National Average Drug Acquisition Cost

Study: PBMs setting wildly variable prescription prices for patients at the counter, per APCI

Retrieved on: 
Tuesday, September 19, 2023

Additionally, the study reveals wild swings in prescription pricing set by PBMs and charged to patients.

Key Points: 
  • Additionally, the study reveals wild swings in prescription pricing set by PBMs and charged to patients.
  • The study was performed by data analytics firm 3 Axis Advisors and was sponsored by American Pharmacy Cooperative, Inc. (APCI).
  • The study is replete with examples of variability and the arbitrariness of PBM-set drug prices.
  • Simply put, the system is broken, and PBMs can no longer be trusted to set drug prices."

Centers For Medicare & Medicaid Services Creates New Hospital Inpatient Payment for Coronary Intravascular Lithotripsy

Retrieved on: 
Wednesday, August 2, 2023

To date, hospitals in the U.S. have been reimbursed for coronary IVL via a New Technology Add-On Payment (NTAP), which provides an incremental payment of up to $3,666 in addition to the relevant MS-DRG payment for a PCI procedure performed in a hospital inpatient setting.

Key Points: 
  • To date, hospitals in the U.S. have been reimbursed for coronary IVL via a New Technology Add-On Payment (NTAP), which provides an incremental payment of up to $3,666 in addition to the relevant MS-DRG payment for a PCI procedure performed in a hospital inpatient setting.
  • The NTAP for coronary IVL will expire on September 30, 2023.
  • In keeping with procedure, CMS analyzed the relevant data collected on coronary IVL under the NTAP program in order to determine how to best code and pay for coronary IVL going forward.
  • "We appreciate CMS' decision to create new MS-DRGs for coronary IVL.

Samsung Bioepis Releases its First US Biosimilar Market Report, Providing Insights on Pricing Trends and Usage Across Molecules

Retrieved on: 
Monday, April 17, 2023

The first quarterly report details the most recent price trends of all molecules for which biosimilars have launched, along with insights into interchangeability of biosimilars.

Key Points: 
  • The first quarterly report details the most recent price trends of all molecules for which biosimilars have launched, along with insights into interchangeability of biosimilars.
  • “The first edition of Biosimilar Market Report from Samsung Bioepis reveals that market competition stimulated by the introduction of biosimilars in the US has contributed to significant price reductions in the biologics market.
  • However, the level of biosimilar usage varies by molecule, with some still taking less than 50% of the market share.
  • Insulin glargine and adalimumab categories reflect recent pricing practices such as unbranded biologics and high/low wholesale acquisition cost (WAC) options.

APCI Endorses the Drug Price Transparency in Medicaid Act

Retrieved on: 
Tuesday, March 21, 2023

BESSEMER, Ala., March 21, 2023 /PRNewswire/ -- American Pharmacy Cooperative, Inc. (APCI) announced today that it heartily endorses the Drug Price Transparency in Medicaid Act, a bipartisan bill introduced in Congress last week that seeks to end significant pharmacy benefit manager (PBM) excesses affecting prescription drug pricing in Medicaid managed care.

Key Points: 
  • BESSEMER, Ala., March 21, 2023 /PRNewswire/ -- American Pharmacy Cooperative, Inc. (APCI) announced today that it heartily endorses the Drug Price Transparency in Medicaid Act, a bipartisan bill introduced in Congress last week that seeks to end significant pharmacy benefit manager (PBM) excesses affecting prescription drug pricing in Medicaid managed care.
  • The Drug Price Transparency in Medicaid Act will put an end to spread pricing practices in Medicaid, saving taxpayer dollars while at the same time reimbursing pharmacies transparently and fairly while caring for state Medicaid patients across the country.
  • "This legislation is a win for taxpayers, patients, pharmacies, and advocates of transparency in the prescription drug marketplace," said APCI CEO Tim Hamrick.
  • APCI is committed to aggressively fighting for the passage of this legislation and calls on community pharmacists and other stakeholders to mobilize and support the passage of the Drug Price Transparency in Medicaid Act.

Liya Lomsadze and Sara Ganz of Capital Rx Named Finalists in the 19th Annual Stevie® Awards for Women in Business

Retrieved on: 
Tuesday, September 27, 2022

NEW YORK, Sept. 27, 2022 /PRNewswire/ -- Liya Lomsadze, Senior Project Manager, and Sara Ganz, Senior Director of Marketing of Capital Rx, have been named Finalists in the Female Employee of the Year category for the 19th annual Stevie® Awards for Women in Business. The two women embraced Capital Rx's mission of changing how prescription drugs are priced and patients are serviced.

Key Points: 
  • The Stevie Awards for Women in Business honor women executives, entrepreneurs, employees and the companies they run worldwide.
  • The Stevie Awards have been hailed as the world's premier business awards.
  • "In its 19th year, the Stevie Awards for Women in Business received a remarkable collection of outstanding nominations," said Maggie Miller, president of the Stevie Awards.
  • Stevie Awards are conferred in eight programs: the Asia-Pacific Stevie Awards, the German Stevie Awards, The American Business Awards, The International Business Awards, the Middle East & North Africa Stevie Awards, the Stevie Awards for Women in Business, the Stevie Awards for Great Employers, and the Stevie Awards for Sales & Customer Service.

