October 19, 2010

PBM Industry Reforms can Reduce Wasteful Health Care Spending, Protect Patient Choice of Pharmacy

By CSS American businessman Victor Kiam best described the small business owners’ mindset by declaring, “An entrepreneur assumes the risk and is dedicated and committed to the success of whatever he or she undertakes.” However, external forces can occasionally constrain...
October 19, 2010 in Health care costs, Patient Safety, PBMs | Permalink | Comments (3)

April 21, 2010

Catching up with Anvita Health

By Matthew Holt Another one of my HIMSS interviews that's taken a while to make it onto THCB. But that shouldn't fool you--Anvita Health is one of the more interesting companies out there, doing complex analytics to personalize and identify...
April 21, 2010 in Electronic Medical Records, Health 2.0, PBMs, Technology | Permalink | Comments (1)

December 04, 2008

Technology should promote patient involvement not replace it

By THCB Reader SR This post came as a comment by SR to Dr. Kibbe's piece on electronic medical records. It's a great consumer perspective and worth reprinting in full. -- THCB Staff Health Care consumers and patients have a...
December 4, 2008 in Electronic Medical Records, PBMs, Personalized Medicine, Technology | Permalink | Comments (1)

February 15, 2008

Peeling The Healthcare Onion, By George Van Antwerp

George Van Antwerp is a Vice President at Silverlink Communications where he focuses on developing healthcare communication solutions across the industry with a focus on the pharmacy space. He and I have been conversing back and forth by email for...
February 15, 2008 in PBMs, Policy, The Industry | Permalink | Comments (8)

March 28, 2007

PBM/PHARMA: The Group Guy

The Group Guy: new blog from a benefits broker who is not too impressed with PBMs or the average knowledge level of his customers about generics.
March 28, 2007 in PBMs, Pharma | Permalink | Comments (2)

February 28, 2007

PBMs: Bob Garris on their trail again?

In Brief non HIMSS news (as I’m still having a little insomnia from jet-lag, and I took it much easier last night on Bourbon street)…. Most THCB readers know that I’m just a wee bit cynical about the “value” provided...
February 28, 2007 in PBMs | Permalink | Comments (0)

February 06, 2007

PBMs: Not responsible for anything much at all?

I have purloined this and reprinted almost in full from AISHealth.com’s Government News of the Week. Caremark Rx, Inc. did not breach its fiduciary duties when negotiating drug prices and managing the formulary for a multi-employer health fund because it...
February 6, 2007 in PBMs | Permalink | Comments (0)

November 03, 2006

PBMs/BLOGS: A blogger at a major PBM

Libratto is a blog written by a senior exec from a PBM, Bob Neaser at Express Scripts. I haven’t exactly been polite about PBMs or more accurately about their customers' willingness to explore their business models over the years. I’ll...
November 3, 2006 in PBMs | Permalink | Comments (1)

November 01, 2006

PBMs: Caremark sneaking out at the top? with UPDATE

CVS has noticed that big PBMs are now making all their money on mail-order pharmacy, particularly from dumb clients who can’t be bothered to cross check what the PBM is charging for mail-oder generics with the price they can get...
November 1, 2006 in PBMs | Permalink | Comments (6)

October 11, 2006

PBMs: Some Employers Look to Break the PBM Habit

Earlier this week referring to the WSJ piece on PBMs (which one ex-reporter suggested to me was investigative journalism that pushed on open doors) I mentioned the University of Michigan which did the math and fired its PBMs, and is...
October 11, 2006 in PBMs | Permalink | Comments (9)

October 10, 2006

PBMs: Why I will stay poor forever

I just don’t understand Wall Street. The FirstDatabank/Mckesson story clearly was bad news for pharmacies/ PBMs are essentially big pharmacies and it was bad news for them as even your punk blogger here pointed out on Friday morning. But that...
October 10, 2006 in PBMs | Permalink | Comments (0)

October 09, 2006

PHARMA/PBMs: How dumb is the customer? Barbara Martinez tells you the answer

Everyone knows that hospitals have a “list” price that only a very few totally powerless uninsured patients pay (and in California that hospitals are bizarrely required to report that price to the state). Then there’s an actual amount that Medicare...
October 9, 2006 in PBMs, Pharma | Permalink | Comments (2)

