PCMA: Drugstore lobby pushes legislation undermining cost-saving pharmacy networks | Supreme Court likely to hear yet another ACA case | GAO: Investigators able to sign up fraudulent applicants for ACA coverage
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July 23, 2014
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PCMA: Drugstore lobby pushes legislation undermining cost-saving pharmacy networks
The independent drugstore lobby's push for legislation requiring Medicare Part D plan networks to include any pharmacy willing to meet contract terms "is a backdoor attempt to ban the popular, low-premium plans that encourage shopping at more affordable pharmacies," said PCMA President and CEO Mark Merritt. A new study by The Moran Company found the definition of a "medically underserved area" is so broad that 95% of all Medicare beneficiaries are affected. The study also found that the legislation would increase federal spending by $21.32 billion between 2015 and 2024. Chain Drug Review (7/22)
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Legislative & Regulatory News
Supreme Court likely to hear yet another ACA case
Two federal court panels issued opposing rulings on whether tax credits for health insurance plans bought through the federally run marketplace are legal under the Affordable Care Act. Unless the full U.S. Court of Appeals for the District of Columbia Circuit overturns the three-judge panel's ruling and agrees with the 4th U.S. Circuit Court of Appeals' ruling, the cases are likely to go to the Supreme Court, experts say. Bloomberg (7/23), The New York Times (tiered subscription model) (7/23)
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GAO: Investigators able to sign up fraudulent applicants for ACA coverage
A new report from the Government Accountability Office reveals that undercover investigators were able to sign up fraudulent identities for health insurance plans and federal subsidies through HealthCare.gov and by phone. Eleven of the fake applicants were approved for coverage subsidies, which amount to almost $2,500 monthly, despite providing invalid Social Security numbers and other fake documents. The findings of the report are still preliminary, according to GAO officials, who plan to disclose the current results to lawmakers today. Health Data Management (7/23), The Washington Post (tiered subscription model) (7/22), The Wall Street Journal (tiered subscription model) (7/22)
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Feds ready contraceptive coverage opt-out alternative
The Obama administration is creating an alternative to the existing form religious organizations may use to inform HHS that they have an objection to offering employees health insurance that covers some or all forms of contraception. The policy is in response to a Supreme Court ruling in favor of Wheaton College in Illinois, which objected to the form. Reuters (7/23)
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Groups start lobbying for 2016 essential health benefits
Overly broad coverage requirements under the Affordable Care Act have led to high insurance premiums, and HHS should change the list of essential benefits for 2016, according to members of the Affordable Health Benefits Coalition, which includes the National Retail Federation and the U.S. Chamber of Commerce. Consumer groups are lobbying to maintain and perhaps expand the list of benefits insurance plans must offer. Kaiser Health News/Capsules blog (7/23)
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Drug Industry Spotlight
Poll: Americans concerned about specialty meds' prices
A poll of 2,010 Americans found 92% are either somewhat or very concerned that they will not be able to afford specialty drugs should they need them in the future. The poll results are "a red flag for the pharmaceutical industry and for Capitol Hill that price is an issue that needs to be addressed," said John Rother, CEO of the National Coalition on Health Care, which sponsored the survey. The Wall Street Journal (tiered subscription model)/Pharmalot blog (7/22)
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Firm to distribute generic version of hypertension drug Aceon
Under an agreement with Symplmed, Lannett will be the U.S. distributor of generic Aceon, used to treat hypertension in people who have stable coronary artery disease. The authorized generic will be available in three strengths. Chain Drug Review (7/21)
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Teva gains tentative OK for HIV treatment
Teva Pharmaceutical Industries obtained tentative FDA approval for its abacavir sulfate and lamivudine tablets for the treatment of HIV-1 infection. Drug Store News (7/22)
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The young do not know enough to be prudent and therefore they attempt the impossible -- and achieve it, generation after generation."
-- Pearl S. Buck,
American writer
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About PCMA
PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 216 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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