Health and Human Services Secretary Alex Azar announced today that drug companies will have to post their prices in ads, a policy that was part of the Trump administration’s blueprint to lower prescription drug prices and reduce consumers’ out-of-pocket costs. The pricing will require rule-making through HHS.
Three pharmacy benefit managers (PBMs) control 80 percent of the third party claims processed for prescription drugs nationally. Employers, insurers, states and federal government agencies and others who pay prescription drug benefits for employees and beneficiaries need to be aware of the PBM industry to be assured they are being charged accurately for this valuable benefit. The West Virginia Public Employees Insurance Agency (PEIA) found it was being charged one-percent more for a prescription drug claim than the PBM was paying the pharmacy a few years ago. This was discovered after WVPA Executive Director Richard Stevens encouraged the PEIA director to have the PBM audited. Approximately $10 million in overcharges were found.
In a recent announcement, the Department of Justice disclosed that AmericourceBergen Corporation and several of its subsidiaries (collectively “ABC”) have agreed to pay $625 million in civil penalties to resolve False Claims Act allegations arising from its operation of a repacking operation that AB claimed was a pharmacy. The $625 million is on top of last year’s separate criminal settlement for $260 million for ABC’s distribution of the drugs from a facility that was not registered with the Food and Drug Administration.
Legislation aimed at bringing greater transparency into pharmacy DIR fees and MAC pricing have both gained support in Congress. Here’s an update on these and other pending legislation in Congress: Pharmacy DIR fees (S. 413) 15 Senators and (H.R. 1038) 86 Representatives; Generic drug pricing transparency, or MAC legislation (H.R. 1316) 56 Representatives; Pharmacy choice in Medicare Part D (S. 1044) 5 Senators and (H.R. 1939) 34 Representatives; Provider status (S 109) 53 Senators and (H.R. 592) 293 Representatives; and Compounding (H.R. 2871) 62 Representatives.
The opioid epidemic continues to worsen. 2017 saw a record 72,000 deaths from drug overdoses, most of them opioid pan pills or illegal opioids like heroin. That’s a 10% increase from 2016. And recent data indicate the toll is still rising.
Statutory mandates requiring prescribers to register with their state’s prescription drug monitoring program (PDMP) and/or use the program may be effective tools to help states realize the full potential of PDMPs, according to a 2017 research article about a study on PDMP mandates and Medicaid enrollees with opioid prescriptions. By the end of 2015, 23 states had adopted mandates for prescribers to register with their states’ PDMP, and 29 states had adopted some version of a mandate to use the PDMP.
The US Centers for Disease Control and Prevention’s National Center for Health Statistics reveal that 14 percent of U.S. adults have diabetes — 10 percent know it and more than four percent are undiagnosed.
