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The Role Of Pbms In Managing Drug Costs
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Book Synopsis The Role of PBMs in Managing Drug Costs by : Anna Cook
Download or read book The Role of PBMs in Managing Drug Costs written by Anna Cook and published by . This book was released on 2000 with total page 88 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309468086 Total Pages :235 pages Book Rating :4.3/5 (94 download)
Book Synopsis Making Medicines Affordable by : National Academies of Sciences, Engineering, and Medicine
Download or read book Making Medicines Affordable written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-03-01 with total page 235 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.
Book Synopsis Pharmacy Benefit Managers by : United States. General Accounting Office
Download or read book Pharmacy Benefit Managers written by United States. General Accounting Office and published by . This book was released on 1995 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book PBMs written by Sheila Shulman and published by CRC Press. This book was released on 1998-06-18 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: PBMs: Reshaping the Pharmaceutical Distribution Network provides HMOs and other third-party payers with information on the new and increasingly important role of pharmaceutical benefit companies (PBMs) in the health care industry. From this text, you will learn how PBMs can maintain and deliver a quality, cost-effective drug benefit plan to your company while achieving the anticipated market share for the product. PBMs: Reshaping the Pharmaceutical Distribution Network offers you suggestions on how to choose which PBM service is correct for your business, such as what qualifications to look for in a PBM, as well as what questions you should ask a respective company. This text also offers ways on how your company can benefit from becoming a client and may make your business more competitive in the pharmaceutical industry. PBMs: Reshaping the Pharmaceutical Distribution Network also informs you about the controversies that have arisen concerning the new position of PBMs in the industry. Through research and evaluation, this text addresses these issues from many different perspectives and gives you insight into other topics concerning PBMs, including: operating methods that PBMs currently rely on for designing and overseeing a drug benefit plan how the Food and Drug Administration currently views the role of PBMs and why they are contemplating regulatory intervention alerting PBMs, pharmacies, pharmaceutical companies, and managed care organizations to new legal issues involving fraud and abuse affecting pharmacy benefit management and pharmaceutical manufacturers reasons why retail drug chains and pharmacist organizations oppose recent industry developments regarding PBMs whether or not PBMs reflect a move toward greater centralized decisionmaking in the health care systemIn addition, PBMs: Reshaping the Pharmaceutical Distribution Network offers pharmaceutical companies, health care providers, and managed care organizations several suggestions for further research, which may make your business or your business relationships more efficient and productive in the future. If you or your company are considering the services of a pharmacy benefit management, PBMs: Reshaping the Pharmaceutical Distribution Network will guide you in choosing a company that helps you deliver the most cost-effective and efficient pharmaceutical benefits to customers.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309498511 Total Pages :103 pages Book Rating :4.3/5 (94 download)
Book Synopsis The Role of NIH in Drug Development Innovation and Its Impact on Patient Access by : National Academies of Sciences, Engineering, and Medicine
Download or read book The Role of NIH in Drug Development Innovation and Its Impact on Patient Access written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2020-01-27 with total page 103 pages. Available in PDF, EPUB and Kindle. Book excerpt: To explore the role of the National Institutes of Health (NIH) in innovative drug development and its impact on patient access, the Board on Health Care Services and the Board on Health Sciences Policy of the National Academies jointly hosted a public workshop on July 24â€"25, 2019, in Washington, DC. Workshop speakers and participants discussed the ways in which federal investments in biomedical research are translated into innovative therapies and considered approaches to ensure that the public has affordable access to the resulting new drugs. This publication summarizes the presentations and discussions from the workshop.
Book Synopsis Prescription Drug Pricing by : Sarah F. Jaggar
Download or read book Prescription Drug Pricing written by Sarah F. Jaggar and published by . This book was released on 1996 with total page 12 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis The Economic Benefits of Pharmacy Benefit Managers by :
Download or read book The Economic Benefits of Pharmacy Benefit Managers written by and published by . This book was released on 2011 with total page 47 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pharmacy benefit managers (PBMs) help to lower health care costs. PBMs currently play a vital role containing costs and improving patient outcomes by serving more than 215 million Americans through health insurance plans, labor unions, private and governmental employers, and Medicare prescription drug plans. PBMs improve prescription drug therapy management for patients and deploy a variety of tools to contain drug costs for payers. PBMs have evolved beyond their core service of prescription drug management to also focus on improving health outcomes and providing treatment solutions for patients with chronic and/or complex conditions.
