Pharmacy Benefit Consultants - Blog

Federal PBM Probe Culminates Decades of M&A

14 Jun, 2022

By Nona Tepper and Maya Goldman, June 14, 2022

Pharmacy Middlemen Sue To Stop Rebate Transparency

22 Aug, 2021

By Marty Schladen, August 20, 2021

Recent MS Drug Developments Demonstrate Plans Should Obtain Customized Formularies ASAP

16 Feb, 2021

How Long Is Your Plan Willing To Throw Away Thousands of Dollars Per Script For An MS Drug? ____________ Review your Plan’s most expensive therapeutic categories, and it’s virtually certain you’ll

Expert warns: Ohio Medicaid Poised for Big Trouble

21 Oct, 2020

By Marty Schladen, August 27, 2020

Is Ohio’s Revamp On Drug Middlemen Working

08 Dec, 2019

By Cathy Candisky and Darrel Rowland, December 8, 2019.

Ohio Medicaid Still Hemorrhaging Money, Expert Testifies

21 Nov, 2019

By Cathy Candisky, November 21, 2019

State’s New Drug Setup Still Riddled With Loopholes

10 Feb, 2019

By Marty Schladen. February 10, 2019.

Require Your PBM To Take Action on Zytiga

10 Jan, 2019

If your Plan wants to decrease and control its costs, you need your PBM to take advantage of every Specialty Drug savings opportunity. Unfortunately, many - if not most -

The Unclear Benefits of Drug Price Coalitions

27 Sep, 2018

By Bob Herman. September 27, 2018.

Create Rational Quantity Limits For Specialty Drugs

24 Jul, 2018

Any Plan that wants to control its prescription coverage costs needs to control the "days supply" of Specialty Drugs that will be dispensed by its PBM. Your Plan can't afford

Ohio Peels Back The Curtain On A Lucrative PBM Profit Center

22 Jun, 2018

By Ed Silverman. June 22, 2018.

AWP: Three little letters that could affect your wallet and health

14 Jun, 2018

By Darrel Rowland and Cathy Candisky, June 13, 2018

Decreasing Drug Costs – Here’s How We Achieved Them

08 Apr, 2018

We're pleased to report that the National Prescription Coverage Coalition has yet again achieved striking savings for our Coalition Members. Based on year-end analyses, our Coalition Members decreased their prescription

Drug prices continue to climb despite barrage of criticism

26 Mar, 2018

By Angelica LaVito. March 21, 2018.

More Drug Price Increases

19 Mar, 2018

Remember when several drug manufacturers promised last year to limit their drug price increases to single digits and claimed other drug manufacturers drastically increasing their drug prices were "outliers"? If those manufacturers'

Long-Dreaded Amazon Threat to Drug Middlemen Draws Closer

30 Jan, 2018

By Robert Langreth and Zachary Taylor. January 30, 2018.

Your Plan Can Decrease Its Prescription Coverage Costs (But You Need To Take Action To Do So)

15 Jan, 2018

We're thrilled to report yet again that the National Prescription Coverage Coalition has achieved striking savings for our Coalition Members. Based on year-end analyses, our Coalition Members decreased their prescription coverage costs by approximately 20% to

PBMs: Will the Amazon Cometh?

01 Dec, 2017

By Robert Calandra. December 1, 2017.

Congress Needs the Political Courage to Defy the Drug Manufacturer Lobby

17 Nov, 2017

Linda Cahn, Op-Ed Contributor. November 17, 2017.

Act Now – Block Lyrica CR Preemptively

17 Nov, 2017

If your Plan wants to control its prescription coverage costs - and minimize disruption to your plan beneficiaries - your Plan needs to act preemptively to block certain drugs before

Act Now – Block Lyrica CR

17 Nov, 2017

If your Plan wants to control its prescription coverage costs - and minimize disruption to your plan beneficiaries - your Plan needs to act preemptively to block certain drugs before they

Plan Administrators: Limit Your Restasis Coverage

05 Oct, 2017

If you missed the latest example of drug manufacturer abuse, you need to learn about Allergan's Restasis antics, understand your Plan's resulting costs, and take action in response. Why? Because

It’s Time To Limit Your Coverage of Restasis

05 Oct, 2017

If you missed the latest example of drug manufacturer abuse, you need to learn about Allergan's Restasis antics, understand your Plan's resulting costs, and take action in response. Why? Because

