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Confusing New PBM Drug Pricing Terms Leave Payors Unsure of Next Steps
Date:8/11/2009

MILWAUKEE, Aug. 11 /PRNewswire/ -- A recently mandated settlement in a class action suit involving drug wholesaler McKesson Corporation and data publishers First Data Bank and Medispan is impacting pharmacy benefit programs in both the short and long terms, according to Greg Rucinski, President & CEO for TRICAST, Inc., a leading next-generation health information business.

"There's a whole lot more than meets the eye in what the U.S. District Court in Massachusetts mandated. Pharmacy Benefit Managers are looking to renegotiate all of their clients pricing agreements resulting from the fallout of this settlement," Rucinski says, adding that TRICAST has issued a White Paper on the issue.

"Many payors are expecting windfall savings because the cost-basis for drugs will decrease in September," Rucinski says. "However, PBMs and pharmacies are protecting any loss in their margins resulting from this pricing rollback, with PBMs moving in several confusing directions regarding pricing."

Many corporate and health plan CFOs and government agencies, as well as other payors, are confronted with new contracts or pricing amendments that recalculate how drugs will be priced. "We are seeing an array of new pricing discount terms, pricing algorithms and different basis of costs," says Rob Shelley, President of PSRx Advisors, a TRICAST partner. "As a result, it is hard for payors to be confident of the next step to manage drug costs."

Details on Pricing Rollback

Average Wholesale Price (AWP) is the pharmacy industry basis for reimbursement of pharmaceuticals dispensed on behalf of third party
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SOURCE TRICAST, Inc.
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