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STAT+: Tennessee officials find Express Scripts violated law governing commercial pharmacy claims

STAT

In an unusual move, an audit of commercial health plans by Tennessee officials found that Express Scripts, one of the largest pharmacy benefit managers in the United States, violated state laws in its dealings with pharmacies, according to newly released documents.

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Independents Outshine PBMs in Manufacturers’ Exclusive Specialty Pharmacy Networks

Drug Channels

Last week, we documented the substantial concentration of dispensing revenues for specialty drugs. See The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents. Today, we examine how manufacturers’ specialty networks contribute to this concentration.

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Independents Outshine PBMs in Manufacturers’ Exclusive Specialty Pharmacy Networks (rerun)

Drug Channels

Last week, we documented the substantial concentration of dispensing revenues for specialty drugs. See The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents. Today, we examine how manufacturers’ specialty networks contribute to this concentration.

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Driving Provider Value for Specialty Pharmacies

National Association of Boards of Pharmacy

Launched in 2019, NABP’s Specialty Pharmacy Accreditation was created to accredit pharmacies providing advanced levels of pharmacy services and disease management tools for patients taking medications that require special handling, storage, and dispensing requirements.

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PBM-Owned Specialty Pharmacies Expand Their Role In—and Profits From—the 340B Program

Drug Channels

Last week, I documented that nearly half of U.S. pharmacies now participate in the 340B Drug Pricing Program. Below, we update our exclusive analysis of the biggest specialty pharmacies within 340B. As you will see below, these specialty pharmacies have dramatically increased their participation in the 340B program.

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Why 340B Hospitals Should Now Build Their Own Specialty Pharmacies

Proxsys Rx

340B ESP and drug manufacturer restrictions are only part of the reason As we noted in a previous post , for 340B-eligible hospitals dealing with increasingly squeezed bottom lines, an in-house specialty pharmacy offers enormous savings and revenue potential. Hospitals can operate specialty pharmacies alongside their retail pharmacies.

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Navigating 340B Program Changes in 2025

Proxsys Rx

In a nutshell, says ProxsysRx 340B Optimization Manager Chance Spivey, the CE would have to pay retail prices first to allow for replenishment and THEN submit documentation like they do for 340B ESP (this time with even more claims info). Automate your 340B program with customized software streamlining documentation and reporting.