New Rx Drugs: The “Latest” Is Not Necessarily The “Greatest” When It Comes To Drugs

09 Aug, 2017

Rx Alert - October 2014 The drug marketplace is constantly changing, and new prescription drugs are continually entering the marketplace. To protect your plan beneficiaries' health - and your Plan's

Fix Your Claims Data Errors – Or Lose Money & Eviscerate the Meaning of Your PBM Contract’s Financial Guarantees

09 Aug, 2017

It’s critically important that every health plan monitor its claims data to determine whether claims data errors are allowing your PBM to overcharge for drugs and misrepresent whether the PBM

New Hep C Realities: December 2014-January 2015

09 Aug, 2017

During the final days of 2014 and first week of 2015, newspapers around the nation announced three new developments that purportedly changed the prescription coverage world: On December 19th, the

Plan Administrators and Fiduciaries: It’s Time To Take REBATE ACTION – File An Accounting Procedure!

10 Jul, 2017

PBMs' questionable rebate conduct, every Plan administrator and fiduciary should consider filing a lawsuit against your PBM seeking an "accounting". As a Plan administrator or fiduciary, you're charged with ensuring

It’s Time To Determine How Much Your PBM Is Depriving Your Plan Of Rebates: File An “Accounting” Procedure

10 Jul, 2017

As newspaper articles multiply describing PBMs' questionable rebate conduct, every Plan administrator and fiduciary should consider filing a lawsuit against your PBM seeking an "accounting". As a Plan administrator or fiduciary, you're charged with ensuring your Plan receives

How Two Common Medications Became One $455 Million Specialty Pill

20 Jun, 2017

by Marshall Allen. June 20, 2017.

How Two Common Medications Became One $455 Million Specialty Pill

20 Jun, 2017

by Marshall Allen. June 20, 2017.

No Quick Cure for Express Scripts’ Ailing Shares

05 Jun, 2017

by Bill Alpert. June 5, 2017.

A Drug Quintupled in Price. Now, Drug Industry Players Are Feuding Over the Windfall

01 Jun, 2017

by Charles Orenstein and Katie Thomas. June 1, 2017.

Express Scripts Sues Manufacturer of Overdose Treatments

01 Jun, 2017

by Angela Mueller. June 2017.

Express Scripts Sues Maker of Overdose Drug, Intensifying Feud

31 May, 2017

by Katie Thomas and Charles Orenstein. May 31, 2017.

Express Scripts’ Lawsuit Reveals Striking Information About PBM Rebates

31 May, 2017

For years, every PBM has refused to disclose the "rebates" that it earns on a drug-by-drug basis. As a result, no one has been able to detect the "net cost"

Express Scripts Lawsuit Should Raise Everyone’s Eyebrows

31 May, 2017

For years, every PBM has refused to disclose the "rebates" that it earns on a drug-by-drug basis. As a result, no one has been able to detect the "net cost"

A Drug Quintupled in Price. Now, Drug Industry Players Are Feuding Over the Windfall

31 May, 2017

by Charles Orenstein and Katie Thomas. May 31, 2017.

Would Amazon Really Succeed As A Pharmacy Benefit Manager?

18 May, 2017

by Ed Silverman. May 18, 2017.

Want To Decrease Your Rx Coverage Costs? Pay Attention to Horizon Pharma’s 1st Quarter Report

15 May, 2017

Horizon Pharma - the manufacturer of three extremely expensive drugs - Vimovo, Duexis and Pennsaid – just released its Quarterly Earnings Report causing its stock to plummet. The Report should

Lessons from Horizon Pharma: Stop Covering Vimovo, Duexis and Pennsaid and Stop Relying on Your PBM’s “Standard” Formulary

15 May, 2017

Horizon Pharma - the manufacturer of three extremely expensive drugs - Vimovo, Duexis and Pennsaid – just released its Quarterly Earnings Report causing its stock to plummet. The Report should also

Inside the ‘Scorpion Room’ Where Drug Price Secrets Are Guarded

04 May, 2017

by Neil Weinberg and Robert Langreth. May 4, 2017.

Striking Savings Are Possible (But Your Plan Needs To Act To Obtain Them)

30 Apr, 2017

We're thrilled to report that yet another Coalition Member that followed our Coalition's recommendations and took aggressive steps to control its prescription coverage costs has now achieved a 16% cost

Striking Savings Are Possible (But Your Plan Has To Act To Get Them)

30 Apr, 2017

A Secret Profit Formula Loved by Drug Middlemen Is At Risk

26 Apr, 2017

by Robert Langreth and Neil Weinberg. April 26, 2017.

