Formulary Watch |

Formulary Watch covers formularies, pharmacy benefit management companies, drug approvals, and other matters related to medications, their prices and insurance coverage.

Editorial Contact: Denise Myshko: dmyshko@mjhlifesciences.com

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MedImpact Selects Simlandi and an Unbranded Humira Biosimilar
MedImpact Selects Simlandi and an Unbranded Humira Biosimilar
MedImpact Selects Simlandi and an Unbranded Humira Biosimilar
August 29, 2024
MedImpact is not requiring patients currently taking Humira to switch, and all three products are on a preferred tier.
Cigna Prefers Zymfentra on Medical Benefit for Crohn’s Disease and UC
Cigna Prefers Zymfentra on Medical Benefit for Crohn’s Disease and UC
Cigna Prefers Zymfentra on Medical Benefit for Crohn’s Disease and UC
August 29, 2024
Zymfentra is a subcutaneous infliximab product used to treat ulcerative colitis and Crohn’s disease. It has a price of $6,181.08 for two shots over four weeks.
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FDA Assigns Review Date for Mirdametinib in Genetic Neuro-Oncology Condition
FDA Assigns Review Date for Mirdametinib in Genetic Neuro-Oncology Condition
August 28, 2024
The FDA has given mirdametinib a Prescription Drug User Fee Act (PDUFA) action date of Feb. 28, 2025, to treat patients with neurofibromatosis type 1 with tumors that grow along the peripheral nerve.
Pfizer Launches Consumer Access Program for Vaccines and Some Medications
Pfizer Launches Consumer Access Program for Vaccines and Some Medications
Pfizer Launches Consumer Access Program for Vaccines and Some Medications
August 27, 2024
Through the PfizerForAll platform, patients can connect with a healthcare professional, find and book vaccines, order tests, and find medication savings information.
Lilly Introduces Zepbound Single-Dose Vial for Cash-Paying Patients
Lilly Introduces Zepbound Single-Dose Vial for Cash-Paying Patients
Lilly Introduces Zepbound Single-Dose Vial for Cash-Paying Patients
August 27, 2024
The monthly price of the 2.5 mg Zepbound single-dose vial is $399 and the 5 mg dose is $549, which Lilly officials said is in line with the savings program for without insurance.
Express Scripts to Remove Humira from Commercial Formularies
Express Scripts to Remove Humira from Commercial Formularies
Express Scripts to Remove Humira from Commercial Formularies
August 26, 2024
Beginning in 2025, Express Scripts will favor biosimilars of Humira, including its own private-label version.
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FDA Grants Approvals for Two Updated COVID-19 Vaccines
FDA Grants Approvals for Two Updated COVID-19 Vaccines
August 22, 2024
The updated vaccines include the KP.2 strain of the Omicron variant, which is believed to be contributing to the increases in COVID-19 infections this summer.
Study Finds Drug Coverage Changes in Medicare Part D Plans
Study Finds Drug Coverage Changes in Medicare Part D Plans
Study Finds Drug Coverage Changes in Medicare Part D Plans
August 22, 2024
Avalere’s Kylie Stengel talks about the regional shifts in formularies and utilization management in Medicare Part D prescription drug plans.
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FDA to Hold Advisory Committee Meeting for Sotagliflozin in Type 1 Diabetes and CKD
FDA to Hold Advisory Committee Meeting for Sotagliflozin in Type 1 Diabetes and CKD
August 21, 2024
The FDA has assigned a Prescription Drug User Fee Act of Dec. 20, 2024, for Zynquista (sotagliflozin) to control glycemic levels in adults with type 1 diabetes and chronic kidney disease.
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FDA Issues Complete Response Letter for Linvoseltamab for Multiple Myeloma
FDA Issues Complete Response Letter for Linvoseltamab for Multiple Myeloma
August 21, 2024
The FDA identified at a third party fill and finish manufacturer. The issues have been resolved, and reinspection is expected in the next few months.
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Chronic Graft-Versus-Host Disease Medication, Niktimvo, Gains FDA Approval
Chronic Graft-Versus-Host Disease Medication, Niktimvo, Gains FDA Approval
August 15, 2024
This therapy is a first-in-class treatment for chronic graft-versus-host disease, which develops in roughly 42% of those who receive a stem cell of bone marrow transplant.
FDA Grants Accelerated Approval for Rare Liver Disease Drug
