Report: PBM savings strategies pay off for employers | Essential health benefits must be affordable, coalition tells HHS | States will embrace Medicaid expansion, insurance exec says
January 24, 2013
PCMA SmartBrief
News for the PBM Industry

Featured Stories
Report: PBM savings strategies pay off for employers
Pharmacy benefit managers negotiate significant rebates from drugmakers and pass on the savings to large employers, a Pharmacy Benefit Management Institute report shows. Drug Channels (1/24)
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Essential health benefits must be affordable, coalition tells HHS
The Essential Health Benefits Coalition, whose members include PCMA, urged HHS to keep affordability for small businesses in mind when setting essential health benefits. HHS should scale back plans to require coverage of at least one drug in each therapeutic category, ease requirements for pediatric dental and vision care coverage and allow the use of techniques to make sure benefit use is supported by evidence-based guidelines, the group said. Modern Healthcare (free registration) (1/23), (subscription required)/Healthbeat (1/24)
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Registration is now open for PCMA's Managed Markets Educational Forum!
Whether you are a seasoned managed markets executive or someone who supports the team, PCMA's Managed Markets Educational Forum will provide valuable education on fundamental, as well as complex and strategic issues relevant to professionals of all levels within pharma managed markets or market access divisions. Visit PCMA's website to learn more about our 2013 events!
Legislative & Regulatory News
States will embrace Medicaid expansion, insurance exec says
Most states will eventually decide to expand Medicaid in accordance with the Affordable Care Act, WellPoint Executive Vice President Richard Zoretic says. Though eligibility and coverage vary among states, most have made efforts to improve the application process by allowing online enrollment and renewal, a Kaiser Family Foundation study shows. Reuters (1/23)
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NAIC president: Postpone health care law to avoid chaos
Implementation of the Affordable Care Act might need to be delayed beyond the scheduled Oct. 1 start of enrollment in order to avoid chaos as millions of uninsured Americans begin using the system, says Jim Donelon, president of the National Association of Insurance Commissioners. "It's [President Barack Obama's] calling-card, signature issue, and to rush it into implementation before it's ready would not be in his overall interest," Donelon says. Bloomberg (1/22)
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Drug Industry Spotlight
House bill would negate Amgen provision in "fiscal cliff" deal
Rep. Peter Welch, D-Vt., introduced a bill that would subject a class of kidney drugs including Amgen's Sensipar to Medicare price controls. The deal approved to avert the "fiscal cliff" included language delaying price controls by two years, which critics say would cost Medicare close to $500 million. The Hill/Healthwatch blog (1/23)
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FDA: Low prices contribute to generic drug shortages
Competition within the generic drug market that keeps prices low also contributes to injectable drug shortages, an FDA report says. Generics manufacturers may try to keep their costs low by cutting corners on quality control, and few generics makers have backup manufacturing facilities available in the event that quality issues halt production, FDA officials said. The Medicare Modernization Act of 2005 lowered reimbursement rates for generic sterile injectable drugs and might have had a role in shortages, they said. MedPage Today (free registration) (1/23)
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All news is an exaggeration of life."
-- Daniel Schorr,
American journalist
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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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