APCI: To Reduce Prescription Drug Costs, Congress Must Fix America's PBM Problem

Retrieved on: 
Wednesday, August 3, 2022

However, these provisions in the reconciliation bill are bandages on a broken prescription drug pricing system in the United States.

Key Points: 
  • However, these provisions in the reconciliation bill are bandages on a broken prescription drug pricing system in the United States.
  • No effort to "right the ship" can be complete if it does not address anticompetitive pharmacy benefit manager (PBM) practices that increase prescription drug prices and restrict patient choice and access to care.
  • But to do that, Congress should focus on PBM practices which continue to drive prescription price increases and keep patients from affording the lifesaving drugs that they need."
  • Established in 1984 and headquartered in Bessemer, Ala., APCI is proud to lead the fight for prescription drug pricing transparency and reform.

CDPHP Selects Capital Rx as New Pharmacy Benefit Manager

Retrieved on: 
Thursday, May 12, 2022

Albany, NY, May 12, 2022 (GLOBE NEWSWIRE) -- CDPHP is thrilled to announce that Capital Rx has been selected as the health plans new pharmacy benefit manager (PBM).

Key Points: 
  • Albany, NY, May 12, 2022 (GLOBE NEWSWIRE) -- CDPHP is thrilled to announce that Capital Rx has been selected as the health plans new pharmacy benefit manager (PBM).
  • CDPHP has long sought a PBM partner that aligns with our mission, vision, and values, and I am proud to say we found the perfect fit with Capital Rx, said CDPHP chief pharmacy officer, Eileen Wood.
  • With Capital Rx, we have full transparency into the pharmacy supply chain and are able to innovate in ways that bring affordability, efficiency, and ease of use to all of our members.
  • CDPHP will leverage Capital Rxs intuitive, cloud-native, enterprise pharmacy platform (EPP) JUDI to increase efficiency and achieve the highest standards of clinical care for its members.

WTW Selects Capital Rx as an Innovative New PBM Partner to Join its Rx Collaborative

Retrieved on: 
Wednesday, April 20, 2022

NEW YORK, April 20, 2022 /PRNewswire/ -- Capital Rx, a healthcare technology company changing the way prescription drugs are priced and patients are serviced, announced today that it has been selected by WTW's Rx Collaborative (RxC), as a new, transformative pharmacy benefits management (PBM) partner. Through this new RxC partner, employers will have access to Capital Rx's cutting-edge technology and services.

Key Points: 
  • - WTW soughta modern, innovative, and transformative pharmacy benefits partnerwith a proven track record of loweringsoaring drug costs fJoint Ventureor employers.
  • Through this new RxC partner, employers will have access to Capital Rx's cutting-edge technology and services.
  • Capital Rx fills a vital role in executing WTW's mission of adding transparency to PBM pricing and revenue sources, while offering significant financial value to employers.
  • As the fastest-growing PBM in the United States, Capital Rx offers a prescription drug pricing arrangement that reflects transparent, competitive costs for all.

Capital Rx Awarded on the Forbes America's Best Startup Employers 2022 List

Retrieved on: 
Wednesday, March 9, 2022

NEW YORK, March 9, 2022 /PRNewswire/ -- Capital Rx , a healthtech company changing the way prescription drugs are priced and patients are serviced, announced it has been named to the Forbes list of America's Best Startup Employers 2022 .

Key Points: 
  • NEW YORK, March 9, 2022 /PRNewswire/ -- Capital Rx , a healthtech company changing the way prescription drugs are priced and patients are serviced, announced it has been named to the Forbes list of America's Best Startup Employers 2022 .
  • Capital Rx is the only pharmacy benefits manager (PBM) company to be recognized on the list this year.
  • Capital Rx is the fastest-growing PBM in the United States that delivers greater transparency in prescription drug pricing.
  • "I'm proud of the entire team at Capital Rx, who strive to deliver the highest quality of care at the lowest price point," said AJ Loiacono, CEO of Capital Rx.

Capital Rx Named to NYC Digital Health 100 by NYCHBL

Retrieved on: 
Wednesday, February 2, 2022

"Being named as one of the NYC Digital Health 100 companies is a true honor and testament to the entire Capital Rx team, who strives to make prescription medications affordable and accessible to all Americans," said AJ Loiacono, CEO of Capital Rx.

Key Points: 
  • "Being named as one of the NYC Digital Health 100 companies is a true honor and testament to the entire Capital Rx team, who strives to make prescription medications affordable and accessible to all Americans," said AJ Loiacono, CEO of Capital Rx.
  • Capital Rx is the fastest-growing PBM in the United States that delivers greater transparency in prescription drug pricing.
  • The NYC Digital Health 100 was released in conjunction with the NYCHBL Healthcare Innovation Report 2022, an in-depth look at the data, trends and insights that define the healthcare industry in NY.
  • To compile the NYC Digital Health 100, NYCHBL used its dynamic database of digital health companies in the region and then invited companies to complete applications with quantitative and qualitative data to broaden the consideration set.