Insight, analysis & opinion from Joe Paduda
If watching the legislative process in DC is akin to watching sausage made, the passage of the Medicare Drug bill might be akin to the composting process. Roy Poses at Health Care Renewal reflects on “60 minutes'” recent piece on the making of Part D; Roy’s deep experience with big pharma adds a good bit of perspective.
Health care reform is coming; read Roy’s piece for a heads’ up on what the legislative process may look like.
Sources indicate Fiserv has terminated its efforts to sell third party biller Third Party Solutions thru Bank of America. This despite Fiserv’s interest in shedding non-core assets, begun under CEO Jeff Yabuki. While Fiserv may still entertain offers, it is unlikely any will approach the rumored goal of $275 million Fiserv was asking for TPS.
While more than a few private equity/venture firms assessed TPS, evidently no term sheets approached the desired valuation. Issues may have included concern about TPS’ “complicated” A/R situation.
Meanwhile, competitor WorkingRx is still for sale…
What does this mean for you?
A temporary continuation of the current awkward third party biller-pharmacy-PBM-payer struggle/business relationship.
The state of Washington is a monopolistic workers comp state; unless an employer is large enough to be self-insured, it has to buy workers comp insurance from the state itself.
As a monopolistic state, the regulators have even more power than in the highly regulated but non-monopolistic states. One area of particular interest is how the state deals with the WC drug formulary, which specifically excludes Actiq and Lyrica.
Washington’s Health Dept. just released new guidelines on the use of narcotic opioids; the guidelines, their development process, and the impact of same should be watched carefully by regulators, insurers, managed care firms and most of all prescribing physicians.
The two major third party billers have been on the block for a few months. The first round of queries went out to financial buyers and lately they’ve opened the process up to potential strategic buyers as well. Why?
Continue reading What’s up with the third party biller auction?
Jim Andrews of Cypress Care (a consulting client and WC PBM) gave a talk yesterday about some of the differences between drug spend in WC and group health. Here are a few of the main points I picked up.
URAC, the accreditation body that seems to be into every aspect of managed care, is now looking to certify PBMs. In a presentation at the PBMI conference in Phoenix last week, a representative provided an overview of the process, modules, timing and certification levels contemplated by URAC.
While the process is only for health lines today, URAC is seriously looking into accrediting WC PBMs…
Brace yourselves.
Continue reading URAC’s foray into pharmacy benefit management
How drugs make it on to formularies has always puzzled me. After listening to a talk on the process, I’m even more mystified.
I’ll be releasing the fourth annual survey of prescription drug management in workers comp in a few weeks. Here are a few early findings.
Continue reading Managing drugs in workers comp – the 4th annual survey
Actiq is a narcotic taken in lollypop form, a technique that gets the drug to the pain centers quickly. Developed for break-through cancer pain, evidence now suggests that only 10% of Actiq users have cancer.The high-powered narcotic has been the subject of several recent reports and a state attorney general investigation concerning off-label use.
Despite what some Congressional Dems say, requiring CMS Secretary Mike Leavitt to negotiate drug prices with big pharma is not going to save us gazillions of dollars.
It also won’t lead to a sudden decline in pharmaceutical research (sorry, Manhattan Institute). It’s good political theater, but the real impact will be minimal.
Unless…
Continue reading How to make negotiating drug prices pay off