Postscript (12/2/2017) Amazon is now the best hope for a consumer-directed pharmacy benefits website that “crosses the chasm” by suggesting lower cost therapeutic equivalents. It has been ten years since we wrote a paper on The Future of Consumer-Directed Pharmacy Benefits . The possibility of consumer-directed health care got a new life in the mid-2000s […]
Tag Archives: pharmacy benefit manager business model
Was CVS’s Formulary Exclusion of Mavyret a Violation of Antitrust Laws?
Summary In October 2017, CVS Caremark (CVS) finally decided to exclude from its 2018 drug formulary the new-to-market Hepatitis C Virus (HCV) drug Mavyret despite it being list priced aggressively by its manufacturer AbbVie at an estimated 72% below the list price of Gilead Sciences’ incumbent HCV drug Harvoni. We estimate that Gilead Sciences had […]
AbbVie’s Mavyret Drug Pricing: Disruptive to the Pharmacy Benefit Manager Business Model
Summary: AbbVie’s pricing for its new Hepatitis C Virus (HCV) drug Mavyret is disruptive to the current PBM business model because it forces the Big 3 PBMs to consider a drug for inclusion in their national formularies that is aligned with their clients interests — more cost-effective than Harvoni — but not aligned with their […]
Merck Data Discredits PBM-Sponsored Study of Brand Drug Price Inflation
Summary We present data supplied by the drug company Merck that discredits a study sponsored by the pharmacy benefit manager (PBM) trade association showing no correlation between PBM rebate rates and brand drug price inflation. Introduction The management of the prescription (Rx) drug benefit portion of health care plans has become the domain of contracted […]
Pharmacy Benefit Managers
CURRENT PAPERS ON PBMs A Position Auction Demonstration Project for Lowering Reference + Biosimilar Rx Drug Prices in Medicare Part B (8/19) Off-Target: Pelosi’s Binding Arbitration Proposal to Reduce Medicare Part D Drug Prices (04/19) Quantifying a Pharmacy Benefit Manager (PBM) Fee-For-Service Business Model (03/19) CVS’s Negligent Handling of Its 2019 Formulary Change In Coverage […]
Pharmacy Benefit Manager Rx Drug Rebates – PBMs
A Position Auction Demonstration Project to Lower Reference + Biosimilar Rx Drug Prices in Medicare Part B (8/19) Pharmacy Benefit Managers as Conflicted Countervailing Powers (01/07) Who is Best at Negotiating Pharmaceutical Rebates? (12/05) The Role of Pharmacy Benefit Managers in Formulary Design: Service Providers or Fiduciaries? Journal of Managed Care Pharmacy Vol. 10 No. […]
Preferred Provider Pharmacy Networks
PREFERRED PROVIDER PHARMACY NETWORKS The CVS-Caremark Merger and the Coming Preferred Provider War (12/06) Medicare Part D and Preferred Provider Pharmacy (04/05) The CVS-Caremark Merger: The Creation of an Elasticity of Demand for Retail Rx (11/06) Contrary to What Wall Street and the FTC Say, The PBM Business Model is Misaligned (11/05) Sins of Omission’: […]