Author :F. Randy Vogenberg Publisher :International Foundation of Employee benefit ISBN 13 :9780891546962 Total Pages :180 pages Book Rating :4.5/5 (469 download)
Book Synopsis Pharmacy Benefits by : F. Randy Vogenberg
Download or read book Pharmacy Benefits written by F. Randy Vogenberg and published by International Foundation of Employee benefit. This book was released on 2011 with total page 180 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pharmaceuticals have become an integral component of medical treatment, with some medications completely transforming health care outcomes and delivery. Drug therapy has been proven to reduce health care costs, increase productivity and enhance the quality of life for many people. When was the last time you examined the prescription drug component of your health care benefits? This primer offers factors to consider when designing or modifying pharmacy benefits, including the pros and cons of carving benefits into a health plan as well as carving them out as a separate prescription drug plan. A practical checklist is provided in almost every chapter to help you focus on important issues, including what questions to ask potential vendors.
Download or read book Pharmacy Benefit Managers written by and published by . This book was released on 2000 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The provision of prescription drug coverage to Medicare beneficiaries was a major issue in the 106th Congress, and is likely to continue to be a major issue in the 107th Congress. Much attention is being focused on this issue because of reports about the financial burden that prescription drug prices place on the elderly. Several legislative proposals introduced in the 106th Congress, which may be reintroduced in the 107th Congress, seek to create a prescription drug benefit for the Medicare population that is managed by private entities, including pharmacy benefit managers (PBMs). All of the major bills introduced in the 106th Congress that would provide a prescription drug benefit for seniors would use private entities (including PBMs) to manage the benefit. Under S. 2342 (the President's bill), S. 2541 (the "MEND" bill), and S. 2758 (the "MOD" bill), the federal government would provide prescription drug coverage to Medicare beneficiaries, but the benefit would be managed by private entities, such as PBMs. H.R. 4680 and S. 2807 (the "Breaux-Frist" bill) would allow private entities contracted by the federal government (likely insurers, or other riskbearing companies) to provide coverage; these private entities could use PBMs to manage the benefit. A PBM manages a prescription drug benefit on behalf of the benefit sponsor, which may be a health plan, a health maintenance organization, or an employer. To control costs, PBMs help determine which drugs are used and negotiate prices for those drugs. PBMs control costs by employing mechanisms such as formularies, prior authorization, tiered co-payments, therapeutic substitution, generic substitution, mail order pharmacy services, disease state management, and drug utilization review. Additionally, PBMs negotiate rebates with manufacturers and discounts with retail pharmacies. This report examines various options that are available to policymakers as they consider whether to make use of PBMs to deliver a prescription drug benefit to seniors under Medicare. With respect to a PBM benefit, the central (though not the only) issue is implementation of cost-control mechanisms. Various techniques are used in the private sector to control costs. As with private sector providers of benefits, policymakers face an array of options that will determine the extent to which the prescription drug benefit is restrictive. This report describes the operation of the PBM industry, its techniques for serving its benefit sponsors and clients, and various issues that are raised by the prospect of employing PBMs under Medicare. This report will be updated as necessary.
Book Synopsis Formularies, Rebates, and the Economics of PBM Bargaining by : Luke M. Froeb
Download or read book Formularies, Rebates, and the Economics of PBM Bargaining written by Luke M. Froeb and published by . This book was released on 2023 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: For 181 million Americans not on Medicare or Medicaid but insured through their employer, labor union, or private insurance health plan, the primary restraints on pharmaceutical prices are pharmaceutical benefit managers (PBMs) who administer health plan drug benefits. PBMs use the aggregate demand of their constituent plan sponsor clients -- employers, unions, government agencies, health insurers, and others -- to negotiate lower prices.Recently, the use of formularies and PBM-negotiated rebates have come under fire. Critics allege PBMs act to maximize rebates rather than reduce prices, and that rebates lack transparency, contribute to increasing prices, and are not passed on to the benefit of patients. Yet, sophisticated plan sponsors have choices in how to administer their prescription drug benefits and almost all choose to hire PBMs to manage their drug benefit rather than internalize drug procurement, negotiation, clinical evaluations, and benefit administration.This report examines the role of formularies and rebates in the provision of prescription drugs. We respond to the criticisms of PBMs by discussing the often misunderstood principles of formulary management and rebates and how they are essential parts of the bargaining process between PBMs and pharmaceutical manufacturers. We demonstrate that economic logic and evidence, as well as multiple investigations by independent and government groups, find that PBM bargaining reduces drug prices.
