The Coalition to
Protect Patient Choice
of David Balto
Competitive healthcare is healthcare with choices
Advocacy on consumer healthcare competition issues aimed at lowering prescription drug costs
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.
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.
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.
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
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.
April 04, 2019
Powerful House Committee To Weigh Legislation Aimed At Shedding More Light on High Drug Prices
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
Ohio Legislators Frustrated At Slow Pace of PBM Reforms
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
Grassley, Wyden Question Role of Middlemen in Skyrocketing Insulin Prices
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
Key House Lawmakers Reach Bipartisan Deal to Advance Long-Stalled Drug Pricing Bill
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
Big Pharma's Go-To Defense of Soaring Drug Prices Doesn't Add Up
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
States Are Tackling America's Drug Pricing Problem
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 Probes Pharmacy Benefit Managers For Allegedly Overcharging State Medicaid
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
Partisan Squabbles Shadow Congress's Efforts to Lower Drug Prices
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
A Drug Pricing Mystery: Who's Behind All the Outrage Over Rebates?
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
Survey: About 1 in 10 US Adults Rationing Medicine In Effort To Lower Costs
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
Senate Panel Asks CVS and Four Other Pharmacy Middlemen to Testify About Drug Prices
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
One GOP Senator Is Urging the Drug Industry to Make Good On Lowering Drug Prices
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
The Real Price of Medications
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
Eli Lilly Will Sell Half-Price Version of Humalog, Its Popular Insulin
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
Proposal to Regulate Pharmacy Benefit Managers Passes Out of Senate
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
Pharmaceutical Company CEOs Face Grilling in Senate Over High Drug Prices
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
Drug Pricing Fight Centers on Insulin
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
Attorney General Dave Yost Seeking $16 million Repayment From Pharmacy Middleman OptumRx
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 Medicaid Releases Report on Pharmacy Benefit Program
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
A Step Forward On Drug Prices Should Not Be Overlooked
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
A Big PBM Wants Drug Makers to Agree to Rebate Demands That Would Preserve Its Bottom Line
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
Drug Price Debate Targets Pharmacy Benefit Managers
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
Democrats Unveil Bill For Medicare To Negotiate Drug Prices
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
As Trump Calls On Congress to Lower Drug Prices, Some Democrats Cheer. Others Scoff
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
PBMs Launch Counterattack Following Trump Administration's Plan to End Drug Rebates
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 Bat Away Trump's Olive Branch on Drug Pricing
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
DeWine Wants Crackdown on Pharmacy Middlemen, Managed Care Groups
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
Bill Goes After Middlemen In An Effort to Lower Prescription Drug Prices In Montana
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
The Trump Administration Is Taking On Middlemen That Inflate Drug Prices
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.
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
CVS Just Bought Your Local Drugstores, Mail-Order Pharmacy and Health Insurer. What's Next, Your Hospital?
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 Both Ends of Capitol, Both Parties Warn Big Pharma on Drug Prices
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
Indian Tribe Joins Big Pharma At the Supreme Court, Defending a Lucrative Deal
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
Pharmacy Benefit Managers Marked Up Generic Drugs For NY Medicaid, But Where Did The Money Go?
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
Looking to 2020, Democrats Take on Prescription Drug Prices
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
Baker Outlines Steps to Lower Medicaid Drug Prices
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.
January 18, 2019
Secret Rebate Trap Strategy Blocks Patients From Buying Generic Drug
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
All Congress's Ideas for Bringing Down Prescription Drug Prices, Explained
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.
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 Makes Dubious Case for Rebates' Impact on Drug Prices
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
Skoufis Targets Prescription Drug Prices
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 Returns, Lawmakers Rush to Detail Drug Pricing Agendas
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
Prescription Drug Costs Driven By Manufacturer Price Hikes, Not Innovation
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
Democrats Look To Unlikely Ally on Drug Pricing: Donald Trump
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.
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.
January 04, 2019
This Bottle of Pills Costs $20 in One State and $130 in Another
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
Drugmakers Raise Prices on Hundreds of Medicines
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
As Drug Prices Soar, Policymakers Eye Dose of Government Intervention
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
Judge Seeks Monitoring of CVS and Aetna During Antitrust Review
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
Consumer Groups Submit Comments Opposing the Merger of CVS and Aetna
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
DeWine Must Make Medicaid PBM Reform a Top Priority
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
Investigation of Generic 'Cartel' Expands to Over 300 Drugs
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
Ohio Leads Ways As States Take On Pharmacy Benefit Manager Middlemen
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
Merged CVS-Aetna Won't Extend Transparency, Competition Guarantees
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 state