Career Development : Calendar

Understanding the pharmacy benefit manager 'shell game'

09/14/22

Sept. 14, 1 p.m. ET

In this webcast, Ohio-based, award-winning journalist Darrel Rowland will explain the strategies pharmacy benefit managers use to boost profits by increasing what patients pay out of pocket for their medications and limiting the drugs that insurers will cover. He'll also talk about how pharmacy benefit managers have driven smaller and locally owned pharmacies out of business.

These strategies and others led the Federal Trade Commission to begin an investigation this spring into the practices of the six largest PBMs — CVS Caremark, Express Scripts, OptumRx, Humana Inc.; Prime Therapeutics, and MedImpact Healthcare Systems — and Rowland will help prepare journalists to report on the outcome of that investigation.

View the webcast

Links

A press release about a report from the U.S. Senate Finance Committee on insulin and the role of PBMs and other actors in the drug-supply chain:

• https://www.finance.senate.gov/chairmans-news/grassley-wyden-release-insulin-investigation-uncovering-business-practices-between-drug-companies-and-pbms-that-keep-prices-high

The press release includes a link to all of the material the committee reviewed, including the full text of the committee’s investigative report and the committee’s records: HERE.  

And here’s a link to the report itself:

• https://www.finance.senate.gov/imo/media/doc/Grassley-Wyden Insulin Report (FINAL 1).pdf

Here are links from the Federal Trade Commission on its PBM investigation into PBMs:

• https://www.ftc.gov/news-events/events/2022/06/future-pharmaceuticals-examining-analysis-pharmaceutical-mergers

• FTC-DOJ Listening Forum - Health Care- April 14, 2022

• The Future of Pharmaceuticals - June 14, 2022

• The Future of Pharmaceuticals - June 15, 2022

• Merger Guidelines Listening Forum- June 21, 2022

Other sources mentioned included:

• Antonio Ciaccia at 3 Axis Advisors, a consulting firm, and at 46Brooklyn Research, drug-price researchers and on Twitter at @A_Ciaccia

• Adam J. Fein, PhD, CEO of Drug Channels Institute.

And here’s a link to a report in 2019 from the Massachusetts Health Policy Commission on what’s called the ‘black box’ in the relationship between health insurers and PBMs:

• Cracking Open the Black Box of Pharmacy Benefit Managers

Darrel Rowland

Joseph Burns

Darrel Rowland is an independent journalist who has won multiple awards for his work over more than three decades at The Columbus Dispatch in Ohio as a reporter and editor. His work has focused on what he calls accountability stories about pharmacy benefit managers and on a wide variety of other topics. Stories he supervised led to the resignation of an Ohio attorney general, and he has reported on a scandal in which state officials admitted to improperly withholding $40 million in child-support payments to single parents.