Advanced Medical Pricing Solutions (AMPS), a pioneer in healthcare cost management, is pleased to announce it has acquired Drexi, a pharmacy solution that enables savings by transparent pricing and pass-thru on prescription medications available at a nationwide network of more than 65,000 pharmacies. “This acquisition is part of AMPS’ strategic vision and growth plan to provide a spectrum of programs to manage healthcare costs,” said Kirk Fallbacher, AMPS president and CEO. “With the addition of Drexi, AMPS can now drive savings on more than 90 percent of the benefit expense associated with a self-funded group.”
Southern Scripts announced today that it has received a capital commitment of $100 million from Water Street Healthcare Partners to expand its unique pharmacy benefit management (PBM) model that delivers significant savings to U.S. employers and maximizes members’ access to medications. Founded in 2011 by pharmacists dedicated to creating a truly different PBM model, Southern Scripts features a one-of-a-kind offering focused on customizable solutions that generate significant savings for its customers. A pioneer in pharmacy benefit innovations, Southern Scripts passes through 100 percent of drug pricing and rebates to its customers.
Centene CEO Michael Neidorff joins Yahoo Finance Live to discuss his company’s recent acquisition of Magellan Health, as well as the disbanding of Haven (Amazon, Berkshire, JPM health venture).
Centene Corporation (NYSE: CNC) and Magellan Health, Inc. (NASDAQ: MGLN) today announced that they have entered into a definitive merger agreement under which Centene will acquire Magellan Health for $95 per share in cash for a total enterprise value of $2.2 billion. The transaction, which was unanimously approved by the Boards of Directors of both companies, will broaden and deepen Centene’s whole health capabilities and establish a leading behavioral health platform.
It’s not a secret that the healthcare industry is slow to change. The traditional models for pharmacy benefit managers have been under particular scrutiny of late, with these companies seeing the revival and finalization of the dreaded “rebate rule” and a Supreme Court ruling that could open the door for greater regulation. With these increasing calls for evolution, it begs the question: What would the PBM “of the future” look like? For John Sculley, chairman of startup PBM RxAdvance and former CEO of Apple, it starts with starting to think about how to shake up the traditional rebate approach.
In a ruling that could pave the way for increased regulations by states such as Ohio, the U.S. Supreme Court on Thursday rejected a challenge of a 2015 Arkansas law putting restrictions on pharmacy benefit managers. “We have overwhelming evidence that the PBM marketplace is highly dysfunctional and exceedingly costly,” said Antonio Ciaccia, former lobbyist for the Ohio Pharmacists Association who is now with 3 Axis Advisors, a company set up to expose drug-pricing irregularities. “With the industry problems growing worse, it is encouraging to see the Supreme Court assert the authority of states to control their own fates, rather than leaving their prescription drug costs and access in the hands of a largely unchecked multibillion-dollar industry.”
The pharmacy benefit management (PBM) industry used to occupy a rather small, obscure corner in the back offices of the American healthcare system. PBMs were just prescription claims processors. But over the past 20 years or so, the industry consolidated and the remaining companies became powerful middlemen in the complex pharmaceutical supply chain. Now the industry has an increasingly high profile (not always for favorable reasons) and has consolidated even further, with its large players owned by or partnering with even larger companies. Yet plenty of smaller players have survived and even thrived by finding a niche, such as workers’ compensation, specialty drugs or certain types of diseases.
Supreme Court justices on Tuesday questioned whether states have the authority to regulate how much middlemen hired by insurance plans pay pharmacies. During oral arguments, several justices asked about the burden health plans face since many states have a patchwork of PBM regulations. The case, Rutledge v. Pharmaceutical Care Management Association, could decide the fate of those state PBM regulations. The justices are weighing whether the Employee Retirement Income Security Act allows states to force pharmacy benefit managers to pay pharmacies at least their cost of acquiring a drug.
PharMerica completed the acquisition of OnePoint Patient Care (OPPC) on Wednesday. OPPC is one of the nation’s largest (and the largest non-payer owned) provider of dedicated hospice pharmacy and pharmacy benefits management (PBM) services, serving more than 350 unique hospice providers. OPPC is the only hospice pharmacy provider of scale offering same-day local dispensing and delivery through owned pharmacies, a key differentiator and enabler of optimal customer service. OPPC operates 15 pharmacy locations across the United States today.
Startup pharmacy benefit manager Capital Rx is teaming up with Walmart to bring greater transparency to specialty and mail-order prescriptions. Capital Rx provides PBM services to employers and health plans through its “clearinghouse” model, in which they provide unit costs for drugs upfront to clients. The model is also designed to prevent “spread pricing,” in which a PBM charges a payer significantly more than a pharmacy’s price for a drug to reap profits. Joining up with Walmart, a company that was early to sign on with Capital Rx, makes the PBM the first to offer that price transparency across retail, specialty and mail-order medications.
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