News and notes from around the interweb:
- PBMs ranked by market share: CVS Caremark is No. 1. Three companies dominate the pharmacy benefit manager market, accounting for 79 percent of all prescription claims in 2020, according to data from Health Industries Research Companies, an independent, non-partisan market research firm. To assess market share, HIRC used self-reported data from twenty-nine pharmacy benefit manager leaders collected in December 2020 and January 2021.
- Documenting Patient Interventions Is Essential. The most common MRPs or medication-related problems included Beers criteria medications (mostly antidepressants, protein pump inhibitors, gabapentin, and opioids), medication omission, drug-condition interaction, duplicate therapy, medication nonadherence, drug-drug interactions, untreated conditions, dose that were too low, and doses that were too high. MRPs were also equally prevalent among face-to-face versus phone interventions. However, the presence of documentation in the “assessment” section of the comprehensive medication review (CMR) was higher when MTM was conducted via phone (42%) compared to face-to-face (28%).
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Documents reveal the secrecy of America’s drug pricing matrix. Several people who work in the industry, who asked not to be named due to the confidential nature of coalitions, said most employers, regardless of how big they are, have no idea what they’re giving up when they enter coalitions. Once employers are locked into the coalition, they can’t get a full second opinion on the drug prices they pay, experts said.
- Over 800 Prescription Medications Got More Expensive in January 2022. The list prices for 810 prescription drugs increased by an average of 5.1 percent between Dec. 29 and Jan. 31, according to a GoodRx report released Feb. 4. Of the 810 medications that saw price increases in January, 791 were brand drugs, 19 were generics, 199 were specialty drugs and 84 were healthcare practitioner-administered drugs. The 791 brand drugs’ prices increased by an average of 4.9 percent, and the 19 generic drugs’ prices increased by an average of 12.6 percent. Price hikes in January 2022 were on par with January 2021, which saw 832 price hikes. In January 2022, drug prices rose by an average of 5.1 percent, half a percentage greater than in January 2021. The price hikes came from 155 drugmakers.
- As It Mulls Whether to Grant Cert in ERISA Case on PBM Fiduciary Liability, Supreme Court Seeks Government’s Input. In December, the Supreme Court requested that U.S. Solicitor General Elizabeth Prelogar file a brief in John Doe 1 v. Express Scripts Inc., weighing in on whether the Court should hear a case about prescription drug costs. If the Supreme Court adopts the petitioners’ position, pharmacy benefit managers (PBMs) could face significant legal exposure under ERISA for decisions that affect prescription drug prices.