Book Synopsis Pharmacy Benefit Managers, Rebates, and Drug Prices by : Joanna Shepherd
Download or read book Pharmacy Benefit Managers, Rebates, and Drug Prices written by Joanna Shepherd and published by . This book was released on 2019 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pharmacy benefit managers (PBMs) manage the drug benefits for over 95 percent of Americans with prescription drug coverage. However, conflicts of interest inherent in the PBM business model create perverse incentives for drug price increases. The most significant conflict of interest arises from manufacturer rebates paid to PBMs. PBMs negotiate rebates from drug manufacturers in exchange for giving the manufacturers' drugs preferred status on a health plan's formulary. Because the rebates paid to PBMs are typically a percentage of a drug's list price, drug makers are pressured to increase list prices in order to satisfy PBMs' demands for higher rebates. Although a portion of the increasing rebate dollars may eventually find its way to patients in the form of lower co-pays, many patients still suffer from the list prices increases. This Article analyzes various proposals to rein in PBM rebates and asserts that, compared to the other proposals, a point-of-sale rebate system maintains many of the benefits of selective contracting while minimizing incentives to increase drug list prices.
Book Synopsis Managed Care Pharmacy Practice by : Navarro
Download or read book Managed Care Pharmacy Practice written by Navarro and published by Jones & Bartlett Publishers. This book was released on 2008-12-11 with total page 659 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed Care Pharmacy Practice, Second Edition offers information critical to the development and operation of a managed care pharmacy program. The text also covers the changes that have taken place within the delivery of pharmacy services, as well as the evolving role of pharmacists.
Download or read book Pharmacy Benefits Management written by and published by . This book was released on 1995 with total page 38 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Pharmacy Benefit Managers by : United States. General Accounting Office
Download or read book Pharmacy Benefit Managers written by United States. General Accounting Office and published by . This book was released on 1997 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis How Increased Competition from Generic Drugs Has Affected Prices and Returns in the Pharmaceutical Industry by :
Download or read book How Increased Competition from Generic Drugs Has Affected Prices and Returns in the Pharmaceutical Industry written by and published by U.S. Government Printing Office. This book was released on 1998 with total page 94 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Drugs, Money, and Secret Handshakes by : Robin Feldman
Download or read book Drugs, Money, and Secret Handshakes written by Robin Feldman and published by Cambridge University Press. This book was released on 2019-04-11 with total page 201 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the warped world of prescription drug pricing, generic drugs can cost more than branded ones, old drugs can be relaunched at astronomical prices, and low-cost options are shut out of the market. In Drugs, Money and Secret Handshakes, Robin Feldman shines a light into the dark corners of the pharmaceutical industry to expose a web of shadowy deals in which higher-priced drugs receive favorable treatment and patients are channeled toward the most expensive medicines. At the center of this web are the highly secretive middle players who establish coverage levels for patients and negotiate with drug companies. By offering lucrative payments to these middle players (as well as to doctors and hospitals), drug companies ensure that inexpensive drugs never gain traction. This system of perverse incentives has delivered the kind of exorbitant drug prices - and profits - that everyone loves except for those who pay the bills.
Download or read book Medicare written by Gustav A. Ravn and published by Nova Snova. This book was released on 2020-04-22 with total page 362 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over the course of the last few years, our healthcare system has begun a shift toward rewarding physicians for the quality of care rather than the quantity, and building off these efforts, providers, doctors, health systems, and payers are willing to explore new value-based arrangements and open the door to providing new benefits for their beneficiaries. The Medicare Access and CHIP Reauthorization Act began to shift Medicare towards being a more value-based payment system. Chapter 1 discusses the models that are working toward improve the quality of care and reducing cost. Total expenditures for the Medicare Part D drug program exceeded $100 billion in 2016. Part D plan sponsors may use a pharmacy benefit manager (PBM) to provide drug benefit management services for Part D coverage, such as negotiating drug rebates and other price concessions and paying pharmacy claims. Policymakers have sought a better understanding of PBMs' roles in the drug supply chain and plans' and PBMs' efforts to manage Part D drug spending and use. Chapter 2 examines, (1) the extent to which Part D plan sponsors use PBMs, (2) trends in rebates and other price concessions obtained by both PBMs and plan sponsors for Part D drugs, and (3) how PBMs earn revenue for services provided to Part D plans. The Social Security Act requires boards of trustees to issue reports to Congress by April 1 each year on the financial status of the Social Security and Medicare trust funds. Chapter 3 (1) describes how the boards of trustees develop the annual Trustees reports, and (2) examines the extent to which the boards of trustees have provided the reports to Congress by the April 1 deadline, and what factors account for any delays. The Centers for Medicare & Medicaid Services (CMS) implemented a competitive bidding program (CBP) for certain durable medical equipment (DME), such as wheelchairs and oxygen. The Patient Protection and Affordable Care Act required CMS to adjust fee-for-service payment rates for certain DME items in non-bid areas. On January 1, 2016, adjusted rates for 393 items went into effect in non-bid areas. Chapter 4 examines (1) payment rate reductions and any changes in the number of suppliers; (2) any changes in the utilization of rate-adjusted items; and (3) available evidence related to potential changes in beneficiaries' access to rate-adjusted items.