Coalition pushes drugmakers to justify high prices | CBO lowers estimate for federal spending on health care by 2039 | Calif. submits plan to cut Medicaid backlog
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July 16, 2014
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Coalition pushes drugmakers to justify high prices
The National Coalition on Health Care is pushing drugmakers to reveal what they spend on research and development and to justify the high price of specialty drugs such as Gilead's hepatitis C drug Sovaldi. InsideHealthPolicy.com (subscription required) (7/15)
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Legislative & Regulatory News
CBO lowers estimate for federal spending on health care by 2039
The Congressional Budget Office slightly lowered its projection for federal spending on health care in 25 years, from 8.1% of the nation's gross domestic product to 8%. The government is expected to spend more on Medicare, Medicaid, the Children's Health Insurance Program and Affordable Care Act insurance subsidies due to an aging population and increases in insurance coverage. Cost control provisions in the Affordable Care Act are expected to hold back spending. The Hill (7/15), Los Angeles Times (tiered subscription model) (7/15)
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Calif. submits plan to cut Medicaid backlog
California officials submitted a plan to the CMS that they say would cut a backlog of pending Medi-Cal applications from 600,000 to 350,000 within six weeks. The plan includes fixing technical problems with the state's insurance enrollment system and informing people of how to get care while their Medi-Cal applications are being processed. Los Angeles Times (tiered subscription model)/L.A. Now blog (7/15)
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Other News
PBM Industry News
Judge allows lawsuit against Rx copay coupons to proceed
A federal judge dismissed two union health plans' claims that Merck & Co.'s copay coupons for branded drugs were intentionally fraudulent, but the judge let stand claims that the copay coupons illegally interfered with the health plans' contracts. The health plans have 30 days to file an amended complaint, and Merck asked the court for an Aug. 13 deadline for answering the amended complaint. The unions say Merck's copay coupons upset "carefully balanced cost-sharing principles underlying the prescription health care coverage that Plaintiffs offer their members" and would increase the plaintiffs' prescription drug costs by $32 billion over the next decade. Bloomberg Government (subscription required) (7/15)
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Drug Industry Spotlight
Many patients don't follow doctors' orders
More than half of patients prescribed a controlled substance are not taking the drug as directed, a Quest Diagnostics analysis of more than 422,000 patient laboratory results found. Forty-three percent appeared not to have taken the prescribed drug at all, 35% had taken an additional drug and 22% had taken a drug other than the one prescribed. The noncompliance rate was 70% among patients ages 18 to 24. The Wall Street Journal (tiered subscription model)/Pharmalot blog (7/15)
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American businesswoman
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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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