FTC makes strides to boost competition and hold PBMs accountable

FTC makes strides to boost competition and hold PBMs accountable

https://ncpa.org/newsroom/qam/2024/04/24/ftc-makes-strides-boost-competition-and-hold-pbms-accountable

Two pieces of news about the Federal Trade Commission (FTC) that will affect the health care community. Chair Lina Khan revealed this week that an update into the agency’s investigation of pharmacy benefit managers will be released in the coming months, far sooner than planned, bowing to pressure from Congress and taking into account NCPA’s tireless advocacy efforts. (In March, NCPA co-hosted a Small Business Rising Coalition event with Khan, and earlier this month, Khan participated in a roundtable of community pharmacists in Pennsylvania co-hosted by NCPA—among the first organizations to cheer the FTC when it launched its inquiry into insurer PBM practices in 2022.) The second piece of news will have a broader impact on the health care industry. On Tuesday, the FTC finalized a rule banning noncompete agreements for all American workers—agreements that hospitals have widely used for years to retain their physicians and prevent them from bouncing to another hospital. “Noncompete clauses keep wages low, suppress new ideas, and rob the American economy of dynamism, including from the more than 8,500 new startups that would be created a year once non-competes are banned,” said Khan in an FTC press release. “The FTC’s final rule to ban non-competes will ensure Americans have the freedom to pursue a new job, start a new business, or bring a new idea to market.” To counter, the U.S. Chamber of Commerce and other business groups filed a lawsuit yesterday seeking to block the noncompete ban, as reported by the Wall Street Journal and other outlets. This is an ongoing story and we’ll keep you posted.

APDF goes to Washington DC to lobby members of Congress -042424

New Cash Rx Discount Card that won’t take everyone to the cleaner

It is becoming more and more evident that the PBM industry – the top 4-5 PBM companies controls ~ 90% of all third-party Rxs. Below are a couple of recent posts on my blogs that show how these PBM’s are financially screwing both the pts and especially the independent pharmacies.  I had my own independent pharmacy for 20 yrs, my heart belongs to that group of pharmacists.  Below is a link for a new “Rx discount card” that has been cobbled together by a group of independent pharmacists, that I have belonged to since its creation a year or so ago.  I just got this email announcement about this new “cash discount card”. They did not ask me to promote it, nor do I make any money for doing so.  The graphic on this page does not have active hyperlinks. Click on the last hyperlink below to go to the original graphic where the hyperlinks are active.

https://www.pharmaciststeve.com/pbm-rebate-schemes-to-suppress-biosimilar-humira-cost-patients-6b-iqvia-analysis-finds/

https://www.pharmaciststeve.com/cash-crunch-pushes-independents-to-the-brink-data-shows-pbms-the-cause/

https://www.pharmaciststeve.com/pts-being-robbed-at-the-pharmacy-counter-and-totally-unaware-of-it/

https://www.rphally.com/rx-savings-card?cid=d95d02e9-fc60-4549-88eb-30c1035c7ed1

APDF goes to Washington DC to lobby members of Congress -042324

The Biden administration has finalized new Title IX regulations:new regulations officially add “gender identity”

Biden revises Title IX

protections for pregnancy,trans people and assault victims

https://www.msn.com/en-us/news/us/biden-revises-title-ix-protections-for-pregnancy-trans-people-and-assault-victims/ar-AA1njyNs

The Biden administration has finalized new Title IX regulations that codify protections for transgender people, as well as enhance protections for victims of sexual assault or harassment and pregnant people.

“For more than 50 years, Title IX has promised an equal opportunity to learn and thrive in our nation’s schools free from sex discrimination,” said U.S. Secretary of Education Miguel Cardona in a statement on the revision. “These final regulations build on the legacy of Title IX by clarifying that all our nation’s students can access schools that are safe, welcoming, and respect their rights.”

The new regulations officially add “gender identity” onto the list of protections from sex-based discrimination for the first time, though the administration said it has already been applying this standard.

A decision on the administration’s proposed Title IX rule that would prohibit a blanket ban on transgender athletes from participating on teams aligned with their gender identity was not included in today’s announcement. That process is still ongoing, according to a senior administration official.

The Title IX update also now offers full protection from all “sex-based harassment,” broadening the definition to include “sexual violence and unwelcome sex-based conduct that creates a hostile environment by limiting or denying a person’s ability to participate in or benefit from a school’s education program or activity.”

