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New Jersey Governor Signs PBM, Drug Price Legislation
New Jersey Governor Signs PBM, Drug Price Legislation
New Jersey Governor Signs PBM, Drug Price Legislation
July 11, 2023
Governor Phil Murphy has signed three pieces of legislation that would require PBMs to use prescription drug rebates to lower premiums and out-of-pocket costs for consumers and prevent the practice of spread pricing.
CMS Expands Leqembi Coverage After FDA’s Full Approval
CMS Expands Leqembi Coverage After FDA’s Full Approval
CMS Expands Leqembi Coverage After FDA’s Full Approval
July 7, 2023
Medicare will cover Alzheimer’s drugs with full approval, including Leqembi — if the physician and patient participate in a real-world registry trial to gather additional data.
Prime Therapeutics Names Mostafa Kamal President and CEO
Prime Therapeutics Names Mostafa Kamal President and CEO
Prime Therapeutics Names Mostafa Kamal President and CEO
July 6, 2023
The Magellan Rx Management CEO is replacing Ken Paulus, who has held the top job at Prime since May 2019.
8 Humira Biosimilars now Available, but Formulary Questions Remain
8 Humira Biosimilars now Available, but Formulary Questions Remain
8 Humira Biosimilars now Available, but Formulary Questions Remain
July 5, 2023
Most of the Humira biosimilars are available with two pricing options. Of the larger PBMs, only Optum Rx so far has weighed in on a coverage decision.
Report: Medical Costs to Rise 7% Next Year
Report: Medical Costs to Rise 7% Next Year
Report: Medical Costs to Rise 7% Next Year
July 4, 2023
The increase is expected to be somewhat offset by the impact of biosimilars coming to market and more care being provided in outpatient settings.
Study: Medicaid Coverage Uneven for Gene Therapies
Study: Medicaid Coverage Uneven for Gene Therapies
Study: Medicaid Coverage Uneven for Gene Therapies
July 2, 2023
Recent study finds that Medicaid coverage for some of the first gene and cell therapies was at times delayed and not consistent with federal requirements.
FDA Approves $2.9 Million Gene Therapy for Hemophilia A
FDA Approves $2.9 Million Gene Therapy for Hemophilia A
FDA Approves $2.9 Million Gene Therapy for Hemophilia A
June 29, 2023
BioMarin is offering an outcomes-based warranty that will reimburse payers up to 100% of the cost if a patient does not respond to Roctavian.
New Pediatric Growth Hormone Therapy Costs $8,300 Monthly
New Pediatric Growth Hormone Therapy Costs $8,300 Monthly
New Pediatric Growth Hormone Therapy Costs $8,300 Monthly
June 29, 2023
Longer-acting growth hormone reduces frequency of injections. It will be available in August.
 Sarah Emond to Take Helm of ICER
 Sarah Emond to Take Helm of ICER
Sarah Emond to Take Helm of ICER
June 28, 2023
Sarah Emond will continue with ICER’s efforts to assess drug cost-effectiveness and health plan access policies that began with founder Steve Pearson, M.D., who will transition to an advisor role in 2024.
Employer Group Issues Guide for Contracting with PBMs
Employer Group Issues Guide for Contracting with PBMs
Employer Group Issues Guide for Contracting with PBMs
June 28, 2023
The National Alliance of Healthcare Purchaser Coalitions has issued a playbook to help companies navigate what they see as a flawed PBM contracting model and lack of competition.
 First Gene Therapy for Duchenne Priced at $3.2 Million
 First Gene Therapy for Duchenne Priced at $3.2 Million
First Gene Therapy for Duchenne Priced at $3.2 Million
June 23, 2023
Elevidys is a one-time therapy that delivers to muscle a gene that codes for a shortened, functional form of dystrophin, which is mutated in Duchenne muscular dystrophy.
Optum Rx’s Choice: Hyrimoz, Cyltezo and Amjevita
Optum Rx’s Choice: Hyrimoz, Cyltezo and Amjevita
Optum Rx’s Choice: Hyrimoz, Cyltezo and Amjevita
June 23, 2023
Optum Rx will include the three biosimilars on its standard formulary at parity with Humira.
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