tci Medicare Compliance & Reimbursement - 2005 Issue 25

Pharmaceuticals: Plans, PBMs, Pharmacies Jockey For Part D Positioning

Are pharmacies raising rates for health plans?As the implementation of the prescription drug benefit draws closer, health plans are grappling with the fact that their current business partners soon will be competitors. Health plans interested in participating in Medicare Part D by sponsoring a prescription drug plan are scrambling to finalize their formularies and offer bids to the Centers for Medicare and Medicaid Services. Meanwhile, the Pharmaceutical Care Management Association, the lobbying group for pharmacy benefit managers. is accusing pharmacies of making life difficult for health plans and PBMs. In a May 20 letter PCMA...

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