Spread Pricing – Marking Up Drug Claims

27 Mar, 2017

As featured on The National Community Pharmacists Association (www.ncpanet.org).

Bloomberg Article on PBMs – quotes Cahn

17 Mar, 2017

Drug Costs Too High? Fire the Middleman Caterpillar’s lowered drug bills show why pharmacy benefit managers are under fire. by Neil Weinberg and Robert Langreth March 3, 2017 at 5:00:12 AM EST From

Drug Costs Too High: Fire the Middlemen

03 Mar, 2017

by Neil Weinberg and Robert Langreth. March 3, 2017.

Pull Back the Curtain on Manufacturers’ and Switch Operators’ Efforts To Undermine Your Plan’s Cost Savings Efforts

11 Jan, 2017

Plan Administrators: Have you ever heard of "switch operators"? Do you have any idea what they do? Most important, do you realize that drug manufacturers are surreptitiously paying switch operators

Manufacturers Are Using “Switch Operators” To Undermine Your Plan’s Cost Saving Efforts

11 Jan, 2017

Plan Administrators: Have you ever heard of "switch operators"? Do you have any idea what they do? Most important, do you realize that drug manufacturers are surreptitiously paying switch operators to interfere with

Pharmacy Benefit Managers Could Be In Legislative Crosshairs

03 Jan, 2017

by Christian Britschgi. January 3, 2017.

Don’t Be Fooled By Eli Lilly’s & Express Scripts’ New Diabetes Program

21 Dec, 2016

If you've been preoccupied with Trump's latest cabinet appointments, you may have missed the news about a new program sponsored by Eli Lilly and Express Scripts. With great fanfare, the

Don’t Be Fooled By Eli Lilly’s & Express Scripts’ New Insulin Program

21 Dec, 2016

If you've been preoccupied with Trump's latest cabinet appointments, you may have missed the news about a new program sponsored by Eli Lilly and Express Scripts. With great fanfare, the two

Don’t Be Duped By Manufacturers’ Single Digit Price Increase Pledges

21 Dec, 2016

Recently, Novo Nordisk's President became the second drug manufacturer to make a "Single Digit Price Increase Pledge." Replicating Allergan's vow three months ago, Novo's Jakob Riis promised that Novo would

Don’t Be Duped By Manufacturers’ New “Single Digit Price Increase Pledges”

16 Dec, 2016

Message from Mylan: It’s Time For Every Health Plan To Address Rebate Issues

17 Nov, 2016

For more than a decade, our firm has called on every PBM to identify all rebates (and other monies) the PBM is receiving from manufacturers - as well as the "net costs" of every drug

Message from Mylan: Pay Attention to Rebates

17 Nov, 2016

For more than a decade, our firm has called on every PBM to identify all rebates (and other monies) the PBM is receiving from manufacturers - as well as the

Take Action To Decrease Your Plan’s Crestor Costs

17 Nov, 2016

If you examine your Heath Plan's claims data, it's extremely likely you'll discover that Crestor is costing your Plan a small fortune. Typically, Crestor represents more than 1% of

Take Action To Decrease Your Plan’s Crestor Costs

13 Nov, 2016

If you examine your Heath Plan's claims data, it's extremely likely you'll discover that Crestor is costing your Plan a small fortune. Typically, Crestor represents more than 1% of a Plan's total

Pay Attention to Your Metformin HCL ER Diabetes Costs

30 Oct, 2016

If you examine your claims data, you'll likely discover that among your "Top 50 Most Expensive Drugs" is a line item for generic "metformin HCL ER". Metformin HCL is a

Pay Attention to Your Metformin HCL ER Diabetes Costs

30 Oct, 2016

If you examine your claims data, you'll likely discover that among your "Top 50 Most Expensive Drugs" is a line item for generic "metformin HCL ER". Metformin HCL is a longstanding, very inexpensive diabetes

Additional Information About New Drugs’ Dangers

09 Oct, 2016

We previously wrote about new drugs' dangers, and received many requests for additional information. Accordingly, we thought our readers would benefit from the following additional information reflecting why all health

MORE REASONS to Protect Your Beneficiaries Against New Drugs’ Dangers

09 Oct, 2016

The FDA’s Latest Hep C Drug Warning Makes Clear Why You Should Protect Your Beneficiaries From New Drugs’ Dangers

