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In an unusual move, an audit of commercial health plans by Tennessee officials found that Express Scripts, one of the largest pharmacy benefit managers in the United States, violated state laws in its dealings with pharmacies, according to newly released documents.
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: The 340B DrugPricing Program: Trends, Controversies, and Outlook. Last week, we documented the substantial concentration of dispensing revenues for specialtydrugs. Click here to see the original post from April 2024.
Last week, I documented that nearly half of U.S. pharmacies now participate in the 340B DrugPricing Program. Below, we update our exclusive analysis of the biggest specialtypharmacies within 340B. Hospitals are the primary 340B covered entities that engage with these specialtypharmacies.
Regardless of your answer, theres no question the 340B DrugPricing Program remains a critical resource for eligible healthcare providers, enabling them to stretch scarce federal resources to provide essential services to underserved communities. Perform self-audits to proactively identify and address your 340B program gaps.
Pharmacies and Pharmacy Benefit Managers , our 13th edition, provides a comprehensive, fact-based, and non-partisan tool for understanding the entire U.S. drugpricing, reimbursement, and dispensing system. The 2022 Economic Report on U.S. The chart below illustrates the depth and breadth of the 2022 edition.
General Comments The NHC appreciates CMS’ commitment to actively engaging with stakeholders, including patients, consumer advocates, and health experts, in implementing the Medicare DrugPrice Negotiation Program (DPNP). This includes collecting data on utilization management practices, formulary changes, and patient experiences.
HRSA issues “Administrative Dispute Resolution” ruling On April 19, HRSA issued a ruling entitled “340B DrugPricing Program; Administrative Dispute Resolution.” Understand, and master, your 340B specialtypharmacy opportunities. The 340B revenue potential of specialtypharmacy is staggering.
The survey attempts to account for the differences in financial reports between pharmacies by asking specific questions about the major points of contention in accounting practices (how do you categorize your rebates? I presume that their fill-at-specialty-pickup-at-retail program counts these rx revenues in the specialtypharmacy division.
I consult with pharmacies to help them understand “DIR fees” – the post-adjudication fees that PBMs contractually force upon pharmacies as a condition of accepting taxpayer-subsidized Medicare Part D business. These fees, as documented by CMS, have increased by 109,000% in the past 10 years.
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