July 18, 2005
PBMs: Just to keep you up to date, with UPDATE
We haven't heard much about the plans that will end up being the Medicare Part D quasi-PBMs. These are known in CMS-speak as the Participating Prescription Drug Plans [PDP], and they're going to be selling plans/enrolling seniors and then administering their benefits similarly to the way that PBMs do it for the private sector now. The first enrollment date is November 15th. I looked diligently in this CMS document advising the plans but I couldn't tell when the applications to qualify had to be in by, but suffice it to say that they are well under way and CMS will presumably soon be announcing which plan is up in which area when.
On the other hand if (as we can assume they will) the current PBMs get into this game, they may have to think twice about continuing some of their business practices. Caremark, for example, is facing even more whistleblower suits about reselling returned stock. Supposing that the Federal government is now the end customer, I suspect some clean up needs to go on across the PBM industry which has sailed very close to the legal wind in recent years and has several state AG suits in process to show for it.
UPDATE: Promoted from the comments, (thanks Matt!) Forbes ran an article last month that I missed on how and why the scams will increase as Medicare Part D takes shape. It's really worth reading the whole thing. As my old boss Ian Morisson use to say, a claim is an agreement made between a doctor and a patient to defraud an insurer!