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Data Proves PBM Industry Maximized Profit At Patient Expense

Cision Newswire, June 15, 2020 Physicians and Patient Advocates Call for More State Disclosures The Alliance for Transparent and Affordable Prescriptions (ATAP) reacted today to a report issued by the Texas Department of Insurance (TDI) showing the financial activity of the pharmacy benefit manager (PBM) industry in the Lone Star State. Texas law requires that PBMs annually report to the Insurance Commissioner aggregate data on rebates. “The Texas rebate report is unambiguous. The PBM industry has been generating significant profits while patients struggle to afford the cost of prescription drugs,” stated ATAP’s President Dr. Robert Levin. “Since 2016, through a complex rebate and price concession, the PBM industry in Texas pocketed more than $350 million in revenue, while passing a mere $16 million in savings to enrollees.” The data as reported by the PBM industry and compiled by the TDI may be found here:  https://www.tdi.texas.gov/reports/documents/drug-price-transparency-PBMs.pdf “PBMs owe it to patients to pass along savings to them,” Dr. Levin continued. “Now that Texas is …

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Study finds millions in Medicaid unfairly pocketed by Pharmacy Benefit Managers

The Capitolist February 4, 2020 A new Florida study, released last week, found that major health care companies using pharmacy benefit managers (PBM’s) have positioned themselves to pocket millions of dollars from the state’s Medicaid system that were intended to lower costs for millions of low-income Floridians. The study found that despite processing less than half of one percent of all pharmacy claims, specialty pharmacies affiliated with PBM’s managed to collect 28 percent of the available profit margin from dispensing prescription drugs. The study was commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. using data obtained from Florida’s Agency for Health Care Administration (AHCA) by the Small Business Pharmacies Aligned for Reform.  Smaller pharmacy operators say the report proves that larger, vertically integrated companies that use PBM’s are using “predatory” business practices that short-circuit the free market. State lawmakers expressed alarm at the news and underscored the need …

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PBMs favor their own pharmacies in the Florida Medicaid program

STAT News Plus January 31, 2020 As angst rises over the prices paid for medicines, a new analysis finds some pharmacy benefit managers that contract with Medicaid managed care organizations in Florida are pushing prescriptions to drugstore chains they control, raising costs for consumers and taxpayers. The report, which analyzed approximately 350 million state Medicaid pharmacy claims from 2012 through 2019, noted that PBMs sometimes reimbursed their own pharmacies for certain medicines at substantially higher rates than what other drug stores received, and payments to their affiliated pharmacies greatly exceeded the cost to dispense the drugs. Continue Reading on STAT News

Pharmacists Say They Take Hit In Medicaid

Health News Florida January 31, 2020 Amid a legislative tussle with millions of dollars on the line, people who operate pharmacies in Florida contend they are getting short-changed by the state. A report released Thursday maintains that pharmacists participating in Florida’s Medicaid managed-care program are being woefully underpaid. State Medicaid officials estimate the cost of doing business in the Medicaid program is $10.24 per filled prescription. But on average, Medicaid managed-care plans paid pharmacists $2.72 per claim in 2018. The 202-page analysis was commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. and was conducted by 3 Axis Advisors. It was based on a review of more than 350 million Medicaid managed-care claims between 2012 and 2019 and claims data from more than 100 small community pharmacies across Florida to help validate the state data. The claims showed researchers what each managed-care company reported paying for each drug …

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New study highlights predatory practices by pharmacy benefit managers that drive up costs for patients, taxpayers

Capitol Soup, January 30, 2020 Study analyzing 359 million prescription AHCA drug claims documents widespread abuse   Legislators and advocates for reducing costs and improving access to prescription drugs today hailed a new independent study documenting that Pharmacy Benefit Managers (PBMs) have pocketed millions of dollars from the Florida Medicaid system – funds that should have been directed toward health care for millions of low-income residents. The study, commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. with data obtained from the Agency for Health Care Administration (AHCA) by the Small Business Pharmacies Aligned for Reform (SPAR), highlights the predatory nature of a handful of vertically integrated PBMs and managed care organizations (MCOs). Sen. Gayle Harrell and Rep. Jackie Toledo, who have each filed legislation to rein in predatory PBMs, underscored the need for greater transparency and oversight when it comes to PBMs’ role in Florida. Continue Reading on …

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