If Medicare pursued the same strategy that pharmacy benefit managers use to weed out certain medicines and offer alternatives for private health plans, the federal government could have saved nearly $3 billion from 2012 and 2015, according to a recent analysis.

How so? Well, pharmacy benefit managers purportedly try to limit costs for private health plans by excluding certain medicines from their formularies, or lists of drugs for which reimbursement is available. But as the authors of the JAMA Internal Medicine research letter note, the extent to which such maneuvers are used by all Medicare Part D plan administrators is unknown.

Unlock this article by subscribing to STAT Plus and enjoy your first 30 days free!


What is it?

STAT Plus is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's included?

  • Daily reporting and analysis
  • The most comprehensive industry coverage from a powerhouse team of reporters
  • Subscriber-only newsletters
  • Daily newsletters to brief you on the most important industry news of the day
  • Online intelligence briefings
  • Frequent opportunities to engage with veteran beat reporters and industry experts
  • Exclusive industry events
  • Premium access to subscriber-only networking events around the country
  • The best reporters in the industry
  • The most trusted and well-connected newsroom in the health care industry
  • And much more
  • Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.
  • While the study has merit on it’s face, there is another reality. The current (2018) Part D plans do have formularies that are pushing generics or , more properly, excluding branded drugs to some extent. Then you have to consider the pushback against interfering with ‘doctor-patient.’
    How much of this spend is already PBM managed for the subscribers? An additional factor to consider.

    • The PBMs so not always aggressively pursue generic alternatives there are numerous examples where generic drugs are not covered long after initial launch because of rebates offered to PBMs from the originator companies

Comments are closed.

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy