Latest news with #BenefitManagers
Yahoo
17-04-2025
- Business
- Yahoo
Arkansas Gov. Sarah Huckabee Sanders signs bill blocking PBM ownership of pharmacies into law
LITTLE ROCK, Ark. – A hotly contested bill was signed into law by Gov. Sarah Huckabee Sanders on Wednesday. The legislation blocks Pharmacy Benefit Managers (PBMs) from owning pharmacies in Arkansas. The bill was signed on the last working day of the current legislative assembly and had received extensive debate in both chambers. Arkansas bill would prevent Pharmacy Benefit Managers from owning pharmacies The governor said signing the bill was a matter of taking care of an overdue need. 'For far too long, drug middlemen called PBMs have taken advantage of lax regulations to abuse customers, inflate drug prices, and cut off access to critical medications. Not anymore,' Sanders said. 'These massive corporations are attacking our state because we will be the first in the country to hold them accountable for their anti-competitive actions, but Arkansas has never been afraid to be a conservative leader for America.' Arkansas Attorney General Griffin signs letter asking for federal law to prohibit Pharmacy Benefit Managers from owning pharmacies Earlier this week, Arkansas Attorney General Tim Griffin led a bipartisan group of 38 other state and territory attorneys general in writing a letter to congressional leadership requesting action to prevent anti-competitive PBM practices. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
17-04-2025
- Business
- Yahoo
CVS shares statement after Arkansas bill restricting PBMs from owning pharmacies is signed into law
LITTLE ROCK, Ark. – CVS officials said a new law restricting Pharmacy Benefit Managers from owning pharmacies will result in the closure of more than 20 Arkansas pharmacies. Gov. Sarah Huckabee Sanders signed HB1150 into law on Wednesday afternoon. Arkansas Gov. Sarah Huckabee Sanders signs bill blocking PBM ownership of pharmacies into law CVS Health released a statement shortly after the governor signed the bill into law, flatly calling the law 'bad policy.' 'CVS Health welcomes a good faith discussion with policy makers in Arkansas and across the country on ways to make medicine more affordable and accessible,' CVS shared in a statement. 'Unfortunately, HB1150 is bad policy that accomplishes just the opposite: it will take away access to pharmacy care in local communities, hike prescription drug spending across the state by millions of dollars each year, and cost hundreds of Arkansans their jobs.' According to CVS, they have 23 pharmacies across the state. They also noted that this law will close more than 100 mail-order pharmacies in Arkansas. Arkansas bill would prevent Pharmacy Benefit Managers from owning pharmacies Sanders said signing the bill was a matter of taking care of an overdue need. 'For far too long, drug middlemen called PBMs have taken advantage of lax regulations to abuse customers, inflate drug prices, and cut off access to critical medications. Not anymore,' the governor said. 'These massive corporations are attacking our state because we will be the first in the country to hold them accountable for their anti-competitive actions, but Arkansas has never been afraid to be a conservative leader for America.' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Fox News
18-03-2025
- Business
- Fox News
Bipartisan bill seeks to stop pharmacy middlemen from driving up drug costs for financial gain
FIRST ON FOX: A bipartisan group of lawmakers is pushing to reform the incentive structure for Pharmacy Benefit Managers (PBMs), arguing that it drives up patient costs by encouraging them to favor higher-priced drugs while withholding potential savings. Led by physician and GOP Iowa Rep. Mariannette Miller-Meeks, the group introduced the "Delinking Revenue from Unfair Gouging (DRUG) Act" on Tuesday, requiring that PBMs in the commercial market only charge a flat fee for their services related to a specific prescription drug, versus letting them continue to charge a percentage of the drug price. PBMs are third-party intermediaries between insurance companies, drug manufacturers and pharmacies that serve to control drug prices and access. The current incentive structure for PBMs, according to the DRUG Act's sponsors, encourages them to drive up the list price of drugs to increase profits. "Pharmacy benefit managers (PBMs) have excessive influence over the prices patients pay at the pharmacy counter," said Miller-Meeks. "Local Iowa pharmacies are closing due to greedy PBM practices, impacting proximity and access to medications for Iowans. The DRUG Act will put downward pressure on prescription drug prices and insurance premiums by removing the incentive for PBMs to drive up the list price of medications." According to the Iowa Pharmacy Association, PBMs have been using opaque reimbursement models that often pay back pharmacies less than the list cost of a drug and the services provided to dispense it. As a result of these practices, pharmacies in Iowa and across the country have been forced to close, the association said in a January report. Twenty-nine Iowa pharmacies and 2,300 pharmacies nationwide closed their doors in 2024, according to the association. While PBMs have played important roles in making drugs more widely available, through decades of mergers and acquisitions, the three largest PBMs now manage nearly 80% of all prescriptions filled in the U.S., according to a 2024 report from the Federal Trade Commission. The DRUG Act's reforms serve to address this anti-competitiveness, which the bill's sponsors say will also help lower costs. "Pharmacy Benefit Managers (PBMs) contribute to high drug costs because they are incentivized to steer patients towards drugs that are more profitable for PBMs, but may be less clinically effective for consumers," said Rep. Nannette Barragán, D-Calif., one of the bill's co-sponsors. "This broken system disproportionately harms low-income individuals, seniors, and those with chronic illnesses who rely on life-saving prescriptions to manage their health." Rep. Donald Norcross, D-N.J., another co-sponsor of the DRUG Act, said families in his district "are crying out for relief from high prescription drug prices." "Americans deserve access to quality health care and affordable prescription drugs," Norcross said. "The DRUG Act reins in prescription drug prices by removing the incentive for pharmacy benefit managers to drive up costs, increasing transparency and prioritizing patients over profits."
