves affordability and, by extension, access to vital treatment regimens." 

June 28, 2018

Co-pay accumulator adjustment programs are the latest way patients are being manipulated to pay more for drugs. These adjustment programs change how plans process copay assistance and prescription drug coupons so that these forms of support no longer count toward a patient’s out-of-pocket maximum.The effect is that patients pay more out-of-pocket annually as less money is put toward their deductible.