US Healthcare

Direct-to-consumer: New avenue for PBMs could provide political shelter

Departing from their traditional role working for payers as third-party administrators of prescription drug coverage, two of the largest pharmacy benefit managers are taking a direct-to-consumer approach through drug discount programs.   The discount cards (also known as consumer cards, point-of-sales cards, or 100 percent copay cards) bypass the payers that PBMs typically serve, disrupting […]

CBO Score of AHCA Offers Few Surprises, Pegs 23M Loss on Insurance Rolls

The new Congressional Budget Office on the American Health Care Act looks remarkably similar to the old score, and still creates major conundrums for the U.S. healthcare industry. The CBO estimated 23 million fewer insured Americans by 2026, down slightly from the 24 million project under the original AHCA. Elimination of the Affordable Care Act […]

Outcomes-Based Contracting Gain Steam

Amgen’s recent offer to refund to health plans the cost of its statin add-on therapy Repatha for eligible patients who take it and then suffer a heart attack or stroke highlights the extent pharmaceutical companies are willing to go to overcome insurance access barriers to expensive, groundbreaking therapies. The refund offer was announced along with […]