National Reports-Some recent media reports have indicated that the Medicare drug benefit has been responsible for increased earnings for pharmaceutical companies and increased membership for health plans. That may or may not be the case, say industry watchers.
NATIONAL REPORTS-Some recent media reports have indicated that the Medicare drug benefit has been responsible for increased earnings for pharmaceutical companies and increased membership for health plans. That may or may not be the case, say industry watchers.
Robert Taketomo, PharmD, MBA, president/CEO at Ventegra in La Jolla, Calif., says the Medicare drug benefit definitely has rewarded many of the companies that service Medicare plans. "The financial incentive to provide products and services to support this program were enormous, and the benefits of the initial 'Medicare effect' are being seen in many earnings reports," Taketomo says.
It is important to recognize that the majority of beneficiaries are individuals who were previously enrolled in Medicaid, says Kimberly P. McDonough, PharmD, president of Advanced Pharmacy Concepts, a pharmacy benefits audit and consulting firm in North Kingstown, R.I. "Pharma was required by law to provide rebates to all states for Medicaid expenditures," she explains. "Many states also negotiated supplemental rebates. These rebates are not mandated under Medicare. It is my sense that, with some exceptions, the Medicare rebates are not as broad or high as those received by Medicaid. This would be beneficial to pharma."
David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
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Upended: Can PBM Transparency Succeed?
March 6th 2024Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.
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Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization’s innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company.
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The deliberate disconnection of Change Healthcare to ring fence a cyberattack entered its seventh day today. Prescribers are finding ways to get pharmacy claims processed, and UnitedHealth Group says disruption to the dispensing of prescriptions has been minimal. But independent pharmacies want more information and protection from financial consequences from pharmacy benefit managers.
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