OptumRx’s Chief Clinical Officer shares his insights on the latest developments and trends he’s seen in the healthcare industry.

James Comer (R-Ky), House Committee on Oversight and Accountability chairman, sent letters to the Office of Personnel Management, Centers for Medicare and Medicaid Services and the Defense Health Agency asking for documents that show how PBMs’ practices are affecting federal government healthcare programs. In addition, he sent letters to CVS Caremark, Express Scripts and OptumRx, asking them to provide information on their tactics.

The largest six pharmacy benefit managers are being scrutinized by the Federal Trade Commission, while Congress is debating the Pharmacy Benefit Transparency Act. Meanwhile, states have their own ideas for reining in what they see as excesses of the industry. With all this heat, what is the message from the head of the Pharmaceutical Care Management Association?

Requiring that PBMs bid on a per member per month guarantee would reduce the employer’s uncertainty by securing the actual per member per month cost to the employer.

Large employers, particularly self-insured companies, can demand a better and fairer system. They can use their contracting power to insist that their plans cover all FDA approved drugs.

UnitedHealth’s 2020 revenue jumped by $15 billion from the year before. As the payer gears up for 2021, leaders except to see demand for telehealth and online pharmacies continue, driving their focus on these services.

Some healthcare startups that offer at-home prescription deliveries and test kits have experienced delays with the USPS. They shared how they’re navigating the changes.

Boston, Massachusetts-based WithMe Health launched out of stealth with $20 million in funding and Oak HC/FT Partner Chris Price at the helm.

Regulatory approval for the purchase is predicated on Aetna’s previously announced plans to sell off its Medicare Part D business to WellCare Health.

In a position statement, ASCO said PBM practices can result in medication dispensing errors, harm physicians’ ability to treat patients and drive up costs.

Cracking down on manufacturer rebates for PBMs is part of administration plan to cut drug and out-of-pocket costs.

Before the end of the year, UnitedHealthcare will add “clinically focused” notifications to Health4me, based on individuals’ claims data.