Clinical Role - Payer

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Value assessment frameworks are expected to play a more pivotal role in decisions that affect future patient choice and access.
Rising drug prices for disease-modifying therapies resulted in substantial increases in spending for Medicare beneficiaries with multiple sclerosis.
Announced by the HHS and FDA, the plan seeks to safely import medications that would provide a cost savings to consumers, but some pharmacy and other health care professionals have expressed concerns. 
Costs remain the top concern of healthcare purchasers of pharmacy benefits, but employers are also concerned with ensuring appropriate use of medication and adherence to medication, according to a new report from the Pharmacy Benefit Management Institute (PBMI).
With discussion and debate happening for months in Washington, DC, over drug pricing and the role of pharmacy benefit managers (PBMs), the Institute
for Clinical and Economic Review (ICER) published a white paper this week that analyzes 3 possible alternatives to the pharmaceutical rebate system fostered by PBMs.
Several efforts are underway nearly a year after the Trump administration released its blueprint to lower drug prices in May 2018, but tracking their outcomes depends on what metric is used to define drug prices, according to a session at the Academy of Managed Care Pharmacy Managed Care & Specialty Pharmacy Annual Meeting, held March 25-28 in San Diego, California.
A policy from the Trump administration to benefit patients and alleviate the high cost of prescription drugs would eliminate rebates from pharmaceutical
companies to pharmacy benefit managers.
Prescription benefits consultant Chris Robbins, chief executive of cer of Arxcel, describes the finger-pointing in Congress over lowering drug costs this way: “If it weren’t so true, it might be almost humorous.”
A day after stakeholders told a House of Representatives subcommittee about problems accessing and paying for insulin, Cigna and its pharmacy benefit manager Express Scripts said they are launching a program for patients with diabetes in their commercial plans so that they pay no more than $25 for a 30-day supply of insulin.
A new legislation signed by Governor Ned Lamont has brought cause for celebration among Connecticut pharmacists and patients alike in the fight for drug pricing transparency.
Direct and indirect remuneration (DIR) fees are imposed by pharmacy benefit managers (PBMs) on pharmacy providers after a drug claim has already been submitted, adjudicated, and even paid out to a pharmacy.
Loren Kirk, director of Stakeholder Engagement for the Pharmacy Quality Alliance, speaks to Pharmacy Times on the findings of the Pharmacy-Provided Care Action Guide Report, during the Pharmacy Quality Alliance Annual Meeting.