Denise Myshko

ICER adds a more formal process to evaluate the diversity of clinical trials and an assessment of a product’s impact on patient and caregiver productivity. ICER also plans to evaluate how newer methods — which would consider the change of a drug’s price over time and disease severity — can be applied to its value assessment.

Developing novel drugs to treat cancer remains a strong focus for drug developers. Several first-in-class therapies have become available over the last few months.

An analysis from 3 Axis has found that PBMs control how much pharmacies are reimbursed. This can vary significantly depending on the PBM contracts with insurers, creating a system with large inconsistencies in the prices that consumers pay for both generics and branded products.

The FDA has requested an additional study. ARS Pharmaceuticals plans to appeal the decision.

Even though committee members voted in support of Onpattro for patients with cardiomyopathy related to transthyretin-mediated amyloidosis, there were questions about whether it provided a clinically meaningful benefit. The FDA set an action date of Oct. 8, 2023.

CMS has included an additional 34 drugs on the list on products subject to rebates if their price increases are higher than inflation.

Cell and gene therapies can be used for patients with cancer and serious diseases who have limited or no treatment options — but at a cost.

Addressing drug affordability and accessibility will involve tackling the interrelated problems of high prices and problematic pharmacy benefit manager practices, says Benjamin N. Rome, M.D., with Brigham and Women’s Hospital in Boston.

In total, Medicare beneficiaries paid $21 billion for 100 drugs that receive the most rebates, while health plans paid $5.3 billion after rebates.

This House bill combines aspects of previously submitted bills — specifically on transparency related to prices on hospital services, laboratory tests, healthcare coverage and PBMs — into one package.

The decision by Scripius (previously Select Health Prescriptions) was made based on the cost of Dupixent, as well as because of an increased demand to use Dupixent for mild atopic dermatitis when the primary patient population is those with moderate to severe disease.

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.

Nonprescription Narcan will be available beginning in September in pharmacies and grocery stores, as well as online retailers and have a suggested cost of $44.99.

Experts expect more lawsuits challenging CMS’s authority to negotiate drug prices for Medicare Part D.

Using AI-powered population health analytics, EmpiRx’s model aims to drive better health and financial outcomes with clinical-based pharmacy care.

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.

Sohonos was approved to treat children with fibrodysplasia ossificans progressive, an ultra-rare disease that transforms the body’s soft tissue into bone. It has an annual list price of $624,000.

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.

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

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.

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

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.

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

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.