06 Oct, 2016

The latest FDA Black Box Warning about hepatitis C treatments demonstrates why it's imperative that your Plan implement methods for protecting your beneficiaries against the dangers of new drugs. After all,

Protect Your Plan Beneficiaries From New Drugs’ Dangers

06 Oct, 2016

End Your PBM’s Refill Pill Mill

27 Sep, 2016

Unbeknownst to health plans, many PBMs are dispensing through their subsidiary pharmacies far more pills than needed, at great cost to the health plans. Thus, if your health plan is

Hep C Drugs: Is Your Plan Really Benefiting From Your PBM’s “Deal”?

27 Sep, 2016

HR Execs: Do you think your PBM's shake-down of hepatitis C manufacturers really decreased your health plan's costs? If so, you should follow Ronald Reagan’s approach with the Russians: "Doveryai no

Controlling New Specialty Drug Costs: Lessons from Farydak & Kalydeco

27 Sep, 2016

In February 2015, the FDA approved Farydak, a new treatment for multiple myeloma. The drug’s wholesale price: $6,860 for a 21 day cycle. But note that unless a health plan negotiates strong

Protect Your Health Plan Against Astronomical Drug Price Increases

26 Sep, 2016

Drug prices were in the news this week because of a shocking 5000% increase in the cost of a single drug: Daraprim. But during the first 9 months of 2015, the

Control Testosterone Use – For Health & Cost Reasons

26 Sep, 2016

Spend a few minutes studying your health plan's claims data, and you'll very likely discover your plan is spending large sums of money on men's testosterone products. In fact, you'll

Stop Covering Rx Drugs That Are Available Over-the-Counter

26 Sep, 2016

Virtually all health plans are spending a small fortune covering Proton Pump Inhibitors - drugs like Nexium, Prilosec and Prevacid, and their generic equivalents (esomeprazole, omeprazole and lansoprazole). Unfortunately, almost no PBMs

When Drugs Lose Their Patent Protection, Change Your Coverage and Save!

26 Sep, 2016

If your Plan is like most Plans in the country, you are spending a small fortune on Abilify, even though Abilify lost its patent protection in 2015 and a generic equivalent is available at

Stop Paying For Drugs The FDA Has Never Even Approved

26 Sep, 2016

Approximately 100 years ago, at the turn of the twentieth century, anyone could market any concoction claiming it solved any - or every - health problem. Dr. Bull advertised a purportedly

Protect Your Plan: Address Extreme Price Increases

25 Sep, 2016

You've undoubtedly heard that Turing Pharmaceuticals purchased a low-cost drug, Daraprim, and raised its cost by 5433% last year. And Turing's smug CEO, Martin Shkreli, defended the price hike as perfectly reasonable.

Does Your Health Plan Actually Need the Large Chain Pharmacies In Your Retail Pharmacy Network? (The Short Answer is “No!”)

25 Sep, 2016

Most health plans' prescription coverage programs allow plan beneficiaries to purchase drugs at virtually all retail pharmacies in the United States, regardless of the prices charged by those pharmacies. But

It’s Time To Exclude High-Cost Pharmacies From Your Retail Pharmacy Network

25 Sep, 2016

Pharmacy Benefit Managers Under Pressure

23 Jul, 2016

by Bill Alpert. Cover Story, July 23, 2016.

Pharmacy Managers Unleash Big Data

30 Jun, 2016

by Zachary Tracer. June 30, 2016.

Are You Taking Action To Protect Your Health Plan Against Extreme Drug Price Increases?

22 Jun, 2016

You've undoubtedly heard that Turing Pharmaceuticals purchased a low-cost drug, Daraprim, and raised its cost by 5433% last year. And Turing's smug CEO, Martin Shkreli, defended the price hike as

It’s Time To Stop Paying For Drugs That Were Never Even Approved By The FDA

26 May, 2016

Approximately 100 years ago, at the turn of the twentieth century, anyone could market any concoction claiming it solved any - or every - health problem. Dr. Bull advertised a

Just How Much Is Your Plan Spending On Abilify – and Other Drugs – That Have Recently Lost – Or Will Soon Lose – Their Patent Protection ?

27 Apr, 2016

If your Plan is like most Plans in the country, you are spending a small fortune on Abilify, even though Abilify lost its patent protection in 2015 and a generic

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