Among several policy proposals, the Pharmaceutical Care Management Association says that pharmacy benefit managers could improve Medicaid efficiency, allowing the program to serve more people, says PCMA President and CEO Mark Merritt. "I think there's a bipartisan understanding that Medicaid needs to be run more efficiently -- from a fiscal conservative point of view to save money -- but also from a humanitarian point of view that if it isn't run more cost efficiently, it's not going to be able to cover as many people with significant benefits," Merritt said. "There's no reason that Medicaid, the program for the poor, is paying more for pharmacy benefits than the Medicare program or the private market," Merritt added.
Connect with specialty pharmacy's most influential leaders
The sPCMA Business Forum, a networking and educational conference held March 8 & 9th in Orlando, FL, attracts the highest number of executives and decision makers from PBMs and the nation's largest specialty pharmacies of any industry conference. Learn more.
Rules proposed by HHS aim to stabilize the individual health plan market as Congress works on repealing and replacing the Affordable Care Act. Provisions include a shorter open enrollment period, stricter eligibility verification for special enrollment periods and permission for insurers to drop consumers who have not paid their premiums.
Overall health care spending is expected to rise over the next decade and account for 19.9% of the economy by 2025, with the pace of growth to rise 5.4% this year compared with growth of 4.8% for 2016, according to a CMS report. Prescription drug spending is projected to grow 6.4% annually over the next eight years, partly fueled by specialty drugs, while Medicare spending is also expected to increase as more Americans grow older.
The Internal Revenue Service says it will not withhold tax refunds this year from people who do not prove they have complied with the Affordable Care Act's requirement that they have health insurance or show they are exempt. The IRS said the change aligns with President Donald Trump's executive order that sought to reduce ACA-related rules.
Molina Health Plan said revenue declined last year due to problems with Medicaid and poor performance in some exchange-sold plans and said the Trump administration should change the risk adjustment formula this year, rather than waiting until 2018.
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.
Contact PCMA Charles Cote
Vice President, Strategic Communications