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November 21, 2012
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News for the PBM Industry

  Featured Story 
  • 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) LinkedInFacebookTwitterEmail this Story
  Legislative & Regulatory News 
  • 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) LinkedInFacebookTwitterEmail this Story
  • 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) LinkedInFacebookTwitterEmail this Story
  Opinion, Commentary & Analysis 
  • 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) LinkedInFacebookTwitterEmail this Story
  Editor's Note 
  • 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! LinkedInFacebookTwitterEmail this Story
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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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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