September 19, 2006

HEALTH PLANS/PBMs: Employers are dumb and therefore get punked

I couldn’t write about this yesterday because I spent the day hanging out in airports, but plenty of people emailed me about Barbara Martinez of the WSJ and her continued journey into the seemy side of employer benefits. As I’ve...
September 19, 2006 in Health Plans, PBMs | Permalink | Comments (5)

August 07, 2006

PBMs/HEALTH PLANS: Medco makes out; Kaiser not so pretty

So Medco is making even more money by switching to generics. Medco Health Solutions Inc. reported a 24 percent jump in second-quarter earnings and raised its profit forecast, citing speculation that a generic version of the top-selling blood thinner Plavix...
August 7, 2006 in Health Plans, PBMs | Permalink | Comments (2)

July 25, 2006

PBMs: Rebates are nearly dead; can the PBMs keep their generic margins?

Vanessa Furhman continues her swath through the PBM industry in the WSJ. The article is called Managers of Drug Benefits Agree To More Transparency in Pricing. Apparently bullied into this by fear of losing some big clients, both Medco and...
July 25, 2006 in PBMs | Permalink | Comments (2)

May 19, 2006

HEALTH PLANS/PBMs: Don't be evil?

I’m in Miami to talk to the Blues Association about blogging and new media. I think my theme is that You Shouldn’t Be Evil (or whatever the Googlers say…) But it looks like Caremark is joining United and ACS in...
May 19, 2006 in Health Plans, PBMs | Permalink | Comments (3) | TrackBack

May 11, 2006

PBMs: Is the edifice crumbling--not yet!

Conundrum—It was reported in their most recent 10K that what Medco got in rebates from manufacturers went down, and that really hit profit from that sector of their business in the most recent quarter. But their overall profits went up?...
May 11, 2006 in PBMs | Permalink | Comments (7) | TrackBack

February 09, 2006

PBMs: More on the enigma of how PBMs make money

California Healthline had an article about PBMs role in Medicare Part D. (Hat tip Joe Paduda). Not entirely un-coincidentally, the report that I wrote with Jane Sarasohn Kahn on The Prescribing Infrastructure: Are we ready for eRx, which CHCF published...
February 9, 2006 in PBMs | Permalink | Comments (2)

February 01, 2006

PBMs: Is PCMA learning AHIP's tricks?

I'm so fond of analyzing "research" by AHIP that I've missed some from PCMA, the trade group of the PBMs. But if you go to their site you'll learn that you, the consumer, are about to save $1.3 trillion over...
February 1, 2006 in PBMs | Permalink | Comments (3)

January 27, 2006

PHARMA/HEALTH PLANS/PBMs/POLICY: Meanwhile Ignangi on drug pricing, best price and fraud

I’m listening to the webcast of the KFF Forum on Medicare, and in the middle Karen Ignagni comes out with this gem. But Karen Ignagni, president and CEO of America's Health Insurance Plans, countered that so far, health insurers are...
January 27, 2006 in Health Plans, PBMs, Pharma, Policy, Policy/Politics | Permalink | Comments (1)

January 10, 2006

POLICY/PHARMA/PBMs: Health spending collapses--all the PBMs doing! (No, not really).

So the numbers on national health expenditure are out, and health spending plummeted by 50% in 2004!! Oops, what I meant to say was that health spending only went up by 7.9% — barely enough to trouble the scorers (as...
January 10, 2006 in PBMs, Pharma, Policy | Permalink | Comments (0)

November 10, 2005

PBMs: The future of PBMs--a work in progress

There's an interesting article in AISHealth.com's Business News of the Week called Why the Plans of a Major Drug Purchasing Coalition Did Not Work. The quick story is that a group of employers got together in late 2004 and made...
November 10, 2005 in PBMs | Permalink | Comments (1)

September 12, 2005

PBMs: Are the rebate chickens coming home to roost?

