Report highlights high cost of specialty drugs | Appeals court rules against FTC in pay-for-delay case | CMS issues final rule to clamp down on Medicare fraud
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April 27, 2012
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Report highlights high cost of specialty drugs
Specialty-drug makers have "near-monopoly pricing power," and most of these drugs are covered under medical insurance plans, not pharmacy benefit plans, a study found. "The division of benefit structures makes management of specialty drugs more complex and challenging for payers," the study authors wrote. Modern Healthcare (subscription required) (4/26)
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Legislative & Regulatory News
Appeals court rules against FTC in pay-for-delay case
A federal appeals court upheld a ruling that a deal between Solvay SA and three other companies to delay generic versions of Solvay's Androgel until 2015 did not violate antitrust laws, as the Federal Trade Commission alleged. Bloomberg (4/25)
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CMS issues final rule to clamp down on Medicare fraud
The CMS on Tuesday issued a final rule intended to combat Medicare fraud and save the U.S. almost $1.6 billion in costs over a decade. A Government Accountability Office report, however, said that more needs to be done and pressed the CMS to run pre- and post-payment claims evaluations and to address program vulnerabilities. Healthcare IT News (4/24)
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GOP report: PPACA will raise costs
The PPACA will raise the cost of health care through higher taxes, fees and administrative requirements, according to a report compiled by House Energy and Commerce Committee staff with input from corporate members of a presidential jobs panel. Democrats dismissed the report as partisan and pointed to other corporations that have said the law will not have a negative effect. The report also says some large companies are being urged by consultants to cut health coverage in 2014 and shift workers instead to state-run exchanges. Reuters (4/26), The Wall Street Journal (tiered subscription model) (4/26)
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Drug Industry Spotlight
McKesson agrees to $190M settlement in pricing lawsuit
McKesson will pay more than $190 million to settle claims that it issued false reports about drug prices, forcing Medicaid to pay extra for prescription medications. While the company thinks it did not violate the False Claims Act, "this settlement was in the best interest of our employees, customers, suppliers and shareholders," spokesman Kris Fortner said. Bloomberg Businessweek (4/26)
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Amgen partners with clinical-research organization on biosimilars
Amgen and PRA, a clinical-research organization, agreed to collaborate in a series of late-stage trials to develop the former's biosimilar drugs. The deal makes PRA the exclusive provider of CRO services for Amgen's biosimilars. MedCityNews.com (4/26)
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SmartQuote
Ideas are like rabbits. You get a couple and learn how to handle them, and pretty soon you have a dozen."
-- John Steinbeck,
American writer
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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 216 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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