FDA Grants Accelerated Approval for Rare Liver Disease Drug
FDA Grants Accelerated Approval for Rare Liver Disease Drug
August 15, 2024
Livdelz is an oral therapy to treat patients with primary biliary cholangitis, a progressive autoimmune disease. It is expected to be available in pharmacies next week.
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Prurigo Nodularis Medicine Nemluvio Approved by FDA
Prurigo Nodularis Medicine Nemluvio Approved by FDA
August 13, 2024
This first-in-class treatment targets multiple disease mechanisms such as itch and inflammation associated with this condition.
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CMS Assigns Reimbursement Code for Investigative Cell Therapy
CMS Assigns Reimbursement Code for Investigative Cell Therapy
August 13, 2024
Prademagene zamikeracel is a cell therapy in development to treat patients with recessive dystrophic epidermolysis bullosa (RDEB), a rare connective tissue disorder.
Top 3 PBMs Provide Coverage for Zymfentra
Top 3 PBMs Provide Coverage for Zymfentra
Top 3 PBMs Provide Coverage for Zymfentra
August 13, 2024
Zymfentra launched in March 2024 as the first subcutaneous formulation of infliximab for patients with ulcerative colitis and Crohn’s disease. It has a list price of $6,181.08 for two shots over four weeks.
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Insurance Companies Starting to Cover Anktiva, a Bladder Cancer Immunotherapy
Insurance Companies Starting to Cover Anktiva, a Bladder Cancer Immunotherapy
August 12, 2024
No information, however, is available about which insurance plans are providing coverage of Anktiva or what the utilization management requirements are.
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Biosimilar Enzeevu Approved by FDA to Treat Neovascular Age-Related Macular Degeneration
Biosimilar Enzeevu Approved by FDA to Treat Neovascular Age-Related Macular Degeneration
August 12, 2024
Enzeevu is biosimilar to Eylea (aflibercept), which was FDA-approved in 2019.
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FDA Issues Complete Response Letter for MDMA-Assisted Therapy for PTSD
FDA Issues Complete Response Letter for MDMA-Assisted Therapy for PTSD
August 12, 2024
In June, an FDA advisory committee voted against approval of midomafetamine capsules (MDMA) for adults living with posttraumatic stress disorder (PTSD).
Nasal Spray for Treatment of Anaphylaxis Approved by FDA
Nasal Spray for Treatment of Anaphylaxis Approved by FDA
Nasal Spray for Treatment of Anaphylaxis Approved by FDA
August 9, 2024
Neffy is the first epinephrine product that does not need to be administered by injection and the first new epinephrine delivery method in 35 years. It will be available at a starting price of $25.
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OIG: Medicare Paid More for Stelara under Part D than Part B
OIG: Medicare Paid More for Stelara under Part D than Part B
August 9, 2024
New analysis shows that differences in the methods used to set drug payment amounts under Part B versus under Part D result in different payment amounts for the same drugs.
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FDA Approval Granted for Novel Parkinson’s Treatment
FDA Approval Granted for Novel Parkinson’s Treatment
August 8, 2024
Crexont kept symptoms at bay for an extra 30 minutes a day when compared with other Parkinson’s drugs.
Payers to Increase Utilization Management if the IRA Leads to Higher Costs
Payers to Increase Utilization Management if the IRA Leads to Higher Costs
Payers to Increase Utilization Management if the IRA Leads to Higher Costs
August 8, 2024
In a recent survey, payers said their priorities include addressing the impacts of Medicare’s Drug Price Negotiation Program and the Part D redesign.
Mallinckrodt Launches Acthar Gel Self-Injectable for Autoimmune Conditions
Mallinckrodt Launches Acthar Gel Self-Injectable for Autoimmune Conditions
Mallinckrodt Launches Acthar Gel Self-Injectable for Autoimmune Conditions
August 6, 2024
SelfJect is priced at parity with the Acthar Gel multi-dose vial and syringe.
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Cigna’s Second Quarter Revenue Increased 25%
Cigna’s Second Quarter Revenue Increased 25%
August 1, 2024
Cigna officials cite significant growth in Evernorth Health Services and Express Scripts for the increase in revenue.
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