These changes roll back the narrowed definitions of sexual harassment implemented by former President Donald Trump’s Education Secretary Betsy DeVos.

The regulations update also enhances protections for students, employees, and applicants against discrimination “based on pregnancy, childbirth, termination of pregnancy, lactation, related medical conditions, or recovery from these conditions.”

The final regulations, which take effect Aug. 1, also require increased accountability for schools in promptly responding to information about misconduct based on sex discrimination, according to the Biden administration.

Schools will be required to train employees “about the school’s obligation to address sex discrimination, as well as employees’ obligations to notify or provide contact information for the Title IX Coordinator” and strengthen requirements for schools conducting “reliable and impartial” investigations of all complaints.

“These regulations make crystal clear that everyone can access schools that are safe, welcoming, and that respect their rights,” Cardona said.

The original Title IX law was < 100 WORDS. This new proposed change is > 1000 PAGES. It seems that no matter if a person has Chromosomes “XX” or “XY” historically the determination of the “sex” of a human. If this becomes law, each individual can arbitrarily decide which “sex” they identify as.

Payvider: Health Insurance Payer and Healthcare Provider Combination Explained

APDF goes to Washington DC to lobby members of Congress

Two Years And $113 Billion Later, D.C.’s ‘America Last’ Crew Has No Plan For Ending The Russia-Ukraine War

When you look into the rearview mirror, “we” seem to like to be “in a war”. The last time that we won a war was 1945 – almost 80 years ago – and that took TWO A-BOMBS.  When Obama came to office we were 9 trillion in debt and when he left we were ~ 20 trillion and in the last 8 yrs we have added nearly 15 trillion. Our National debt is approaching 35 trillion. When Russia first invaded Ukraine, “we” gave them enough “stuff” to not lose this battle but not enough to win this battle. “we” gave them – compared to what Russia had – bows/arrows, slingshots, BB-guns.  As the battle went on, “we” provided Ukraine with a little more powerful and longer-range “stuff” several times. The House just approved 95 billion to be given to Ukraine, Israel, and Taiwan. With Ukraine getting the lion’s share.

Isn’t anyone concerned about those politicians/bureaucrats within the DC Beltway? It took us 235 yrs +/- to amass a 9 trillion national debt and our national debt has nearly quadrupled in 16 yrs?  The Congressional Budget Office projects that our national debt will hit 50 trillion by the end of the decade. This year, the cost of the interest on our national debt will exceed ONE TRILLION DOLLARS more money than we spend on national defense! The proposed budget for the next Federal fiscal year – starting Oct 1, 2024, will be REDUCED for the FOURTH year in a row!

There are 435 members of the House and at least 33 Senate seats up for this election. Is it time to CLEAN HOUSE – vote out all the incumbents? We can start FRESH with at least the House. Members of Congress expect that 95% will get reelected, regardless of what they promised to do and didn’t or promised not to do and did! 

To CLEAN HOUSE would be a BLACK SWAN EVENT!  I suspect that those newly elected members of Congress would listen to their constituents about their concerns.

Two Years And $113 Billion Later, D.C.’s ‘America Last’ Crew Has No Plan For Ending The Russia-Ukraine War

https://thefederalist.com/2024/04/19/two-years-and-113-billion-later-d-c-s-america-last-crew-has-no-plan-for-ending-the-russia-ukraine-war/

You don’t have to be a Putin stooge to see that dumping endless U.S. funds into Kyiv without proper oversight is a terrible idea.

Another week has come and gone, and America’s political leaders are still focused on one thing: shipping more money to Ukraine.

On Friday, the GOP-controlled House advanced a rule allowing the lower chamber to pass what effectively amounts to a massive foreign spending package. The bills under consideration seek to ship U.S. taxpayer dollars to Ukraine, Israel (and Hamas-controlled Gaza), and Taiwan. A “divest-or-ban” bill that would prohibit TikTok from operating in the U.S. under its current China-based ownership will also reportedly be considered.

The aforementioned rule was passed Thursday night by the House Rules Committee with help from Democrats. The rule effectively allows the House to vote on each funding measure separately without having to combine them into one package before sending it to the Senate for consideration.

As Federalist Senior Tech Columnist Rachel Bovard explained, “[I]f each title passes, they will all be fused into one package without a final vote (known as a MIRV),” and that “package is then added as a House amendment to the Senate foreign aid bill (the two are effectively the same); in parliamentary speak, the House concurs in the Senate amendment with a House amendment.”

