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Part D: A Big Chance for Small PBMs

This article was originally published in RPM Report

Executive Summary

Smaller PBMs are making bigger bets on the new Medicare drug market. Companies like RxAmerica, CVS/Pharmacare and Argus think their business models give them an edge over the "big three" pharmacy benefit managers in this major new market. If they are right, it could transform the entire US pharma sector.

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Where is the Waste in Part D?

Rooting out waste in federal health care spending is one of few points of perennial bipartisan agreement in health policy. In that spirit, a Senate Committee wants to focus on trimming the waste in the Medicare pPrescription drug program-but first they have to figure out where it is.

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United and Humana remain by far the biggest players in the stand-alone drug insurance market for Medicare, but the field is gaining on them. They don't seem to mind. Is that a sign that the market is "mature"? Or a warning of rocky times ahead for a critical program for pharma.

Medicare Rx in 2009: Re-Politicizing Drug Prices

Remember when the Democrats took over Congress and promised to do something about prescription drug prices under Part D? They didn't get very far, and they haven't been talking about it since. But when beneficiaries get ready to renew their Part D coverage in 2009-and see how much their costs are going up-there may be a lot more to talk about.

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