May 4, 2021
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Featured Story
Congressional Democrats agree on the need for government action on drug prices, but they don't agree on how to reallocate any savings from drug price reform.
Full Story: Kaiser Health News (5/4) 
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CEO: PBMs Reduce Rx Costs for Employees
Newtek Business Solutions CEO Barry Sloane discusses how PBMs help his company reduce Rx costs and improve access. Florida-based Newtek Business Solutions is a business development company that helps small and midsize businesses run their operations.
Legislative & Regulatory News
A study in Health Affairs found Medicare spending on common imaging and laboratory tests increased by more than $73 million from 2013 to 2016, and vertical integration in the industry was a key driver of that spending increase. "Medicare and many other payers pay more for the exact same service if it is done in the hospital versus the non-hospital setting," RAND policy researcher Christopher Whaley said, but a CMS effort to institute site-neutral payments was struck down in court.
Full Story: FierceHealthcare (5/3) 
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Major drug distributors McKesson, AmerisourceBergen and Cardinal Health, defending themselves during their first trial over arguments that they exacerbated the opioid epidemic, placed blame on pharmaceutical firms, regulators and doctors. The companies, which were sued by the city of Huntington and Cabell County in West Virginia, argued they are intermediaries and should not be held responsible for the epidemic.
Full Story: Reuters (5/3) 
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HHS' Health Resources and Services Administration has launched a new program intended to cover the cost of COVID-19 vaccine administration for people whose insurance does not fully cover the vaccine. The COVID-19 Coverage Assistance Fund will reimburse providers for eligible claims using national Medicare rates.
Full Story: Healthcare Finance (5/3) 
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The federal government is winding down mass COVID-19 vaccination sites as demand declines and ramping up targeted approaches involving refrigerated vans, community health clinics, local primary care providers, walk-up vaccination sites and door-to-door campaigns in communities with the lowest vaccination rates. Communities where a high proportion of residents refuse vaccination will experience continued sickness and death, while communities with high vaccine uptake will return to normal, says Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security.
Full Story: Politico (5/3) 
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Drug Industry Spotlight
Novavax announced it has broadened the scope of its late-stage trial, evaluating its COVID-19 vaccine candidate in up to 3,000 adolescents between the ages of 12 to 17. Data from this study, which is being conducted in the US and Mexico, is expected to be available in the second quarter.
Full Story: Reuters (5/3) 
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Chance is the first step you take, luck is what comes afterward.
Amy Tan,
May is Asian American and Pacific Islander Heritage Month
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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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Charles Cote
Vice President, Strategic Communications
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