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Health Headlines
September 9, 2022

Even plans that are supposed to save patients money can end up costing them dearly.

July 18, 2022

The Federal Trade Commission has an opportunity to impact healthcare for Americans.

June 29, 2022

Copay Assistance Is a Lifeline for Patients. So Why Are Insurers Blocking It?

In today’s broken insurance system, patients too often pay more for a medicine than what their insurance company pays.

May 4, 2022

Lawsuit against SaveOnSP alleges it exploited program designed to help patients cover out-of-pocket prescription costs

August 19, 2020

Manufacturer Cost-Sharing Assistance Programs Can Save Chronically Ill Patients Hundreds to Thousands of Dollars Annually

A recent analysis by IQVIA shows that chronically ill patients who used manufacturer cost-sharing assistance in 2019 saved hundreds to thousands of dollars on their out-of-pocket costs. 

February 13, 2020

A New Battle Between Insurers and Big Pharma is Costing Sick People Thousands

Copay accumulator policies are a growing industry trend and they have caught the attention of Ohio legislators.

Critics of the accumulator policies say the insurers are “double dipping” by taking patient money and the copay assistance. 

Ohio Capital Journal 2.13.20

December 12, 2019

House Votes to Give the Government the Power to Negotiate Drug Prices

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

Pelosi Drug Pricing Plan Would Save $456 Billion Over 10 Years: Analysis

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

Pharma's Take on the Pelosi Drug Pricing Bill: Fair Warning or Fearmongering?

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

Changes Coming to Grassley-Wyden Bill

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

Policy Recommendations for Pharmacy Benefit Managers to Stem the Escalating Costs of Prescription Drugs: A Position Paper From the American College of Physicians

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 American Way of Paying For Drugs Isn't Working

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

Key House Committee Passes Speaker Nancy Pelosi's Sweeping Drug Pricing Bill

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

CBO Says House Speaker Nancy Pelosi’s Drug Pricing Plan Saves Medicare $345 Billion Over Decade

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

House Progressive Circulates Letter Seeking Change to Pelosi Drug Pricing Bill

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

Holding Pharmacy Benefit Managers Accountable Is Crucial In Delaware

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."

"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

Lawmakers Ask FTC To Scrutinize Pharma Mergers Over Antitrust Concerns

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

Consumer Groups, Unions Urge Caution on $63 billion AbbVie Deal for Allergan

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 Plans Lawsuit Against Drug Industry

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

Pelosi Energizes Battle to Lower Drug Prices

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

As Congress Considers Lowering Drug Prices, Pharma CEOS Target Key Senators With Campaign Cash

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

NHIS: Diabetes Drug Costs Spur Non-Adherence

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

Sens. Alexander and Murray Take a Bipartisan Step Forward on Drug Pricing

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

How Trump's Plan to Import Canadian Drugs Would Work

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

A Massive Drug Price-Fixing Probe Has Hit Major Roadblocks

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

Blumenthal Provides Common-Sense Solution to to Drug Pricing Crisis

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

Senate Finance Pushes Ahead on Plan to Address High Drug Prices

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

Pelosi Aide: Major Bill to Lower Drug Prices Coming In September

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

Are Prescription Drug Prices Going Down?

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

President Trump Withdraws Plan to Eliminiate Drug Price Rebates

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

So Much for Trump’s Rule About Drug Prices in TV Ads

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 Craves Big Action on Drug Prices to Take to the Campaign Trail

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

Senate Finance Leaders In Talks On Deal To Limit Drug Price Increases

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

It’s a Big Week for Debates about Drug Prices, Whether Pharma Likes it or Not

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

Drug Prices Are A Populist Campaign Issue. Here Are The Latest Proposals to Lower Costs

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

We Either Buy Insulin Or We Die

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

CVS Bought Aetna Last Year. Now A Judge Is Sowing Doubts

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

What's At Stake In CVS-Aetna Merger Hearing: Four Questions

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

House Lawmakers Question Whether Transparency Would Fix Drug Prices

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

House to Vote on Bills to Lower Drug Prices But Republicans Balk At Obamacare Protections

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

CMS Seeks to Limit 'Spread Pricing' by PBMs in Managed Care

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

Drug Industry Patents Go Under Senate Judiciary Committee’s Microscope

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

Trump Needs Help from Pelosi to Notch a Big Drug Pricing Win

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

Movement to Reform Pharmacy Middlemen Reaches A Boiling Point Nationwide

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

Specialty Drugs: The New Arena For Pharmacy Benefit Manager Profits?

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

In Possible Blueprint for Other States, Ohio Attorney General Floats Proposals to Rein in PBMs

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

Meet the 7 Witnesses Lined Up to Testify Against CVS-Aetna Next Month

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

Trial in CVS-Optum Secrecy Case Delayed Again

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

Cummings Accuses Republicans Of Obstructing Drug Prices Investigation

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

Grassley, Wyden Ask HHS Watchdog to Investigate Middlemen 'Spread Pricing'

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

"I Don't Know How You People Sleep At Night": Visibly Irate Lawmakers Blast Pharma, PBMs Over Insulin Prices

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

Why I am Stockpiling Insulin In My Fridge

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

CVS, Cigna, Humana Blame Big Pharma for Skyrocketing US Drug Prices

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

These Senators Received the Biggest Checks from CVS, Humana, and Other Pharmacy Benefit Managers Testifying Tuesday

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.

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

April 08, 2019

Consumer Groups Submit Comments in Support of Proposed Rebate Rule to Lower Drug Prices

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

This Week, Five Pharmacy ‘Middlemen’ Head to Capitol Hill’s Hot Seat. Some of Them Have an Easier Defense than Others

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

Federal Judge to Hear Witness Testimony in Review of Aetna and CVS Merger DOJ Approval

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.