Corbett said that the settlement generally prohibits Caremark from soliciting drug switches when:
-- The net drug cost of the proposed drug exceeds the net drug cost of the originally prescribed drug;
-- The cost to the patient will be greater than the cost of the originally prescribed drug;
-- The originally prescribed drug has a generic equivalent and the proposed drug does not;
-- The originally prescribed drug's patent is expected to expire within six months; or
-- The patient was switched from a similar drug within the last two years.
The settlement requires Caremark to:
-- Inform patients and prescribers what effect a drug switch will have on a patient's co-payment;
-- Inform prescribers of Caremark's financial incentives for certain drug switches;
-- Inform prescribers of material differences in side effects or efficacy between prescribed drugs and proposed drugs;
-- Reimburse patients for out-of-pocket expenses for drug switch related health care costs and notify patients and prescribers that such reimbursement is available;
-- Obtain express, verifiable authorization from the prescriber for all drug switches;
-- Inform patients that they may decline a drug switch and the conditions for receiving the originally prescribed drug;
-- Monitor the effects of drug switches on the health of patients;
-- Adopt a certain code of ethics and professional standards;
-- Refrain from making any claims of savings for a drug switch to patients or prescribers unless Caremark can substantiate the claim; and
-- Inform prescribers that visits by Caremark's clinical consultants and promotional materials sent to prescribers are funded by pharmaceutical manufacturers, if that is the case.
Corbett noted that PBMs enter into contracts with employers and
government health plans to process prescription drug c
|SOURCE Pennsylvania Office of Attorney General|
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