Friday's news that Caremark was settling with the Feds over a whistle-blower over rebates at AdvancePCS gave me some pause for thought. For a start, the number is $135m, and for a relatively low margin business like a PBM, that's...
September 12, 2005 in PBMs | Permalink | Comments (14)

August 04, 2005

PBMs: PBMs tell the truth while hiding the truth

On a day when Caremark's stock continues up into the stratosphere, and the earnings machines that are PBMs seem unstoppable even before they get their hands on all that lovely government money next year, a report came out yesterday about...
August 4, 2005 in PBMs | Permalink | Comments (3)

July 28, 2005

HEALTH PLANS/PBMs: Wall Street loves 'em

It's a wacky day on Wall Street. Since Aetna's quarterly announcement that it made a decent profit hitting expectations, the entire sector has gone a little doolally. And not all at once but over the course of the day. Look...
July 28, 2005 in Health Plans, PBMs | Permalink | Comments (0)

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...
July 18, 2005 in PBMs | Permalink | Comments (1)

April 14, 2005

PBM: Caremark apparently about to face fraud charges?

Writing in The Street Melissa David says that a 6 year-long investigation of Caremark receiving overpayments for Texas Medicaid is about to result in indictments. Caremark stock reacted poorly to the rumors. Of course indictments and charges are nothing new...
April 14, 2005 in PBMs | Permalink | Comments (0)

March 03, 2005

PBMs: Express Scripts net surges

From the "why does this keep happening?" file, it looks like the PBM sector is continuing to remain very profitable. Today it's the turn of Express Scripts to announce that its earnings were up 13 percent. It also revised up...
March 3, 2005 in PBMs | Permalink | Comments (0)

February 03, 2005

PBMs: Caremark article questions the role of the PBM

I'm not a great believer in the effectiveness of PBMs to hold down drug prices. My evidence is that since PBMs have become important drug prices and the share of health spent on them have gone through the roof. Of...
February 3, 2005 in PBMs | Permalink | Comments (0)

August 05, 2004

PBMs: Spitzer puts the boot into Express Scripts

NY A-G Eliot Spitzer continues his swath through the boardrooms of America. He's piling in on the recent investigations and he comes right out and accuses Express Scripts of fraud. The suit alleges the company inflated the cost of generic...
August 5, 2004 in PBMs | Permalink | Comments (1)

July 30, 2004

PBMs: Express Scripts stock battered by multi-state probe

Let me tell you my tale of woe over Krispy Kreme, a stock with a big hole in the middle that I was shorting off and on for the past year. I closed out all positions and went on holiday...
July 30, 2004 in PBMs | Permalink | Comments (0)

July 29, 2004

PBMs: Sorry, got it all wrong, PBMs save money

After years of saying that PBMs need to do something else to maintain their value proposition, and repeating that concept last week, I realize that I've got it all wrong. You see, as this press release from the newly active...
July 29, 2004 in PBMs | Permalink | Comments (0)

July 22, 2004

PBMs: Something old and something new

You may not know this (I admit I didn't) but there's a trade association for PBMs called the Pharmaceutical Care Management Association which yesterday was one of the first to come out and laud the Administration's call for improving the...
July 22, 2004 in PBMs | Permalink | Comments (0)

June 24, 2004

PBMs: Medco layoffs

A while back Medco lost the FEBHP contract to Caremark. Now TheStreet.com reports that Medco is laying off some 7% of its workforce. And its stock has started to rally somewhat on the news. THCB readers will know that I've...
June 24, 2004 in PBMs | Permalink | Comments (0)

April 27, 2004

PBMs: Medco settles state complaints, but pretty cheaply

Medco today settled its ongoing lawsuit with several state attorneys-general at the relatively modest cost of $30m. The stock rose slightly on the news, although there is an another ongoing Federal lawsuit, that TCHB has covered before. While this looks...
April 27, 2004 in PBMs | Permalink | Comments (56)

February 19, 2004

PBMs: Zero sum big swings in the PBM world

If you've been reading THCB for a while you'll know that I'm not overall bullish on PBMs. But of course in any market if you win an account from your competitor that's responsible for over 14% of the competitors' earnings,...
February 19, 2004 in PBMs | Permalink | Comments (0)

February 12, 2004

PBMs: These are the good-old days for the PBMs

Caremark's (and AdvancePCS) stock jumped today because (as expected) the FTC has approved their merger. Both these stocks are at significant all time highs (or at least Caremark is up 8-fold since it got out of the physician business in...
February 12, 2004 in PBMs | Permalink | Comments (0)

January 20, 2004

PBMs: More litigation attacks on PBM behavior, leads to longer term doubts.

