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March 4, 2013

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News for the PBM Industry

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Insurers must report all rate hikes under new rules
Health insurers will be required to report all premium increases under new HHS rules. Current rules require insurers to report rate hikes of no less than 10%. The new rules will allow HHS to "identify patterns that could indicate market disruption," HHS Secretary Kathleen Sebelius said, but insurers say the rule will be burdensome and expensive. The New York Times (tiered subscription model) (3/3)

Registration is now open for PCMA's Specialty Pharmacy Business Forum!
The SPBF provides individuals and companies in the specialty pharmacy chain of commerce with exceptional educational and business networking opportunities. A unique aspect of the conference is "PCMA-Connect," an online networking community that will give attendees the opportunity to search for, connect, and coordinate meetings with existing and potential business customers and partners.

Legislative & Regulatory News

HHS explains rules for multi-state plans
Health insurers offering multi-state plans will in some cases be allowed to comply with federal rules for benefit packages instead of individual state rules, though most state rules are similar, the Obama administration said. The Wall Street Journal (3/1)

Rep. Ryan's budget plan includes voucher-like Medicare
Rep. Paul Ryan, R-Wis., is drafting a budget that would give future seniors a fixed amount of money to buy traditional Medicare or private health insurance. The plan could include the continuation of sequestration's cuts over the next 10 years. Los Angeles Times (tiered subscription model) (3/2)

Change fee-for-service model to cut spending, report advises
Health care payment models that reimburse based on services rendered should be replaced with a blended model, according to a report from the National Commission on Physician Payment Reform. A more efficient model would reimburse better for diagnostics and management, incorporate quality metrics into reimbursement rates, eliminate differential payments based on facility, encourage small organizations to share resources and include fixed payments for certain patients. MedPage Today (free registration) (3/4), Kaiser Health News/Capsules blog (3/4)

Drug Industry Spotlight

FDA to scrutinize 30 compounders in 2 months
The FDA plans to inspect around 30 drug compounders in the next two months amid heightened efforts following a deadly meningitis outbreak tied to compounded drugs. The pharmacies mainly produce sterile drugs for health care providers across the country, FDA spokeswoman Erica Jefferson said. Bloomberg Businessweek (3/1)

Special interests seek to shape laws on compounding pharmacies
While drugmakers urge Congress to regulate compounding pharmacies more tightly, veterinary groups, hospitals and the compounders themselves say that restrictions on mass-producing drugs will result in more shortages. The Washington Post (3/2)

PCMA: How independent drugstores that compound drugs can be part of the patient safety solution

Bill would allow HHS to negotiate prices under public drug plan
Although Medicare Part D has generated significant cost savings, eight Democrats in Congress have reintroduced legislation to form Medicare prescription drug plans as alternatives to privately administered plans under Part D. Similar efforts have failed in the past. Pharmalot.com/Pharma Blog (3/1)

SmartQuote

The man who insists upon seeing with perfect clearness before he decides, never decides. Accept life, and you must accept regret."

--Henri Frédéric Amiel,
Swiss philosopher, poet and critic

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Contact PCMA

Charles Cote
Vice President, Strategic Communications
(202) 207-3610

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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 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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