Here we are approaching the one-year anniversary (September 26, 2010) of the effective date of the McKesson AWP settlement, and unfortunately, little has changed. At WBC (wbcbaltimore.com) we have followed this case from the get-go, through negotiation and settlement. We have helped our clients 
with their direct participation in the class action settlement, as well as active involvement in evaluating their PBM. The question remains: where’s the new pricing standard that was anticipated?
As a refresher, part of the settlement involved the publishing of AWP by First DataBank, who along with McKesson Corp., were defendants in the action. One of the remedies was for First DataBank to cease publication of this standard within 2 years of the effective date of the settlement. Many thought a new benchmark would be introduced in short order to replace the perceived gap in a reliable and representative alternative. Much was written about whether WAC, AMP or ASP would fill the void. Several PBMs altered their benchmark and have adopted WAC in their pricing proposals. So what happens? The vast majority of PBMs simply adjusted their pricing discounts to reflect a lower AWP. They tauted it as “cost-neutral” to the client. What they didn’t say was the adjustment. i.e. reduction in cost, did not save the client any money. They did, however, remind clients that they weren’t going to be charged more!
To further delay the wheels of change, Wolters Kluwer, the publisher of Medispan, which is the largest competitor to First DataBank’s AWP’s Blue Book, has announced that they will continue to publish AWP “until relevant industry or governmental organizations develop a viable, generally accepted alternative.” Interestingly, Medispan was a party in the settlement and had agreed to stop publishing by September 26, 2011. Let’s see if Judge Saris, the judge who heard the case and approved the settlement, has anything to say.
There really is no national standard that has gained traction as a suitable alternative. A committee that was commissioned by the National Council for Prescription Drug Programs recommended that WAC be used as a replacement benchmark for single-source drugs, while no recommendation was made to cover multi-source products. In our opinion, the best bet for future guidance seems to reside with our friends at CMS. They prefer AMP, and plan to begin publishing AMP pricing in October. We believe that if and when this occurs, the rest of the industry will fall into line within a year. It is a big “if” however, since the retail pharmacy associations don’t seem to want any part of more transparent pricing, at least as it applies to their pharmacy setting. When CMS announced a recent plan to produce pricing surveys and publish results with acquisition cost pricing, they were faced with a firestorm of resistance from the pharmacy lobbies. Litigation has been promised if CMS continues to pursue this course, so we’ll have to wait and see what happens. It may be a harbinger of things to come related to PBM pricing benchmarks. Stay tuned!
And like the Frankenstein Monster (huge, ugly, but really just misunderstood) this healthcare ”thing” will be very difficult to kill once it has been given life.
in “cause awareness” is Oprah. It was recently announced that she is helping raise diabetes awareness by promoting free blood glucose screenings at Walgreen’s (
one which incorporates fresh fruits and vegetables as a bigger component of our menu. The fact is that okra (as just one example) is great for you, and that the mucilage and fiber in okra helps adjust blood sugar by regulating its absorption in the small intestine.
It goes something like this: create a crisis fervor, point the finger of blame at some straw dog, and try and steer public opinion for doing something!
PBMs have proffered adjustments to their contracts with plan sponsors to address this situation. The underlying question, however, is “Who pays?”
pharmacy counter and if you are a drug benefit plan sponsor, you’ll be receiving adjusted invoices to reflect this momentous event. The problem is that for most plan sponsors, all this “normalcy” is a bad thing!
Unlike chemical compounding that occurs in regular pharmacy (small-molecule drugs), biologics are created at the cellular level within proteins. Traditional pharmacy uses drugs that address symptoms of disease, and generics must be identical or bio equivalent to their brand name counterpart. Biologics try and fix the actual disease and cannot be replicated exactly.Biosimilars then, are drugs that are “sufficiently similar”to products already approved by the FDA. In fact, some have suggested that we not even call them biosimilar (the term used in Europe) as a descriptor, but prefer “follow-on protein.”