DISCLOSURES
The authors have no relevant conflicts of interest to report.
REFERENCES
1. Wineinger NE, et al. Trends in prices of popular brand-name prescription drugs in the United States. JAMA Network Open. 2(5 e194791);3 May. 2019. doi:10.1001/jamanetworkopen.2019.4791
2. Martin SS. PBM industry today: who's managing drug costs? Manag Care. 2001;10(12):36–38
3. Hiltzik M. Column: The 'clawback': another hidden scam driving up your prescription prices. Los Angeles Times, Los Angeles Times. 9 Aug 2017
4. Van Nuys K, et al. Overpaying for prescription drugs: the copay clawback phenomenon. 2018. USC Schaeffer Center for Health Policy & Economics.
5. Garis RI, Clark BE. The spread: pilot study of an undocumented source of pharmacy benefit manager revenue. J Am Pharmacists Assoc. 2004;44(1):15-21.
6. Garis, RI, Clark BE, Mark V. Siracuse. Shining the light on non-transparent PBM cash flows. America's Pharm. 2004;126:20-25.
7. Silverman E. Spread pricing: from largely unknown to much scrutinized and criticized. Managed Care Magazine. 20 Sept 2019.
8. Candisky C. OptumRx overcharged Ohio on more than 1.3 million prescription claims, attorney general says. The Columbus Dispatch. 8 Feb 2020.
9. Attorney General. Attorney general seeks to recover nearly $16M in prescription overcharge. Ohio.gov. 19 Feb 2019.
10. 3 Axis Advisors. Analysis of spread pricing in New York Medicaid Managed Care. National Community Pharmacy Association, Pharmacist's Society of the State of New York, Inc., 24 Jan 2019.
11. Langreth R, et al. The Secret drug pricing system middlemen use to rake in millions. Bloomberg. 11 Sept 2018.
12. Dusetzina S, et al. Association of prescription drug price rebates in Medicare Part D with patient out-of-pocket and federal spending. JAMA Intern Med. 2017;177(8):1185–1118.
13. Stahl L. Evzio: the overdose-reversal drug with a $4000+ price tag. CBS News, CBS Interactive, 18 Nov. 2018.
14. U.S. Department of Health and Human Services. Fact sheet: Trump administration proposes to lower drug costs by targeting backdoor rebates and encouraging direct discounts to patients. HHS.gov. 31 Jan 2019.
15. U.S. Department of Health and Human Services. Trump administration proposes to lower drug costs by targeting backdoor rebates and encouraging direct discounts to patients. HHS.gov, US Department of Health and Human Services, 31 Jan. 2019
16. Alonso-zaldivar R. Setbacks for Trump's drive to lower prescription drug costs. AP NEWS, Associated Press. 11 July 2019
17. Feldman M. Copay accumulator adjustment policies impede treatment access for patients with rheumatoid arthritis. Rheumatology Practice Management. 2018;6(6).
18. Vacirca J. Pharmacy benefit managers: stop 'treating' my cancer patients. STAT, STAT News, 9 May 2019.
19. American Medical Association. 2018 prior authorization state law chart. Available at https://www.ama-assn.org/sites/ama-assn.org/files/corp/mediabrowser/ public/arc-public/pa-state-chart.pdf. Accessed Nov 16, 2019.
20. Open Secrets. Health services/HMOs top contributors, 2019-2020. Available at https://www.opensecrets.org/industries/indus.php?ind=H03. Accessed Jan 05, 2020.
21. Open Secrets. Health Services/HMOs: Top contributors to federal candidates, parties, and outside groups. Available at https://www.opensecrets. org/industries/contrib.php?cycle=2018&ind=H03. Accessed Jan 05, 2020.
22. Tindera M. These senators received the biggest checks from CVS, Humana and other drug middlemen testifying tuesday. Forbes, 10 Apr 2019.
