PBMs aim to bring down the cost of cancer treatment | Federal exchange does not allow for accurate drug plan info, study finds | House lawmakers pledge support for repealing SGR
January 23, 2015
PCMA SmartBrief
News for the PBM Industry

Featured Story
PBMs aim to bring down the cost of cancer treatment
Cancer immunotherapy drugs are often dispensed in doctors' offices and hospitals and can cost $150,000 for a year of treatment. Pharmacy benefit managers plan to use the same tools with these drugs that they used to get drugmakers to lower their prices on new hepatitis C drugs, Express Scripts Chief Medical Officer Steve Miller says. Bloomberg (1/22)
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Connect with top specialty pharmacy decision makers at the sPCMA Business Forum
From an educational standpoint, speakers at the sPCMA Business Forum are among the industry's top thought leaders. When it comes to networking and conducting business with industry partners and customers, the Business Forum attracts the highest number of PBM and specialty pharmacy senior executives and decision makers of any industry conference. Learn more.
Legislative & Regulatory News
Federal exchange does not allow for accurate drug plan info, study finds
Information on out-of-pocket costs for prescription drug plans sold through HealthCare.gov is often unreliable because the federal exchange lists only four tiers, but many plans have five or six tiers, an Avalere Health analysis found. Kaiser Health News (1/23)
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House lawmakers pledge support for repealing SGR
Members of the House Energy and Commerce Health Subcommittee indicated at a hearing this week that they want to pass a bill to repeal the sustainable growth rate formula for Medicare physician reimbursement, but most want to do so in such a way that it would pay for itself. Former Office of Management and Budget Director Alice Rivlin suggested four ways to offset the $140 billion cost, including incentives for physicians to join accountable care organizations, means-testing of Medicare premiums and the use of competitive bidding. MedPage Today (free registration) (1/21)
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Ark. governor supports Medicaid expansion
Arkansas should continue implementing a public-private expansion of Medicaid under the Affordable Care Act through 2016, when the program should be reevaluated, new Gov. Asa Hutchinson said. Bloomberg (1/22)
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Pa. officials bring down prescription forgery ring
Authorities have brought down a prescription forgery ring with the arrest of 22 people, including suspected ringleader Kevin Andrews of Delaware County, Pa., and Quiana Bostick, a Philadelphia pharmacy employee who allegedly helped forge prescriptions. The Philadelphia-based ring operated in 44 counties and generated about $1.7 million in profits from over 59,000 oxycodone pills obtained using fraudulent prescriptions and stolen doctors' information, according to the state attorney general. The Mercury (Pottstown, Pa.) (1/22)
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Drug Industry Spotlight
Senate proposal would use pharma penalties to support NIH
Sen. Elizabeth Warren, D-Mass., is proposing that drug manufacturers that settle with the government on allegations of paying kickbacks, illegally marketing drugs or defrauding public health insurance programs be forced to give up 1% of profits for each blockbuster drug that received support from public-sector research. The money would go to the NIH. The Wall Street Journal (tiered subscription model)/Pharmalot blog (1/22)
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Errors, omissions, inconsistencies complicate analysis of Open Payments data
Drugmakers misspelled drug names, used multiple names for the same drug and omitted drug names altogether in many of their submissions to the Open Payments database, meant to disclose drug and device makers' financial relationships with doctors. The inconsistencies make analyzing the data more difficult, researchers say. The New York Times (tiered subscription model)/The Upshot blog/ProPublica (1/23)
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Other News
Rough diamonds may sometimes be mistaken for worthless pebbles."
-- Thomas Browne,
English author
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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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