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PBM Legislative Update: One Bill in the House, Three in the Senate | AMCP Nexus 2023
Melissa Andel, M.P.P., of CommonHealth Solutions LLC, thumbnailed the four pieces of legislation advancing through Congress that would tighten regulation and oversight of pharmacy benefit managers (PBMs).
In Washington and in healthcare, pharmacy benefit managers (PBMs) are in the legislative hotseat.
Today at the Academy of Managed Care Pharmacy (AMCP) Nexus 2023 meeting in Orlando, Melissa Andel, M.P.P.,summarized the various PBM bills under consideration and shared some insights into the legislative anbd political forces that are shaping their future and which provisions, if any, will survive and become law.
In a Zoom interview with Managed Healthcare Executive before the meeting, Andel, whose healthcare consultancy is called CommonHealth Solutions and who has worked in legislative affairs for AMCP, gave a brief overview of the PBM bills that have advanced in this session of Congress. A single bill has been put together in the House, according to Andel.
“On the Senate side, it’s a little bit more complicated,” said Andel, with separate bills having been voted out of the finance, health, education, labor and pensions, and commerce committees. The content of those bills is determined, in part, by the jurisdictions of those committees, Andel explained. For example, the Senate Finance Committee’s has jurisdiction over Medicare and Medicaid so its PBM legislation focuses on changing Medicare and Medicaid rules for PBMs and how drug expenditures are managed and covered.
How Prime Therapeutics Tugged on the Reins of the Galloping GLP-1 Spend | AMCP Nexus 2023
October 20th 2023The Minnesota-based pharmacy benefit manager says a program that resulted in patients switching from two incretin therapy prescriptions to one yielded $7,500 in savings per patient and a total of $3.5 million.
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Race, Income Impact Specialty Drug Use of Autoimmune Condition Treatments | AMCP Nexus 2023
October 20th 2023In a platinum award winning poster presented at the AMCP Nexus 2023 conference in Orlando, “Specialty drug use varies by race and wage among employees with employer-sponsored health insurance,” authors expressed that spending on specialty medications for autoimmune conditions has increased in recent years, raising affordability concerns for employers.
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The Oncology Pipeline Is Delivering Exciting New Treatments — and Sticker Shock | AMCP Nexus 2023
October 19th 2023Research continues to develop new therapies for rare cancers and to provide options that allow for fewer toxicities. At the same, however, more new drugs are launching with high price tags.
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The Benefits of ML, AI Use in Managed Care Pharmacy | AMCP Nexus 2023
October 19th 2023Adopting evolving computer system tools like artificial intelligence and machine learning in managed care pharmacies have resulted in efficiency when addressing the challenges they are faced with, according to Jessica Hatton, PharmD, BCACP, associate vice president of Pharmacy at CareSource and Nick Trego, PharmD, senior vice president of Clinical Analytics and Client Services at HealthPlan Data Solutions, Inc.
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Outcomes From Horizon BCBS of New Jersey Oncology Home Infusion Program | AMCP Nexus 2023
October 19th 2023The program yielded savings of $25,000 per patient in its pilot phase but is not expected to produce savings as a routine offering because reimbursement for home infusion was matched to reimbursement at a facility. Horizon executive Timothy O’Shea, Pharm.D., M.S., says cost savings were a “secondary outcome” of the program and noted the high patient satisfaction.
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