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At the 2023 PBMI Annual National Conference in Orlando, Ellen Feeney, director of Clinical Pharmacy Strategies at Highmark shares the tools payers are using to control medication costs outside the traditional ones like utilization management. Feeney also talked about the new program that Highmark kickstarted in 2022 to help manage medication costs.

At this year's PBMI Annual National Conference in Orlando Ben Urick, principal health outcomes researcher at Prime Therapeutics, shared methods for medical cost savings through adherence improvement using integrated medical and pharmacy claims data.

Greg Baker, CEO of AffirmedRx, one of the many new, smaller pharmacy benefit managers (PBMs) challenging the status quo, listed the eight things that employers should know about their PBM. Baker planned to share six key points at the 2023 PBMI National Annual Conference in Orlando, but shared two more with conference goers.

Sampson Davis, M.D., an emergency medicine physician and best-selling author, says a tailored approach is needed.

Ittai Dayan, M.D., M.P.H., co-founder and CEO of Rhino Health, connecting the world’s disparate health data with federated computing, in order to unlock insight and create powerful artificial intelligence, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Case and care management can help health plans cope with seven-figure cell and gene therapies, according to panelists at the Pharmacy Benefit Management Institute’s annual meeting.

Alina M. Czekai, M.P.H., vice president, value-based care strategy, Cohere Health, is one of 12 winners in this year's Emerging Leaders in Healthcare feature. In this video interview, Czekai shares a turning point that changed her career trajectory, recommends a good read for healthcare professionals, and even spills her guilty pleasure: some time with the "Real Housewives" and a glass of red wine.

The keynote speaker for the three-day meeting in Orlando is Sampson Davis, M.D., an emergency medicine physician in New Jersey, an inspirational speaker and co-author of three best-selling books.

Alina Czekai, M.P.H., vice president of value-based care strategy at Cohere Health, a patient-centric, digital health company committed to streamlining the prior authorization process, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Healthcare beyond the doors of the doctor’s office has the potential to offer more care to more people. But payers need to think about how to ensure that care is consistent. Regardless of the setting, care decisions must be based on evidence-based content and supported with strong patient education.

The FDA has approved Reblozyl as first-line treatment in MDS-related anemia and the first generics of ADHD drug Vyvanse. The agency also issued a CRL for bevacizumab to treat wet AMD. Additionally, two companies have submitted supplemental applications. These include Janssen, which is seeking full approval for Balversa for urothelial carcinoma, and AbbVie, which is seeking approval of Skyrizi for ulcerative colitis.

A special registration process could strike the right balance between increasing access to the drug used to treat opioid use disorder while limiting diversion and possible misuse, say an MHE editorial advisory board member and two co-authors.

Magellan Rx Management has begun providing a multi-state solution in which they negotiate with drug manufacturers for value-based contracts for high-cost gene and cell therapies.

In this opinion piece, Karen shares some of the critical issues related to re-enrolling members subject to Medicaid redetermination and covers some of the most important critical success factors for organizations seeking to optimize their response.

Proponents hailed yesterday's announcement of the first 10 drugs subject to Medicare "maximum fair price" starting in 2026 as ushering in an era of lower drug prices and a political victory over pharma. Critics said it is price controls masquerading as negotiation and would smother innovation in one of the most innovative industries in the U.S.

Topping the list is Eliquis, which accounted for $16.48 billion in spending for the 3.7 million people in Medicare Part D who take the blood thinner.

By customizing collaborative models of at-home care to the health needs of the community and the business needs of key stakeholders, organizations can develop an innovative model that achieves mutual goals while strengthening health outcomes, access, and satisfaction.

Researchers of a recent study compared the clinical presentation and treatment outcomes of people with HIV and HIV-negative persons with monkeypox who were treated with tecovirimat, as it was previously unclear if treatment outcomes differed between those with and without HIV.

The FDA has approved the first biosimilar of MS drug Tysabri and granted additional approvals to Abrysvo to prevent RSV in infants, to a higher dose Eylea, and to Ingrezza for a disorder associated with Huntington’s disease. The agency has also set a review date for first-in-class therapy for MDS and granted priority review to Xtandi for earlier treatment in prostate cancer.

The rise in the volume, variety and complexity of tests holds great promise for improving healthcare for patients, but also poses challenges for providers and health plans

A retrospective study found that chronic hepatitis B-related hepatocellular carcinoma (HCC) patients with metabolic-associated fatty liver disease (MAFLD) had better outcomes than patients who did not have MAFLD.

Sandoz’s Tyruko, the first biosimilar to Biogen’s Tysabri, is expected to be available as soon as possible. Pricing has not yet been made available.

Cigna Healthcare has removed prior authorization requirements for a wide range of tests, treatments and medical equipment, but not prescription drugs.

Despite positive safety and quality of life results for FEIBA, the emergency of Hemlibra created difficulties for the FEIBA study and resulted in it being halted.

Since the introduction of direct-acting antiviral therapies, which boast a 95% cure rate, the reported number of HCV cases has fallen.