National Implications in Iowa's Win Over PBMs

Posted Feb. 24, 2015

Iowa's MAC transparency law, which the PBM/mail order lobby challenged in court in hopes using a victory to attack similar laws in other states, emerged intact last week. On Feb. 18 the U.S. District Court for the Southern District of Iowa issued an initial victory for Iowa by granting the state's motion to dismiss the bulk of the claims challenging the law. The Pharmaceutical Care Management Association, representing 11 PBMs, claimed that the 2014 law was preempted by ERISA, constituted an illegal taking by the state of PBM trade secrets, and violated the dormant commerce clause of the Constitution. Iowa sought dismissal of the ERISA and takings claims, and the court sided with the state in rejecting PCMA's arguments with respect to these claims.

 

The Iowa Pharmacy Association and NCPA supported Iowa's insurance commissioner and attorney general in their defense of the law. The landmark law regulates how PBMs manage MACs (Maximum Allowable Costs). Among the provisions is a requirement that PBMs include in their contracts information regarding which of the national compendia they use to obtain pricing data for calculating MAC prices and a process that allows a pharmacy to comment on, contest, or appeal the MAC reimbursement amounts or the MAC list. Importantly, the court concluded that such provisions are not preempted by ERISA.

 

From NCPA eNews Weekly

 
Surescripts Rebates Coming Soon

Posted Feb. 16, 2015

 

According to a recent communication from Douglas Hoey via NCPA Executive Update, Surescripts is expected to begin mailing rebate checks within the next two weeks to independent community pharmacies on its e-prescribing network. The rebates are calculated at 3-cents per billable transaction between Jan. 1 and Dec. 31, 2014. Surescripts also has announced that it will offer a similar rebate program for 2015 transactions, payable early in 2016.

 

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Rite Aid acquires PBM for $2 billion

Posted Feb. 11, 2015

By Michael Johnsen - Published in Drug Store News (edited)

 

CAMP HILL, Pa. — Rite Aid is set to acquire the leading independent pharmacy benefit manager Envision Pharmaceutical in a deal valued at $2 billion, the retailer announced Wednesday. 

 

EnvisionRx provides both EnvisionRx and MedTrak PBMs. The company also offers a national Medicare Part D prescription drug plan through Envision Insurance Company’s EnvisionRx Plus product offering. 

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CMS / Aetna-Coventry Part D Update

Posted Feb. 4, 2015

 

NCPA had a call with CMS this afternoon and we have some developments to report.  In summary, CMS conveyed or confirmed the following information:

 

1)      CMS has issued a Corrective Action Plan (CAP) request to Aetna specifying that Aetna did not meet the Any Willing Pharmacy provisions for 2015 Part D basic plans and  that Aetna must reach out to pharmacies to offer standard terms & conditions to see if they want to participate in any networks they were not included in via the “bid” process from last year.  The CAP includes specific issues that Aetna must address.  CMS has not currently imposed sanctions, only a CAP at this point, but CMS reserved the right to take further action at a later date.

  • CMS verified that the CAP notice specifically addressed Aetna’s need to meet the 2016 Part D Any Willing Pharmacy provisions in the development of their 2016 network(s) and that it would be monitored.
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Sections of a recent letter entitled Not Crying Wolf This Time

by Douglas Hoey, CEO of NCPA offer information on preparing for pay for services.

Posted Feb. 3, 2015

 

For decades, pharmacy students and pharmacists have been assured that they will be paid for services. And, for decades that's been mostly like the boy who cried wolf. Despite dozens of studies plus good old common sense indicating that pharmacists save health care dollars and improve quality of life, the closest the vast majority of pharmacists have come to direct payment for non-dispensing services is from MTM in the Medicare Part D program. But there were some big developments this week that are finally going to make all of those past false alarms a reality—whether we like it or not.

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