RX Alerts

Plan Administrators and Fiduciaries: It’s Time To Take REBATE ACTION – File An Accounting Procedure!

As newspaper articles multiply describing  PBMs’ questionable rebate conduct, every Plan administrator and fiduciary should consider filing a lawsuit against your PBM seeking an “accounting”.

As a Plan administrator or fiduciary, you’re charged with ensuring your Plan receives all monies your Plan is entitled to receive. Moreover, through an accounting, you’re likely to discover your PBM has been hiding large amounts of monies that, if reimbursed, would significantly decrease your Plan’s costs. And given the amounts your Plan may recover, you’ll likely be able to locate a law firm to file a lawsuit on a contingency basis, meaning the litigation won’t cost your Plan a dime.

Read this article to understand why you should file an accounting proceeding, and the information that you should seek.

Time To Determine If Your PBM Is Hiding Rebates

Express Scripts New Lawsuit Reveals There May Be Large Amounts of Hidden Monies

For years, PBMs have consistently refused to disclose any information about their secret “deals” with manufacturers to obtain “rebates” – that PBMs presumably pass through – and “other monies” – that PBMs collect from manufacturers but PBMs may retain for themselves.

But now, a new lawsuit filed by Express Scripts against the drug manufacturer kaleo reveals at least some information about Express Scripts secret deals. And the information is shocking.

Express Scripts is clearly collecting mega-millions of dollars from manufacturers, and much of that money is labeled “administrative fees” and “price protection rebates” that Express Scripts may not be entirely passing through to its clients or the federal government.

Every Plan administrator and fiduciary – and the federal government – should insist on learning more about the millions that Express Scripts and other PBMs are collecting. Go here to learn more.


Want To Decrease Your Rx Coverage Costs? Pay Attention to Horizon Pharma’s 1st Quarter Report

Horizon Pharma – the manufacturer of three extremely expensive drugs – Vimovo, Duexis and Pennsaid – just released its Quarterly Earnings Report causing its stock to plummet.

The Report should cause every Plan to stop providing coverage for all 3 of these drugs and stop relying on its PBM’s “standard” Formulary.

Read this article, and you’ll understand why.

Striking Savings Are Possible (But Your Plan Needs To Act To Obtain Them)

We’re thrilled to report that yet another Coalition Member that followed our Coalition’s recommendations and took aggressive steps to control its prescription coverage costs has now achieved a 16% cost decrease.

Sound too good to be true?

Go here to learn what the Coalition Member did to achieve these savings, and how you can do so as well.

Pull Back the Curtain on Manufacturers’ and Switch Operators’ Efforts To Undermine Your Plan’s Cost Savings Efforts

Like most health plans, your plan may be doing  all it can to steer your plan beneficiaries to use lower-cost drugs. But manufacturers are paying switch operators (like Relay Health and Change Healthcare) to foil your efforts.

If you don’t know what switch operators are or what they do – or your plan is not taking steps to counter switch operators’  machinations – you need to read this article.

Don’t Be Fooled By Eli Lilly’s & Express Scripts’ New Diabetes Program

In December 2016, Eli Lilly and Express Scripts announced a new diabetes treatment program to provide 40% discounts on three Lilly diabetes drugs. But the program is anything unknown-1but what it appears.

We explain why in this article, and provide recommendations for health plans and our media friends.