I've reported before on the suits against Caremark and Medco for all kinds of alleged shenanigans in drug pricing, rebates and other activities kept away from their clients' eyes. There's a bumper crop of news this week about the same...
January 20, 2004 in PBMs | Permalink | Comments (1)

December 22, 2003

PBMs: Even the New York Times notices rebate deals are a little odd

As the careful regular reader will note, I've always been hazy on what value the PBM brings to the health care party. My old IFTF colleagues Ian Morrison and Robert Mittman were at least partially responsible for making sure some...
December 22, 2003 in PBMs | Permalink | Comments (0)

December 04, 2003

PHARMA/PBM: Three tier formularies work

In a New England Journal of Medicine article called The Effect of Incentive-Based Formularies on Prescription-Drug Utilization and Spending a team from Harvard found that three-tier formularies work. Three tier formularies are what PBMs and health plans introduced in response...
December 4, 2003 in PBMs | Permalink | Comments (0)

November 20, 2003

PBMs: Caremark hiccup or It's better to be lucky than good

Well I told you last week that I'd had a small bet on the PBMs losing value this week as investors realized that the Medicare legislation wasn't guaranteed to pass. It happened for random reasons that I bought put options...
November 20, 2003 in PBMs | Permalink | Comments (0)

November 18, 2003

PHARMA/PBMs: Are Cox-2 inhibitors over-used?

Cox-2 Inhibitors have been a major therapeutic class since their introduction in the late 1990s. Led by Pfizer's Celebrex and Merck's Vioxx, the pain-relievers are roughly a $6bn market--not as large as the statin market but nothing to sneeze at....
November 18, 2003 in PBMs, Pharma | Permalink | Comments (0)

November 14, 2003

PBMs: No one's listening to me?

Despite my doubts as to whether we're going to get a Medicare drug bill, the market has decided a) that we will and b) that the PBMs are going to benefit the most from it. The last two days have...
November 14, 2003 in PBMs | Permalink | Comments (0)

November 13, 2003

PBMs/POLICY: Will tentative Medicare deal stick?

I noticed that the PBM stocks took off like a rocket at the end of the trading day yesterday. The news was that a tentative deal Medicare has been reached by the committee negotiating a compromise Medicare bill. PBMs are...
November 13, 2003 in PBMs | Permalink | Comments (0)

October 29, 2003

PBMs: PBMs doing well while CaremarkRx/AdvancePCS' deal is still uncertain

The newly independent PBM Medco Health Services' stock has been doing very well since its independence from Merck just a few months ago. In fact if you received Medco stock at the time of the disbursement you'll find that it's...
October 29, 2003 in PBMs | Permalink | Comments (2)

October 03, 2003

PBMs: The very, very begining of the end for PBMs?

You may remember my post somewhat facetiously titled The End of Managed Care. The concept was that managed care plans had stopped trying to manage physician behavior and had given up in the face of aggressive class action lawsuits from...
October 3, 2003 in PBMs | Permalink | Comments (0)

October 01, 2003

More details on the Medco suit

Here's what Medco said in its IPO offering document last April: In February 2000, two qui tam, or whistleblower, complaints under the Federal False Claims Act and similar state laws were filed under seal in the United States District Court...
October 1, 2003 in PBMs | Permalink | Comments (0)

September 30, 2003

PBM quickie: Feds join lawsuit against Medco

The Feds have backed two whistleblower suits against Medco. The allegations claim that Medco used a variety of techniques to favor Merck (which owned Medco at the time) and was paid $430m in 2001 to switch scripts from Merck's competitors....
September 30, 2003 in PBMs | Permalink | Comments (6)

September 04, 2003

Caremark/AdvancePCS Follow up

Today's New York Times confirms what I said yesterday. Caremark is paying a bit too much for AdvancePCS, but is doing so to get into the Medicare scrum as in the NYT's words "large drug benefit managers jockey for position...
September 4, 2003 in PBMs | Permalink | Comments (0)

September 03, 2003

PBMs again -- Caremark buys AdvancePCS

For serveral weeks the odd rumor that PBM Caremark was going to buy AdvancePCS showed up in the Yahoo ADVP message board. While you shouldn't usually trust what those boards say, this time they were right. Caremark announced a roughly...
September 3, 2003 in PBMs | Permalink | Comments (0)