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- HHS releases drug coverage rules
Under proposed rules issued Tuesday, insurers would have to cover at least one drug in each class or the same number covered under the state's benchmark, whichever is greater. However, HHS rejected requests to cover all drugs in six so-called protected classes. "When plans have more flexibility to design clinically based formularies, they can negotiate bigger price concessions from drug makers and offer more affordable, generous prescription drug benefits to patients," Pharmaceutical Care Management Association President and CEO Mark Merritt said. Politico Pro (subscription required)
(11/20)     
| Legislative & Regulatory News | | |
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- Physicians implicated in counterfeit-drug investigation
A Tennessee doctor pleaded guilty to a felony charge of introducing misbranded drugs into interstate commerce with the intent to defraud Medicaid over his purchase of Roche Holding's Rituxan cancer drug made in an unapproved facility. More doctors have been implicated in an ongoing probe into counterfeit Avastin, also made by Roche. Changes in how Medicare reimburses oncologists might have contributed to a rise in counterfeit drugs in the U.S., experts say. The Wall Street Journal
(11/20)
- 4 ways CEOs say health care costs can be cut
Four insurance and health care CEOs held a moderated discussion on remaking health care and identified four main ideas to help bring down rising costs. They suggest gearing reimbursements to population health management rather than paying for services; creating a transparent system where consumers see and understand the prices they pay for health care; changing reimbursements and incentives to encourage primary care; and creating new delivery models that use nurses and other professionals fully and allow nationwide licensing standards. The Wall Street Journal
(11/19)
| Opinion, Commentary & Analysis | | |
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- FDA needs track-and-trace system for biosimilars
 The FDA should establish a track-and-trace system to monitor biosimilars, as well as a naming system to distinguish biologics from biosimilars to protect patients, writes Dr. Bert Petersen of the New York University School of Medicine. Tracking can help the health system identify and respond to issues such as the recent meningitis outbreak. Furthermore, doctors must decide the suitable biologic drug for a patient, a decision that can't be overridden by an insurance company or a pharmacist, Petersen writes. The Hill/Congress Blog
(11/20)
| Editor's Note | | |
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SmartBrief will not publish Thursday and Friday
In observance of Thanksgiving in the U.S., SmartBrief will not be published Thursday and Friday. Publication will resume Monday. Enjoy the holiday!
| SmartQuote | | |
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 | If the only prayer you said in your whole life was 'thank you,' that would suffice."
--Meister Eckhart,
German theologian and philosopher
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| About PCMA |
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PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 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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| | Recent PCMA SmartBrief Issues:
- Tuesday, November 20, 2012
- Monday, November 19, 2012
- Friday, November 16, 2012
- Thursday, November 15, 2012
- Wednesday, November 14, 2012
| | | Lead Editor: Melissa Turner
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