23. Roland D, Loftus P. Insulin prices soar while drugmakers’ share stays flat. WSJ. 7 Oct 2016.
2. Martin SS. PBM industry today: who's managing drug costs? Manag Care. 2001;10(12):36–38
3. Hiltzik M. Column: The 'clawback': another hidden scam driving up your prescription prices. Los Angeles Times, Los Angeles Times. 9 Aug 2017
4. Van Nuys K, et al. Overpaying for prescription drugs: the copay clawback phenomenon. 2018. USC Schaeffer Center for Health Policy & Economics.
5. Garis RI, Clark BE. The spread: pilot study of an undocumented source of pharmacy benefit manager revenue. J Am Pharmacists Assoc. 2004;44(1):15-21.
6. Garis, RI, Clark BE, Mark V. Siracuse. Shining the light on non-transparent PBM cash flows. America's Pharm. 2004;126:20-25.
7. Silverman E. Spread pricing: from largely unknown to much scrutinized and criticized. Managed Care Magazine. 20 Sept 2019.
8. Candisky C. OptumRx overcharged Ohio on more than 1.3 million prescription claims, attorney general says. The Columbus Dispatch. 8 Feb 2020.
9. Attorney General. Attorney general seeks to recover nearly $16M in prescription overcharge. Ohio.gov. 19 Feb 2019.
10. 3 Axis Advisors. Analysis of spread pricing in New York Medicaid Managed Care. National Community Pharmacy Association, Pharmacist's Society of the State of New York, Inc., 24 Jan 2019.
11. Langreth R, et al. The Secret drug pricing system middlemen use to rake in millions. Bloomberg. 11 Sept 2018.
12. Dusetzina S, et al. Association of prescription drug price rebates in Medicare Part D with patient out-of-pocket and federal spending. JAMA Intern Med. 2017;177(8):1185–1118.
13. Stahl L. Evzio: the overdose-reversal drug with a $4000+ price tag. CBS News, CBS Interactive, 18 Nov. 2018.
14. U.S. Department of Health and Human Services. Fact sheet: Trump administration proposes to lower drug costs by targeting backdoor rebates and encouraging direct discounts to patients. HHS.gov. 31 Jan 2019.
15. U.S. Department of Health and Human Services. Trump administration proposes to lower drug costs by targeting backdoor rebates and encouraging direct discounts to patients. HHS.gov, US Department of Health and Human Services, 31 Jan. 2019
16. Alonso-zaldivar R. Setbacks for Trump's drive to lower prescription drug costs. AP NEWS, Associated Press. 11 July 2019
17. Feldman M. Copay accumulator adjustment policies impede treatment access for patients with rheumatoid arthritis. Rheumatology Practice Management. 2018;6(6).
18. Vacirca J. Pharmacy benefit managers: stop 'treating' my cancer patients. STAT, STAT News, 9 May 2019.
19. American Medical Association. 2018 prior authorization state law chart. Available at https://www.ama-assn.org/sites/ama-assn.org/files/corp/mediabrowser/ public/arc-public/pa-state-chart.pdf. Accessed Nov 16, 2019.
20. Open Secrets. Health services/HMOs top contributors, 2019-2020. Available at https://www.opensecrets.org/industries/indus.php?ind=H03. Accessed Jan 05, 2020.
21. Open Secrets. Health Services/HMOs: Top contributors to federal candidates, parties, and outside groups. Available at https://www.opensecrets. org/industries/contrib.php?cycle=2018&ind=H03. Accessed Jan 05, 2020.
22. Tindera M. These senators received the biggest checks from CVS, Humana and other drug middlemen testifying tuesday. Forbes, 10 Apr 2019.
23. Roland D, Loftus P. Insulin prices soar while drugmakers’ share stays flat. WSJ. 7 Oct 2016.
AUTHOR CORRESPONDENCE
Mark D. Kaufmann MD Mark.Kaufmann@mountsinai.org