Yahoo
19-02-2025
- Health
- Yahoo
Two local counties, others sue over price of insulin
Two counties in the Charlotte area have filed lawsuits in the last few weeks over the price of insulin. Gaston County and Lincoln County join hundreds of similar lawsuits against drug makers, including ones from the cities of Greensboro and Winston-Salem. Stacey Simms says her son was diagnosed with diabetes in 2006, right before he turned two years old. 'At the time, it was just overwhelming, frightening,' she said. She says the price was especially scary. 'It can be very frightening to feel like you don't know what the price is going to be and this feeling of powerlessness as an individual when you go into the pharmacy,' she said. Patients aren't the only ones concerned. Many employers are suing over insulin pricing. 'Just as patients are paying a lot, the employers are paying an awful lot, and a lot of times that's a government employer. It's ridiculous,' said Simms, who has become an advocate and expert on diabetes and insulin. Patients using diabetes apps can miss critical alerts. Here's how to make sure you're getting them There are hundreds of cases pending, including the ones from Gaston and Lincoln counties. They say over the past two-plus decades, they've overpaid millions of dollars for insulin through their employees' health plans. So, they're suing the manufacturers including Lilly, Novo Nordisk, and Sanofi. 'The manufacturers have colluded together to do what's called lockstep price increases, meaning that if one increases their price to adjust for the rebates and fees, the others will at the same time to ensure that no one individual manufacturer sticks out as far as their price increases,' Brandon Bogle, a lawyer for plaintiffs, told Action 9 investigator Jason Stoogenke, who has been tracking concerns over insulin pricing for years. The plaintiffs are also suing Pharmacy Benefit Managers (PBMs), including CVS Caremark, Express Scripts, and Optum Rx. PBMs are middlemen between drug companies and insurance companies. Their job is to negotiate prices both sides can live with so patients can get the medicine they need for affordable prices. 'They have used that control to extract payments from manufacturers, and those manufacturers' payments have been termed rebates, administrative fees, service fees. Different terms are used, but it's all the same thing. It's a kickback scheme,' Bogle said. Lilly says, 'These copycat lawsuits are baseless. In the only three cases where insulin pricing allegations have been put to their proof, the plaintiffs have either dropped their case, lost their motion to proceed as a class action, or settled for no money. These outcomes speak for themselves. Lilly has been working for years to reduce insulin out-of-pocket costs for people with diabetes, against the headwinds of those — like parties filing these lawsuits — that benefit from rebates and choose higher list-price medicines over lower-priced options. Lilly was the first and still only company to cap what people pay at $35 per month for all of our insulins, we cut insulin prices by 70%, and the average monthly out-of-pocket cost for Lilly insulin is just $17.16.' Novo Nordisk says, 'It believes that the allegations against it are meritless, and we intend to vigorously defend against these claims. While we will not comment further about pending litigation, we recognize that not all patient situations are the same and we have a number of different insulin affordability offerings available through NovoCare. Importantly, we continually review and revise our offerings as well as work with diverse stakeholders to create solutions for differing patient needs.' Sanofi says, 'While we will not comment on the specifics of the allegations, Sanofi's pricing practices have always complied with the law and the company is committed to helping patients access the medicine they need at the lowest possible price. Following through on that commitment requires Sanofi to navigate a complex environment. Under the current system, savings negotiated by health insurance companies and PBMs through rebates are not consistently passed through to patients in the form of lower co-pays or coinsurance. As a result, patients' out-of-pocket costs continue to rise while – between 2012 and 2023 – the average net price of our insulins declined by 76%. Sanofi believes that no one should struggle to pay for their insulin, regardless of their insurance status or income level, which is why we have a suite of innovative and patient-centric savings programs to help people reduce their prescription medicine costs. More information can be found at CVS Caremark says, 'Pharmaceutical companies alone are responsible for the prices they set in the marketplace for the products they manufacture. Nothing in our agreements prevents drug manufacturers from lowering the prices of their insulin products and we would welcome such an action. Allegations that we play any role in determining the prices charged by manufacturers for their products are false, and we intend to vigorously defend against this baseless suit. CVS Caremark has led the way in driving down the cost of insulin for all patients: insured, uninsured, and underinsured. Our members on average pay less than $25, far below list prices and far below the Biden Administration's $35 cap. Further, we also provide access to $25 insulin to every American, whether insured or uninsured, through our ReducedRx program at every one of our 67,000 network pharmacies and more than 9,000 CVS pharmacies.' Express Scripts says, 'We typically can't comment on pending litigation,' but did provide its own data showing its 'average member' pays only '$22 per month.' Optum RX says, 'These baseless actions demonstrate a profound misunderstanding of how drug pricing works. For many years, Optum Rx has aggressively and successfully negotiated with drug manufacturers and taken additional actions to lower prescription insulin costs for our health plan customers and their members, who now pay an average of less than $18 per month for insulin. PBMs, like Optum Rx, are the key counterweight to pharmaceutical companies' otherwise unchecked monopoly power to set and raise drug prices.' MORE ACTION 9: Woman says she had hard time convincing credit card company she wasn't dead If this makes it to trial, the plaintiffs' lawyers expect it to be around the end of 2026 or the beginning of 2027. If the plaintiffs win, patients wouldn't get reimbursed for out-of-pocket expenses (because the cities and counties are the plaintiffs), but they could expect prices to drop for them and their employers. The plaintiffs' lawyers say they anticipate similar cases involving other drugs. This is the kind of litigation where cases are grouped together, but it's not a class action. There is a separate class action going on right now over what consumers claim companies owe them directly. VIDEO: Shoppers concerned about impact of tariffs
