Report: Most HMOs depend on PBMs | Drug coverage likely to differ by state with ACA, study finds | PCMA statement on essential health benefits proposed rule
December 5, 2012
PCMA SmartBrief
News for the PBM Industry

Featured Story
Report: Most HMOs depend on PBMs
Some 80% of health maintenance organizations develop their own drug formularies instead of using an associated pharmacy benefit manager's formulary, Sanofi's 2012-13 HMO-PPO Digest shows. Nearly every HMO processes prescriptions through a PBM and more than 80% also dispense drugs through a PBM, but some 27% of HMO prescriptions are filled through in-house pharmacies. Drug Channels (12/5)
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Legislative & Regulatory News
Drug coverage likely to differ by state with ACA, study finds
A new study from Avalere Health shows that basic prescription drug benefits under the Affordable Care Act are likely to differ by state. The Washington Post (tiered subscription model)/The Associated Press (12/4)
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Governors urge flexibility with Medicaid
Governors meeting with President Barack Obama about avoiding automatic tax increases and spending cuts asked for more flexibility in their management of Medicaid and other federal-state programs. CBS News (12/4)
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Drug Industry Spotlight
Lilly wades into generic-drug market
Eli Lilly & Co. will partner with Strides Arcolab to develop and deliver generic cancer therapies in emerging markets. Reuters (12/5)
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FDA may be ready to rethink antibiotic development
An advisory panel's vote last week is among the signals that the FDA may be ready to reconsider requirements for clinical trials of antibiotics. As multidrug-resistant bacteria strains have become more common, new antibiotic approvals have decreased. Nature (12/4)
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U.S. readies for possible entry of generic painkiller from Canada
The White House warned border agents and police to be ready for addictive painkillers to begin flowing across the border from Canada, where generic formulations of the pain drug OxyContin are poised to reach the market. "The potential exists for diversion into the United States because the old formulations, which are easier to abuse, are unavailable in the United States," the warning said. "This alert seeks to raise awareness of this change with law enforcement along the Northern Border so law enforcement and border officials can work jointly to prevent diversion." The Wall Street Journal (tiered subscription model) (12/4)
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Ranbaxy's recalled drug is safe to use, FDA reports
The FDA announced that it is safe to keep taking Ranbaxy Laboratories' atorvastatin calcium drug, which was recalled last month due to possible contamination with small glass particles. Additional information provided by Ranbaxy demonstrated that the likelihood of serious health problems associated with product use was small, an official stated. The Plain Dealer (Cleveland) (12/3)
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The forceps of our minds are clumsy things and crush the truth a little in the course of taking hold of it."
-- H.G. Wells,
British author
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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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