News
from the fight to #SaveIndiePharmacy
New York Times’ The Middlemen series
‘It’s a money game to them’: a son takes on UnitedHealth over his elderly father’s care
Robby Martin has joined a lawsuit against UnitedHealth after the insurance giant cut off his father’s nursing home coverage – five days later his father died at home
Adult Swim’s Common Side Effects Show Pitfalls of Medicare Advantage
The show follows once-separated high school friends Marshall, a mycologist, and Frances, the executive assistant to a pharmaceutical executive, who reconnect after Marshall begins peppering Frances’ boss with questions during a public event announcing a new drug the pharmaceutical company is launching.
22 states sue to block Trump administration cuts to NIH research payments
Attorneys general seek court order to halt 15% cap on research overhead costs
Pharmacies are fed up with PBMs. Here’s what reforms might be coming
Pharmacy benefit managers are under increasing scrutiny due to accusations that they are driving their smaller and more vulnerable independent counterparts out of business.
Drug Costs and Their Impact on Care: Insights from Medicare Patients and Providers
Prescription drug costs are a barrier to care for many patients, but especially so for the nine of 10 Medicare beneficiaries who report taking prescription drugs regularly. In fact, 14 percent of beneficiaries age 65 or older say they skip taking or sometimes do not even fill their prescriptions because of the expense.
UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials
Two months after UnitedHealthcare’s CEO was murdered, the insurer is moving to protect its image
How Medicare Says It Arrives At ‘Fair’ Prescription Drug Prices
When former President Biden signed the Inflation Reduction Act into law in 2022, he said that drug price negotiations and other provisions in the legislation would help lower costs for Medicare beneficiaries by bringing down the prices of certain medicines and capping out-of-pocket costs for many others. What remained hidden from view, however, is how the so-called maximum fair prices of the drugs selected for negotiation are determined. Now we have a glimpse behind the curtain. But it is only a peek.
Cigna sues, wants leeway to tell customers which pharmacies to use
In 2019, Minnesota passed the Minnesota Pharmacy Benefit Manager Licensure and Regulation Act. It prevents Pharmacy Benefit Managers or PBMs from requiring customers on an insurance plan to go to a pharmacy that the PBM owns, often by mail order.
Lawmakers want Indiana to own its own pharmacy benefit manager for state plans like Medicaid
The goal of the bill is to give Indiana a “seat at the table” to play a role in negotiating rebates, pricing, distribution and dispensing fees
Op-Ed: FTC Adds Fuel to the Fire for PBMs. Will Congress Deliver Real Reform?
The FTC's reports and legal actions target PBMs for inflating drug costs and restricting access, focusing on insulin and specialty generics.
Kansas pharmacists are closing their doors as they seek a way to save their businesses struggling from PBM practices
92 independent, mom-pop pharmacies across the state will close their doors for a day of advocacy in Topeka. It’s a situation pharmacists said, without action, will see more pharmacies close. That will make it hard for patients who need them.
Independent pharmacies fight back as PBM reform gains steam
Independent pharmacists across Virginia are rallying behind legislation to reform PBMs, arguing the change is critical for rural healthcare access.
Eagan’s Prime Therapeutics hit with $10.3M judgment in price-fixing case
Safety net provider alleged pharmacy benefit manager collaborated with a rival to set low payment rates to pharmacies.
'Knock out the middlemen' is a campaign promise Donald Trump should keep
Congressional leaders in December struck a deal to rein in PBM practices, but the bill fell apart. President Trump has pledged to “knock out the middlemen ” in health care, so the time is ripe for Congress to reconsider the issue.
PBM Prime Therapeutics to Pay $10 Million Antitrust Case Over Price-Fixing Scheme with Express Scripts, Inc.
In a recent antitrust arbitration ruling, Prime Therapeutics, a pharmacy benefit manager (PBM) owned by 19 Blue Cross and Blue Shield Plans, was found guilty of engaging in horizontal price-fixing in collaboration with Express Scripts, Inc. (ESI), a competitor owned by Cigna.
Congress Can't Wait—Reform Pharmacy Benefit Managers and Deliver Lower-Cost Drugs for Patients | Opinion
As the 119th Congress convenes, policymakers have a historic opportunity to lower prescription drug prices for Americans. As members of Congress begin negotiating the continuing resolution set for March, they can make prescriptions more affordable for Americans and eliminate government waste in the American health care system by prioritizing pharmacy benefit manager (PBM) reform.
Pharma is hopeful about Trump’s second term — here’s what to expect for drugmakers
Pharmaceutical companies appear to be hopeful about their growth under a Trump administration, after former President Joe Biden took a hardline stance on the industry for the last four years.
New AI tool counters health insurance denials decided by automated algorithms
Insurance coverage denials have risen in recent years in the US, driven in part by automated algorithms powered by AI – and some recently launched artificial intelligence tools may fight back by generating automatic appeals.
1 in 2 Americans affected by UnitedHealth cyberattack, new disclosure shows
Updated tally at Change Healthcare, owned by the Eden Prairie-based health care giant, nearly doubles the number of people affected by the massive data breach.
Drugmakers including Purdue Pharma paid pharmacy benefit managers not to restrict painkiller prescriptions, a New York Times investigation found.