Centene is leveraging its investment in RxAdvance to develop a more transparent PBM through Envolve Pharmacy Solutions
Express Scripts Divesting United Biosource. Express Scripts and Avista Capital Partners, a leading private equity firm, recently announced that Avista has signed a definitive agreement to acquire United BioSource (UBC), a wholly-owned subsidiary of Express Scripts Holding Company. Founded in 2003 and headquartered in Blue Bell, Pennsylvania, UBC is a leading provider of pharmaceutical and patient […]
Pharmacy Benefit Manager Market Continues to Evolve. Recent consolidation in the pharmacy benefit manager (PBM) industry has resulted in major market share divided by the three market leaders: Express Scripts, CVS Health (Caremark), and OptumRx (UnitedHealth Group). PBMs remain searching for a value proposition beyond drug distribution with their employer clients. As long as PBMs […]
Designing Pharmacy and Medical Benefits for Cancer Care: An Employer Perspective – published in Value-Based Cancer Care F. Randy Vogenberg, PhD, RPh, FASHP; Catherine E. Cooke, PharmD, BCPS October 2016, Vol 7, No 9 – Employers’ Perspective With the increasing complexity of cancer care after the passing of the 2010 Affordable Care Act, employers as […]
Specialty Drug Spend Under the Medical Benefit — Biologic, biotechnology based, rare disease or high cost pharmaceuticals—collectively known as specialty drugs—can be covered under the pharmacy benefit, the medical benefit, or both depending on the plan sponsors’ benefit design required of the payor. On average, up to 50% of specialty drugs are covered under the […]
Specialty Drug Wave Hitting Medical and Pharmacy Plans Harder: Trends versus reliable benefit strategy to handle the impact through 2020?The U.S. now has two different markets resulting from implementation of the Affordable Care Act (ACA) and resultant trends. Related to specialty or biological drugs, public sector CMS’s forecast of drug spending is somewhat counterintuitive, given […]
Amid the constant change churning the health care marketplace, employers have the opportunity to use value-based tactics to get more for their health benefits, including pharmaceutical spending that is currently the biggest driver of rising health care costs. That message was echoed by all four speakers at the Alliance Learning Circle on “Doses and Dollars: […]
Changes are happening in the PBM market. Traditional services offered by PBMs will be supplanted by new PBM entities that will develop formularies among the services they offer. The new entity PBMs manage and supplement PBM services as an advocate for health care payers. Services include prescription claims analysis and consultation, drug coverage management, PBM contracts […]