Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Pharmacy Services

UPMC, AstraZeneca Enter Value-Based Pharmaceutical Contract

January 30, 2019 - UPMC Health Plan and AstraZeneca are taking on the challenge of a value-based pharmaceutical contract for one of the manufacturer’s cardiovascular medications. Reimbursement for prescriptions of BRILINTA, a drug intended to help heart attack patients forestall or lessen the impact of subsequent events, will be connected to cardiovascular outcomes for targeted populations, the two...


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Price of Insulin Doubles, Increasing Spending for Members, Payers

by Jennifer Bresnick

Dramatic increases in the price of insulin are driving a rapid uptick in overall spending for diabetes care, according to new data from the Health Care Cost Institute (HCCI). Between 2012 and 2016, the point of sale price for insulin...

Walmart, CVS Health Agree on PBM Pharmacy Network Rates

by Jennifer Bresnick

Walmart and CVS Health have signed a multi-year agreement to keep Walmart participating in the CVS Caremark pharmacy benefit management (PBM) commercial and Managed Medicaid pharmacy networks. Walmart will continue to offer services to...

CVS Health to Begin Important Work of Integrating Aetna

by Kyle Murphy, PhD

On the eve of Christmas, Judge Richard Leon of the United States District Court for the District of Columbia decided against halting the integration of the two companies in a merger valued at $69 billion. “Based on CVS’s...

Cigna Announces Closing of $67B Purchase of Express Scripts

by Jennifer Bresnick

Cigna is officially the new owner of Express Scripts after announcing on December 20 that the $67 billion acquisition has closed. Cigna calls the acquisition a “blueprint to transform the healthcare system,” indicating that...

Prescription Drug Prices Rise Again After Brief Pause

by Jennifer Bresnick

Several dozen pharmaceutical companies are planning to raise their prices again in 2019 after temporarily holding off on increases as a result of federal pressure. Reuters reports that nearly thirty drug makers, including Novartis, Bayer,...

Cigna-Express Scripts Deal Secures Approval from CA, NY Officials

by Kyle Murphy, PhD

Cigna secured approvals from New York and California to acquire Express Scripts, according to multiple reports. Zachary Vasile of the Journal Inquirer reports that New Jersey is the remaining state whose approval will enable the...

CVS Unveils New Pricing Tool for Pharmacy Benefit Management

by Chuck Green

CVS Health has introduced a new approach to the pricing of pharmacy benefit management services, the company announced. The Guaranteed Net Cost model simplifies the financial arrangements underlying pharmacy benefit management (PBM)...

CVS-Aetna Merger Now Expected to Close After Thanksgiving

by Kyle Murphy, PhD

Close to a year has passed since CVS Health announced its plan to acquire Aetna in a $69-billion acquisition. Now only the approval of two state departments of insurance stands in its way. In a recent filing to the Securities and Exchange...

Data from Health Plans, PBMs Helps Lower Prescription Drug Costs

by Chuck Green

The health information network Surescripts is using data from both payers and PBMs to give prescribers access to patient-specific and formulary-based benefit and cost information for nearly three-quarters of all covered lives in the...

PBMs, Specialized Formularies Reduce Managed Care Prescription Costs

by Thomas Beaton

Pharmacy benefit managers (PBMs) with specialized drug formularies can help managed care payers significantly reduce prescription drug costs, according to new research published in the Journal of Managed Care and Speciality Pharmacy. The...

CVS-Aetna Merger Gets DOJ Nod as Aetna Sheds Medicare Part D

by Thomas Beaton

The Department of Justice (DOJ) has announced that it will approve the proposed merger between CVS and Aetna as soon as Aetna completes the divestiture of its Medicare Part D business line.   Two weeks ago, Aetna initiated the sale...

AMA: CVS-Aetna Merger Would Reduce PBM Competition, Raise Prices

by Jennifer Bresnick

The American Medical Association is urging the Department of Justice to squash the proposed merger between CVS Health and Aetna.  The combined entity would drastically reduce competition in many pharmacy benefit management (PBM)...

CVS Health Offers New Tools for Lowering Prescription Drug Costs

by Thomas Beaton

CVS Health has launched new cost-saving initiatives that aim to lower beneficiary prescription drug costs through co-pay adjustments, pricing transparency technology, and increased promotion of generic drugs. The initiatives follow a CVS...

Rumors Swirl of Possible Walmart Acquisition of Humana

by Jennifer Bresnick

Walmart may be making a move to acquire Humana, one of the nation’s biggest health payers, according to The Wall Street Journal. Citing sources familiar with the matter – but without comment from Humana or Walmart – the...

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