Broker Regulation

The company then sought payment for many of those prescriptions from Medicare and other federal health care programs in violation of the False Claims Act, the announcement said.

Similar ownership provisions are under consideration in Indiana, New York, Texas and Vermont. 

In addition, the investigation is looking into margin-squeezing activity that reduces the margins of its retail pharmacy competitors by increasing its PBM service fee.

For plan sponsors, the Healthcare Price Transparency Executive Order has far-reaching implications, offering opportunities to manage costs more effectively, enhance plan sustainability and deliver clearer value to employees.

As alternative PBM models seek to up-end a payer’s longstanding relationship with a large PBM, they must be prepared to support clients with smart technology and innovative solutions that enable real-time data, increase transparency and ensure better pricing that impacts drug purchasing decisions.

The drug industry is lobbying for potential tariffs to be implemented gradually instead of immediately being imposed at a 25% rate.