Trump signs health care EOs | JC Scott explains how PBMs have evolved | Gilead agrees to pay $97M for kickbacks to charity
September 25, 2020
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President Donald Trump issued new executive orders that he and HHS Secretary Alex Azar say will ensure Americans with existing health conditions can get health insurance, regardless of whether the Affordable Care Act is fully or partially repealed; allow the import of drugs from Canada; ban balance billing; and require hospitals and insurance companies to post all prices online. Trump also said the federal government will be issuing vouchers worth $200 to cover prescription drug costs for Medicare beneficiaries, which the administration says will be paid for with savings from the so-called most favored nations drug price policy, which has yet to be implemented.
Full Story: STAT (tiered subscription model) (9/25),  Reuters (9/24),  United Press International (9/24) 
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PBM Industry News
Pharmacy benefit managers have always negotiated lower costs with drugmakers and drugstores on behalf of insurance plans, which apply the savings to premiums or to defray individual costs at their discretion, but PBMs have evolved into care managers that help plan sponsors provide holistic services, says Pharmaceutical Care Management Association President and CEO JC Scott. PBMs increasingly use technology and harness data to connect insurance plans, health care providers, pharmacies and patients. They also have deployed real-time benefit tools that help health care providers prescribe the most affordable, effective drugs for their patients, Scott says.
Full Story: B-Time Podcast with Beth Bierbower (9/22) 
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Drug Industry Spotlight
Gilead Sciences agreed to pay $97 million to settle allegations that the company supported a patient advocacy organization as a means to boost sales of its pulmonary arterial hypertension drug Letairis. The Department of Justice had alleged that Gilead's donations to the Caring Voice Coalition were used to cover Medicare beneficiaries' co-pays.
Full Story: Reuters (9/24) 
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The US Court of Appeals for the 6th Circuit has held that plaintiffs in a case against opioid manufacturers and distributors cannot form a "negotiation class" that would have included 33,000 municipalities and counties in settlement talks. The federal judge in Ohio presiding over 2,900 opioid lawsuits had approved the negotiation class model, which would have included an opt-out provision, but drugmakers and six Ohio counties opposed it.
Full Story: Reuters (9/24),  Courthouse News Service (9/24) 
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The FDA issued a Drug Safety Communication this week calling on makers of benzodiazepines to update boxed warning with language about risks associated with the drugs. The action was based on postmarketing data, a literature review and an evaluation of 104 reported adverse events.
Full Story: Regulatory Focus (9/23) 
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There comes a time when you have to stand up and be counted.
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professional American football player
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About PCMA
PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for 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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