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PBM audit restrictions would result in more fraud, tax group says | Americans for Tax Reform letter | FDA user fee reauthorization faces obstacles
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April 25, 2012
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PBM audit restrictions would result in more fraud, tax group says
A House bill restricting pharmacy benefit managers' authority to audit retail pharmacies would allow more fraudulent prescriptions to be filled, Americans for Tax Reform said in a letter to Rep. Cathy McMorris Rodgers. "H.R. 1971 adds a regulatory layer and administrative burden to the PBM-pharmacy relationship that makes it harder to correct errors and respond to fraud. PBMs already follow federal and state regulations for oversight. Injecting more government control and regulation decreases competition in the pharmaceutical industry while driving up prescription drug costs for consumers. Real reform should look to prevent fraud, but H.R. 1971 incentivizes it," the letter reads.
InsideHealthPolicy (subscription required) (9/29) 
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Legislative & Regulatory News
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FDA user fee reauthorization faces obstacles
Differences between House and Senate versions of bills reauthorizing the FDA Prescription Drug User Fee Act could delay the bill's progress. Differences include terms for exclusivity periods for new antibiotics, the FDA's mission and guidelines for how the agency determines devices' risks.
Politico (4/25) 
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Medicare actuary: Prognosis is not good
The outlook for Medicare's long-term solvency is even worse than stated in the annual trustees' report because scheduled reimbursement reductions will not occur, chief actuary Richard Foster says. Medicare spending will reach 10% of gross domestic product by 2086 under changes Foster believes Congress is likely to embrace, he says.
Kaiser Health News/Capsules blog (4/24) 
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Study: Fewer companies provide health coverage
The percentage of workers with access to health coverage through their employer fell from 70% in 1997 to 67.5% in 2010, according to an Employee Benefit Research Institute study. Most Americans who have insurance still are covered through their jobs. Medicaid and Medicare cover about 5% of the workforce, the study said, and about 3% of people purchase health insurance on their own.
The Hill/Healthwatch blog (4/24),  The Washington Post (tiered subscription model)/Wonkblog (4/24) 
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Drug Industry Spotlight
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FDA approves Sun's generic of Lilly's antipsychotic Zyprexa
The FDA is allowing Sun Pharmaceutical Industries to manufacture and sell olanzapine, a generic version of Eli Lilly and Co.'s antipsychotic Zyprexa. The generic-drug-maker said it will sell olanzapine at 20, 15, 10, 7.5, 5 and 2.5 milligrams.
The Wall Street Journal (tiered subscription model)/Dow Jones Newswires (4/24) 
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Opportunity is missed by most people because it is dressed in overalls and looks like work.
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American inventor
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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 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.

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