PCMA sues to block N.D. anti-PBM laws | Home delivery of prescription drugs reduces costs and improves quality | CMS proposes steep cuts to 340B drug reimbursement rates
July 14, 2017
PCMA SmartBrief
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PCMA sues to block N.D. anti-PBM laws
The Pharmaceutical Care Management Association filed a lawsuit asserting that two new North Dakota laws are superseded by the federal Employee Retirement Income Security Act and Medicare Part D. PCMA says the laws would "risk patient safety by restricting health plans' ability to reward drugstores that are willing to meet performance metrics that increase generic dispensing, improve adherence and reduce inappropriate drug use."
The Bismarck Tribune (N.D.)/Forum News Service (7/13),  Bloomberg BNA (subscription required) (7/19) 
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Home delivery of prescription drugs reduces costs and improves quality
Home delivery of prescription drugs reduces costs and improves quality
Home delivery is a convenient, safe and cost-effective option for patients to access prescription drugs. Learn more.
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Legislative & Regulatory News
CMS proposes steep cuts to 340B drug reimbursement rates
CMS proposes steep cuts to 340B drug reimbursement rates
(Joe Raedle/Getty Images)
The CMS on Thursday proposed significantly reducing reimbursement for medications purchased by hospitals under the 340B discount program, designed for facilities that care for poor populations. The proposal would reduce rates to 22.5% below the average sales price for a given drug, down from the average sales price plus 6%. The CMS also is seeking comments on whether Medicare should pay for knee replacements as well as partial and total hip procedures performed in outpatient settings, a change that could affect bundled payments for such procedures.
Bloomberg (7/17),  Modern Healthcare (tiered subscription model) (7/13) 
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Medicare Trustees' report cites concerns but won't trigger IPAB
The Medicare Independent Payment Advisory Board will not be assembled after the Medicare Trustees reported that the program will remain solvent until 2029. However, the Trustees cautioned that health care providers might stop accepting Medicare due to a lack of reimbursement updates in the Medicare Access and CHIP Reauthorization Act.
Modern Healthcare (tiered subscription model) (7/13),  The Washington Post (tiered subscription model) (7/13) 
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HHS OIG identifies opioid super-prescribers
The HHS Office of Inspector General says 401 prescribers wrote more than 256,200 prescriptions last year for nearly 90,000 Medicare Part D subscribers who were at high risk for abuse or addiction.
STAT (tiered subscription model)/Pharmalot (7/13) 
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Senate's revised health plan would allow bare-bones policies
Senate Republicans on Thursday released a revised plan to replace the Affordable Care Act that keeps deep cuts to Medicaid but adds about $70 billion to the more than $100 billion in an earlier proposal for states to reduce premiums and out-of-pocket costs. The plan would let insurers sell bare-bones policies under certain circumstances and would keep two ACA taxes on the wealthy.
The New York Times (free-article access for SmartBrief readers) (7/13),  The Hill (7/13) 
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House user fee bill softens generic-drug competition language
The latest iteration of a House bill reauthorizing the FDA's user fee program says the FDA "may" expedite review of certain competitive generic-drug applications upon request. The previous version of the bill said "shall."
InsideHealthPolicy (subscription required) (7/13) 
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Drug Industry Spotlight
Anthem sues opioid maker over reimbursement claims
Anthem has filed a lawsuit against Insys Therapeutics, accusing the pharmaceutical firm of submitting fraudulent reimbursement claims for its opioid painkiller Subsys, just a few days after two former Insys sales representatives pleaded guilty to paying kickbacks to prescribers. Anthem argues that the drugmaker lied about diagnoses to obtain reimbursement.
Reuters (7/13) 
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Other News
I am tomorrow, or some future day, what I establish today. I am today what I established yesterday -- or some previous day.
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PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 266 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D. PCMA is dedicated to enhancing the proven tools and techniques pioneered by PBMs that generate savings and access for consumers and payors.

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