More Democrats than Republicans voted for the rule during Friday’s vote. The foreign funding bills are expected to be considered by the House on Saturday, according to The Hill.

The Republican-controlled House’s fast-tracking of the measures further puts to shame Mr. “Wartime Speaker” Mike Johnson, who has gone above and beyond to break his repeated pledge to secure the U.S.-Mexico border before advancing foreign funding. This betrayal — combined with his prior surrenders on major policy fights — has prompted at least two House Republicans to back a motion to remove Johnson as speaker.

No Plan and No Statesmen

It’s no secret that the D.C. political class cares more about fortifying Ukraine’s borders than America’s.

Senate Minority Leader Mitch McConnell let the cat out of the bag in May 2022 when he admitted that President Biden and congressional leadership agreed “the most important thing going on in the world right now is the war in Ukraine.” That sentiment was still true for Kentucky’s senior senator nearly a year later, when he regurgitated the same talking point during a Fox News interview.

“[D]efeating the Russians in Ukraine is the single most important event going on in the world right now,” McConnell claimed, as America’s southern border remained open, inflation rose, and the federal government abused its intel agencies to target Republicans.

Of course, neither McConnell nor any other D.C. politico who backs U.S. funding for Ukraine has ever bothered to articulate what America’s strategy is for accomplishing such a feat — and therein lies the main problem.

More than two years and $113 billion later, Ukraine isn’t any closer to beating Russia than the day Moscow launched its invasion. There has been no explanation from the Biden administration or any “Ukraine First” member of Congress on what they view as a reasonable resolution to the conflict.

Those claiming the end goal is a total defeat of Russia are living in a fantasy land. Russia is a nuclear power and possesses one of the most sophisticated militaries in the world. Barring a sudden collapse of Russian governance, there is no scenario in which Ukrainian soldiers are going to be parading through the streets of Moscow, as blue-and-yellow Ukrainian flags wave atop the Russian White House.

Instead of fantasizing, America’s leaders must recognize the current situation in Eastern Europe for what it is. And that means acting like statesmen and negotiating a settlement to end the bloodshed and blank checks.

You don’t have to be a Putin stooge to recognize that dumping endless amounts of U.S. funds into Kyiv without proper oversight and a clear, obtainable objective is a disservice to the American taxpayer and the tens of thousands of Ukrainians being slaughtered in a war they can’t win.

https://i0.wp.com/thefederalist.com/wp-content/uploads/2024/04/President_Joe_Biden_and_Vice_President_Kamala_Harris_meet_with_Leader_Chuck_Schumer_Leader_Mitch_McConnell_Speaker_Mike_Johnson_and_Leader_Hakeem_Jeffries_in_the_Oval_Office-1200x675.jpg?resize=468%2C263&ssl=1

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in the Health Care Sector

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in the Health Care Sector

https://www.ftc.gov/news-events/news/press-releases/2024/04/federal-agencies-launch-portal-public-reporting-anticompetitive-practices-health-care-sector

Today, the Federal Trade Commission, Justice Department, and the U.S. Department of Health and Human Services (HHS) launched an easily accessible online portal for the public to report health care practices that may harm competition.

The online portal, HealthyCompetition.gov, allows the public to report potentially unfair and anticompetitive health care practices to the FTC and the Justice Department’s Antitrust Division. The launch of the new portal advances the Biden-Harris Administration’s efforts to lower health care and prescription drug costs and help create more competitive health care markets that are fairer to patients, providers, payers, and workers.

“All too often, we hear how unfair methods of competition and monopolistic practices may be depriving Americans of access to affordable, high-quality healthcare,” said FTC Chair Lina M. Khan. “This joint initiative between, FTC, DOJ, and HHS will provide a crucial channel for the agencies to hear from the public, bolstering our work to check illegal business practices that harm consumers and workers alike.”

“Competition in health care is crucial to ensuring fair and competitive wages across the healthcare sector and affordable and quality healthcare for all Americans,” said Assistant Attorney General Jonathan Kanter of the Justice Department’s Antitrust Division. “Today’s launch of HealthyCompetition.gov – a one-stop shop to report potential violations of our competition laws to the Justice Department and FTC – will allow the agencies to collaborate early and often, helping to promote economic opportunity and fairness for all.”

