Drug Coverage

Both commercial and Medicaid plans have added Hadlima to their formularies. Hadlima in both high- and low-concentrations has a price that is 85% off Humira.

Carina Dolan, Pharm.D., talks about the trends that are driving both the acute and non-acute spending in hospitals for the next year.

Blue Shield’s new program will unbundle pharmacy services for increased transparency with the goal of saving $500 million annually. The health plan is also teaming up Mark Cuban Cost Plus Drug Company and Amazon Pharmacy.

The number of health plans that put in place restrictive policies that go beyond FDA-approved label is increasing, a new Tufts study finds.

LucyRx has $500 million in equity it will use for acquisitions and to build technology and infrastructure. It aims to be a national, full-service alternative to the big three PBMs.

Illinois Governor JB Pritzker signed into law a bill prohibiting PBM retaliation against pharmacists who disclose information during government proceedings.

Kaiser Permanente has a 95% formulary compliance rate, and this allows the health plan to negotiate with pharmaceutical companies for lower prices.

Following similar agreements, the settlement allows Fresenius Kabi and Formycon to launch their ustekinumab biosimilar no later than April 15, 2025.

Biosimilars that are interchangeable with Humira could provide more competition on price, a new analysis suggests.

Payers’ requirements for the use of Camyzos in patients with obstructive hypertrophic cardiomyopathy are generally consistent with the registration study, but they also imposed restrictions beyond the FDA indication or ICER recommendation.

Current treatments urea cycle disorders, which causes ammonia to build up in the blood, have a bitter taste and smell. Pheburane was developed with a special coating that masks the taste of sodium phenylbutyrate. It has a list price of $4,375 per bottle.

Capital Blue Cross uses algorithms to help find drug manufacturer coupon programs. It has saved $4.5 million in the first quarter of 2023.

Almost half of adults surveyed by KFF would be interested in taking a weight-loss drug, including many who say they only want to lose a little weight.

The specialty pharmacy business is a driver of Cigna’s growth, accounting for 40% of the Evernorth’s revenue.

Researchers say capping insulin costs at $35 a month has the potential to lower events and costs related to diabetes, such as amputations, vision loss, and heart attacks.

CVS’s health services segment includes CVS Caremark, but the company would not break out the revenue the PBM business only.

Breyna is indicated for patients with asthma six years of age and as maintenance therapy for people with COPD.

For Magellan’s clients, Ozempic had the highest trend of any product in 2022, and Wegovy was the fifth highest drug in terms of trend. Diabetes as a whole is expected to become the top condition leading pharmacy trend by 2024.

Rezzayo is a novel once-weekly antifungal to treat invasive candidiasis, a serious infection that can affect the blood, heart and brain. It will have a wholesale acquisition cost of $1,950 per vial.

MacKay Jimeson of the advocacy organization Patients Rising talks about CMS’ decision to limit coverage for Alzheimer’s drugs to those with full approval.

Accountable care organizations (ACOs) use digital health to complement traditional resources.

Renee Rayburg talks about the specialty drug spend, which grew 14.1% in 2022. PSG analysts predict increases will continue to be in the low double-digits for the next three years.

Sara Izadi, Pharm.D., of Capital Rx, talks about Rx Reverse, an integrated clinical program designed to help members reverse diabetes and fight obesity.

The FTC says that prior statements and studies about the PBM industry no longer reflect current market realities.

An analysis by Biosimilars Council has found that the reference product Lantus accounts for 54% of new prescriptions and is 78% of total market volume but demand for the unbranded interchangeable insulin glargine is increasing.

The newly formed Peterson Health Technology Institute was launched with $50 million to analyze clinical benefits and economic impact of new health technologies.

About 36% of Medicare Part D enrollees will benefit from the Inflation Reduction Act’s out-of-pocket caps for prescription drugs, which will go into effect in 2025.

Most private health insurance plans are required to cover vaccines for COVID-19 without patient cost-sharing.

In the short term, two gene therapies now under review at the FDA — lovo-cel and exa-cel — can reduce the frequency of painful crises in patients with severe sickle cell disease.

KFF analysis has found that 10 drugs account for 22% of all Medicare Part D spending in 2021.