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Prescription Drug Rates

Quality Measures Challenging in Pharmaceutical Value-Based Contracts

October 17, 2017 - Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures.   Pharmaceutical companies are generally reluctant to engage in value-based reimbursement contracts, says a recent PricewaterhouseCoopers survey, with 61 percent stating that negotiations with payers often...


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Medicaid Drug Pricing Rule May Inhibit Value-Based Contracts

by Thomas Beaton

A Medicaid drug pricing rule which safeguards deep discounts for the public program can potentially inhibit value-based contracts agreements between payers and pharmaceutical companies, according to research from the Journal of Health Politics,...

Pharmaceutical Industry Slow to Embrace Value-Based Contracts

by Thomas Beaton

Sixty-one percent of pharmaceutical companies are not yet participating in value-based contracts due largely to the belief that current policies make it too difficult to negotiate with payers and see a return on investment, according to a PricewaterhouseCoopers...

How Pharmacy Benefit Managers Lower Prescription Drug Prices

by Thomas Beaton

Payers in both the private and public sectors require new strategies that offset the rising cost of prescription drugs. Pharmacy benefit managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS...

Pharmacy Benefit Manager Accountability is Key for Employers

by Thomas Beaton

As prescription drug costs continue to rise employers should ensure that they have strong pharmacy benefit manager (PBM) accountability measures in place to maximize cost-savings and plan efficiency, according to a report from the Midwest Business...

AARP: Congress Must Take Action on ACA Market Stabilization Solutions

by Thomas Beaton

In order to protect healthcare consumers and stabilize the ACA marketplace, Congress must pass legislation that creates affordable and accessible coverage options, protects Medicaid and Medicare program funding, and expands prescription drug...

Employers Must Prepare Retirees for $275K in Expected Care Costs

by Thomas Beaton

Employers are starting to prepare and educate retirees for expected post-retirement care costs of $275,000, according to market analysis published by Fidelity Investments. The analysis found a 6-percent increase in costs over a similar report...

Pre-Authorizations, Rx Limits Cut Opioid Abuse by 30% Nationwide

by Thomas Beaton

Anthem BlueCross BlueShield (BCBS) organizations across the country collectively pledged to lower opioid abuse by 30 percent, and the company as a whole reached that goal two years ahead of schedule according to a press release. Declared a national...

Employer Reference Pricing Lowers Prescription Drug Expenses

by Thomas Beaton

As payers and employers learn to counter significant increases of prescription drug expenses, reference pricing may hold the key to lowering drug spending and increasing consumer purchases of lower cost drugs, according to research published...

Employers Expect 2018 Benefit Costs to Rise $14K Per Employee

by Thomas Beaton

Large employers will have to rely on healthcare delivery innovations and cost management strategies as employers face a 5 percent rise in the cost of providing employee healthcare benefits, according to a National Business Group on Health (NBGH)...

Employer Cost Management Strategies Combat High Insurance Costs

by Thomas Beaton

Employers expect healthcare spending to increase by 5.5 percent in 2018, up from a 4.6 percent increase in 2017, according to a Willis Towers Watson survey. The continued rise in costs has turned health cost management as a top employer concern,...

Opioid Use Fell 32% in CA BCBS Prescription Drug Safety Program

by Thomas Beaton

The Blue Shield of California Health Plan, an independent member of Blue Cross Blue Shield (BCBS), successfully lowered overall opioid use by 32 percent during the first two years of its Narcotic Safety Initiative (NSI).   The NSI leveraged...

Increasing Competition Can Reduce Prescription Drug Prices

by Thomas Beaton

Reducing prescription drug prices for payers requires market-based solutions that increase competition and deregulate federal drug policies, the Pharmaceutical Care Management Association (PCMA) wrote in a letter to HHS secretary Tom Price.  ...

Harvard Pilgrim Enters Outcomes-Based Pharmaceutical Contracts

by Jesse Migneault

Harvard Pilgrim Health Care has signed a three-year value-based care contract with drug maker AstraZeneca for two therapies used to treat acute coronary disease and type 2 diabetes. The arrangements will use patient outcomes as a measure of the...

Pharmacy Benefit Managers Help Reduce Payer Drug Spending

by Jesse Migneault

Pharmacy benefit managers (PBMs) are instrumental in helping payers provide appropriate access to prescriptions, expand access, and rein in drug spending, according to a recent report from the Pharmaceutical Care Management Association (PCMA)....

Prescription Drugs Account for 22% of Payer Premium Spending

by Thomas Beaton

Prescription drug costs consume the largest proportion of dollars spent on healthcare premiums, with 22 cents out of every dollar going to medication costs, says AHIP in a new data brief. Eighty percent of every dollar is spent on medical expenses,...

Does Tiered Cost-Sharing Promote Appropriate Medication Use?

by Jacqueline Belliveau

Health plans have traditionally used tiered formulary cost-sharing arrangements to reduce healthcare spending and incentivize appropriate medication use. But a recent Journal of Managed Care & Specialty Pharmacy study found that stakeholders...

CMS Halts on Changing Medicare Part B Prescription Guidelines

by Vera Gruessner

The American Hospital Association (AHA) reported on December 16 that a finalized rule for the prior proposal to test new models for prescription drug payments under Medicare Part B has been scrapped. The Centers for Medicare & Medicaid Services...

Patients Need More Guidance on Medicare Prescription Drug Plans

by Vera Gruessner

Among Medicare beneficiaries, 34 percent are not taking the time to review their Medicare Advantage prescription drug plan before renewing during the open enrollment period, according to a Walgreens survey. Nearly one in five or 19 percent stated...

Rising Specialty Drug Prices Plague CMS, Medicare Beneficiaries

by Vera Gruessner

Even though the Obama administration’s Patient Protection and Affordable Care Act assisted Medicare beneficiaries by attempting to end a drug coverage gap called the “doughnut hole” through plan payments and drug manufacturer...

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