The cost of prescription drugs has long been one of the most widely discussed and debated health policy topics, but policy makers have historically differed in how to deal with this issue.However, in the last few years Pharmacy benefits managers (PBMs) are gaining more and more attention in the debate and are becoming more and more common in their proposals given their central role in the drug supply chain. Bipartisan reform..
PBM manages prescription drug use and spending on behalf of health insurance companies by negotiating rebates with pharmaceutical companies, formulating insurance plan formulas, and refunding prescription drugs to pharmacies.However PBM is Was criticized For lacking transparency and absorbing the savings they make. Earlier federal reports found that most of PBM’s savings were passed on to health insurance sponsors, but in fact PBM is insured because it allows PBM to maintain a certain percentage of rebates. You are encouraged to place high-priced medicines in your company’s prescription book. negotiation. To study such potentially anti-competitive business practices, the Federal Trade Commission (FTC) last week inquiry Investigate how PBM’s vertical integration with insurance companies, mail-order, specialty pharmacies, and healthcare providers impacts access to prescription drugs and affordability.
FTC’s interest in studying PBM practices began in February of this year, when FTC first proposed a study to investigate how PBM practices would be disadvantageous to independent or specialized pharmacies. It is attracting attention. However, the motion eventually failed in a two-to-two vote on concerns that the study did not address the impact of PBM practices on consumer drug costs. Following that vote, the agency began requesting public comments on this issue, returning over 24,000 responses by the May 24 deadline. The substantive public interest and the appointment of a fifth FTC commissioner in May, and the expansion of a new study to investigate the impact of PBM practices on both pharmacies and consumers, were unanimously updated last week. Helped to pass at -0. vote.
The new investigation will be issued under Section 6 (b) of the FTC Act and authorities will be able to conduct the investigation “without specific law enforcement purposes”. Therefore, the investigation itself has not found that PBM is guilty of cheating. However, as part of the investigation, the FTC will charge fees and clawbacks to non-affiliated pharmacies, spread prices, strategies used to direct consumers to PBM-owned pharmacies, independent pharmacies, and Especially the use of specialty drug lists.
The survey covers six of the largest PBMs: CVS Caremark, Express Scripts, Inc., OptumRx, Inc., Humana, Inc., Prime Therapeutics LLS, MedImpact Healthcare Systems, Inc., 95% by 2020. I’ve processed the above. All US prescription claims. The three largest of these, CVS Caremark, Express Scripts, Inc., and OptumRx, Inc., processed nearly 80% of the claims. Within 90 days of receiving the order, each PBM must provide the FTC with detailed information about the company’s policies and procedures regarding participation in the pharmacy network, placement of prescription and prescription drug lists, and rebate calculation. I have. Request data dating back to January 1, 2017.
Taking a step back, the drug supply chain and payment system, more specifically the contracts and price negotiations that take place from the manufacturer to the patient, are part of a long and complex process with many intermediaries. .. , Manufacturers, wholesalers, insurance companies, PBMs, and pharmacies, all of which add price distortions to the market. Ideally, research may provide some coveted transparency in PBM pricing practices. However, policy makers should keep in mind that while PBM practices are important, they are only a small part of the drug price pie.
Chart Review: Covid-19 Relief Spending on Ventilation Systems in US Public Schools
Evan Turkowsky, Healthcare Policy Intern
Of the $ 122 billion American rescue program allocated to public schools $ 5 billion Assigned for improvement of heating, ventilation, and air conditioning (HVAC) systems.. June 10th, Centers Centers for Disease Control and Prevention report How in a public school Wrong Locale ((((Cities, suburbs, towns, and rural areas). Chosen to improve their ventilation strategy..I found it that Most public schools do not major investment In this area Because the funds are available.that’s all 70 percent of all Public school In this study We chose to inspect and / or validate existing HVAC systems, but less than 40% chose to replace or upgrade them.And numbers depend on the locale.. for example, Almost 43 Percentage of municipal schools Exchange or upgrade HVAC system, Compared to less than 30 percent of local schoolsAs shown in the graph below. The most common reported strategies At all schools Includes non-technical methods (73.6) percent) Use of fans Move class activities out,was many Common in local schools (61.7%) Compared to the school All other locales.
Date Source: CDC Mortality and Mortality Weekly Report