“Americans depend on competitive health care markets to provide quality choices and lower costs for coverage. That’s why we are working to tackle anticompetitive practices in the health care markets,” said HHS Secretary Xavier Becerra. “The Biden-Harris Administration and HHS know it is our responsibility to stop monopolistic, anti-competitive practices that undermine the delivery of health care to Americans. The information provided by the public will help to root out these behaviors.”

Complaints will undergo preliminary review by staff at the FTC and Justice Department, Antitrust Division. If a complaint raises sufficient concern under the antitrust laws or is related to HHS authorities, it will be selected for further investigation by the appropriate agency. This action may lead to the opening of a formal investigation.

The privacy and confidentiality policies that govern information submitted through the portal, including any personal information members of the public choose to provide, can be found at: DOJ Privacy PolicyDOJ Antitrust Division Confidentiality Policy Regarding Complainants, and FTC Privacy Policy.

HealthyCompetition.gov is the latest effort by the FTC, DOJ, and HHS to promote competition in health care markets to ensure that every American has access to high-quality, affordable care. As announced in December 2023, the FTC, DOJ and HHS have continued to partner on new initiatives, which included a joint request for information to seek input on how private-equity and other corporations’ control of health care is impacting Americans.

The Federal Trade Commission develops policy initiatives on issues that affect competition, consumers, and the U.S. economy. The FTC will never demand money, make threats, tell you to transfer money, or promise you a prize. Follow the FTC on social media, read consumer alerts and the business blog, and sign up to get the latest FTC news and alerts.

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PBM rebate schemes to suppress biosimilar Humira cost patients $6B, IQVIA analysis finds

PBM rebate schemes to suppress biosimilar Humira cost patients $6B, IQVIA analysis finds

https://drugstorenews.com/pbm-rebate-schemes-suppress-biosimilar-humira-cost-patients-6b-iqvia-analysis-finds

The Biosimilars Council released a new analysis by IQVIA that reveals a PBM strategy to protect $2 billion in profits by “strangling” the biosimilar market and preventing savings for patients.

The Biosimilars Council, a trade association representing manufacturers of biosimilar medicines, released a new analysis of IQVIA data revealing health plans and patients missed out on savings up to $6 billion as a result of rebate schemes by pharmacy benefit managers. The report highlights the strategy created by pharmacy benefit managers to protect $2 billion in profits by suppressing adoption of lower-cost versions of the brand drug Humira, once the best-selling drug in the world.

“Rebate and fee revenue tied to the list price continues to maintain a stranglehold on coverage decisions, to the detriment of patients and ultimately payers,” said Craig Burton, executive director of the Biosimilars Council. “Even when plans cover the biosimilars, they place the biosimilar on parity with the higher-priced brand and remove any incentive for patients to use the lower-cost biosimilar. It is critical that Congress enact legislation to rein in such PBM abuses.”

In the past year, multiple biosimilar alternatives to Humira launched in the U.S. Despite price discounts of greater than 80%, biosimilar adoption has been disappointingly slow, achieving less than 2% market share, the council said.

[Read more: A new environment for biosimilars]

IQVIA found that adalimumab biosimilars offer up to $6 billion in potential savings to the U.S. healthcare system; however, switching all U.S. patients would lead to an estimated 84% decrease in PBM profits. Because the majority of branded adalimumab is dispensed by large specialty pharmacies, a switch also would represent a potential loss of revenue for these business that frequently share corporate ownership with PBMs. IQVIA also found that, even when rebates are taken into account, lower wholesale acquisition cost biosimilar options have lower net costs for employers and patients, the council noted.

The IQVIA analysis shines a light on the perverse incentives causing this slow adoption: continued PBM reliance on rebates and fees that are tied to brand drug high list prices; and, PBM practice of rewarding their vertically-integrated in-house specialty pharmacy networks compared to independent specialty and retail pharmacies.

“Today’s report highlights a key barrier to biosimilar adoption,” said David Gaugh, interim president and CEO of the Association for Accessible Medicines. “PBM decisions to continue covering the brand Humira resulted in a loss of $6 billion in potential savings for patients and commercial and employer health plans—all because full coverage of the biosimilars would have reduced PBM and their vertically integrated specialty pharmacy profits by about $2 billion. It is critical that Congress and the Administration move quickly to ensure rapid adoption of biosimilars, to the benefit of patients.”