March 1st 2024
Beginning in 2025, people with Medicare Part D drug coverage will have the option to pay out-of-pocket costs in monthly payments spread out over the year.
February 29th 2024
iDose TR was approved to reduce intraocular pressure in patients with ocular hypertension or open-angle glaucoma. It has a wholesale acquisition cost of $13,950 per dose/implant.
February 26th 2024
CarelonRx will provide digital coaching and wellness tools and incorporate behavioral and social health screenings for members.
February 23rd 2024
The economy and healthcare costs are the issues voters want to hear about going into the 2024 presidential election, finds a survey by KFF.
February 22nd 2024
Avalere’s Kolton Gustafson talks about CMS’ new model for negotiating outcomes-based agreements for sickle cell gene therapies for patients in state Medicaid programs.
The VA Replaces Humira with Hadlima on National Formulary
Payers now covering Hadlima include United Healthcare, Prime Therapeutics and associated Blues plans, and some managed Medicare organizations.
IQVIA: Rebates put Biosimilar Manufacturers at a Disadvantage
Rebates, falling prices, and rebate walls, where drug manufacturers agree to a certain price in exchange for an exclusive contract with payers, limit competition and create a dynamic of misaligned incentives.
Newly Approved Vaccines Face a Fragmented Policy Landscape
The Inflation Reduction Act has helped to close some of the gaps in insurance coverage for vaccines, including some of the newly approved ones.
Express Scripts Adds Voquezna to Formulary for Gastroesophageal Reflux
Voquezna is a potassium-competitive acid blocker, which has a mechanism similar to proton pump inhibitors but with a more rapid action. It has a list price of $650 for a 30-count bottle.
The IRA’s Out-of-Pocket Cap to Benefit more than 1 Million People
In three states — California, Florida, and Texas — more than 100,000 Part D enrollees exceeded $2,000 in spending on prescription drugs in 2021, finds a new analysis from KFF.
CVS’s Health Services Revenue Grew to $186.8 Billion
CVS’s Health Services segment — which includes its PBM CVS Caremark — now accounts for more than half of CVS’s total revenue.
HHS: Patients Should Not Face High Copays for Paxlovid
Although HHS is no longer managing the distribution of COVID-19 drugs, Secretary Xavier Becerra has been closely monitoring distribution of the antivirals Paxlovid and Lagevrio.
Survey: Many Support Medicare Coverage of Weight Loss Drugs
Although most older adults support Medicare coverage of medications for weight loss drugs, only one in three favor paying more in premiums for this coverage, finds University of Michigan survey.
Evernorth is “Foundational” to Cigna’s Business
The bulk of Cigna’s $195.3 billion 2023 revenue comes from Evernorth. And Cigna is positioning itself to grow Evernorth even more.
Rite Aid Completes Sale of Elixir Solutions
The sale, valued at about $576.5 million, is part of Rite Aid’s restructuring plan after filing for bankruptcy in October 2023.
Medicare Drug Price Negotiation Begins Today
New research finds that in 2022, U.S. prices across all drugs were almost three times higher than in other countries.
Biogen to Stop Selling Alzheimer’s Drug Aduhelm
Biogen will focus its resources on Leqembi and research of other treatments for Alzheimer’s disease.
Tyson Foods Selects Rightway as its PBM over CVS Caremark
CVS Caremark will continue to manage specialty drug benefits for Tyson Foods.
Drug Price Transparency Takes a Coalition
Joseph M. Shields talks about the formation of Transparency-Rx and its goals of achieving PBM reform that focuses on “corrective steps to address the misalignment in the marketplace to ensure that there’s competition and choice.”
HHS Reminds Plans to Provide Coverage for Contraception
Coverage of contraceptives and contraceptive care without cost-sharing is required under the Affordable Care Act.
10 State Medicaid Programs Include Pheburane for Urea Cycle Disorders
Current treatments for 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.
Will Patients Benefit from Drug Price Negotiations?
Peter Rubin of No Patient Left Behind worries that patients may not see benefits, either in lowered costs or continued investment in new therapies, from drug price negotiations required under the Inflation Reduction Act.
Asthma Rescue Medication Airsupra is Now Available
Airsupra is an anti-inflammatory rescue medication that can treat the symptoms of asthma while helping to prevent an attack.
Justice Department Drops Appeal in Copay Assistance Case
A 2020 rule stands in which copay assistance from pharmaceutical companies counts toward deductibles for brand name drugs without a generic competition.
Biosimilars to Lead to $192 Billion Loss for Originators by 2028
IQVIA’s most recent Global Use of Medicines report projected that market introductions of new biosimilar and generic drugs will increase projected losses for originator products from $111 billion to $192 billion over the next five years.
Gene Therapy for Bladder Cancer Now Fully Available
Adstiladrin delivers a gene that encodes for the interferon alpha-2b protein, and it provides an option for those at high risk of recurrence and metastatic bladder cancer.
Study: Health Plan Design Influences Biosimilar Adoption
Less flexible plans, such as health maintenance organizations, are more likely to use biosimilar therapies than more flexible plans.
Harrow Launches Vevye for Dry Eye Disease
Vevye is a water- and preservative-free solution of cyclosporine, which allows for improved bioavailability.
Brent Eberle: “Not all Cost-Plus is Created Equal"
Clients are cautious about how the cost in “cost-plus” programs is determined, how rebates factor in and the benchmarks used, says Navitus’s Brent Eberle.
Court Approves Rite Aid’s Sale of Elixir PBM to MedImpact
The transaction is valued at about $575 million. The sale is part of Rite Aid’s restructuring plan after filing for bankruptcy in October 2023.
CVS Caremark to Remove Branded Humira from Formularies
CVS Caremark has entered into an agreement with AbbVie, the manufacturer of Humira, to supply Cordavis with Humira to develop a cobranded product. Cordavis is a CVS company developing private label therapies.
UCB Launches Zilbrysq for Generalized Myasthenia Gravis
Zilbrysq has a list price $1,047.19 for a 23 mg syringe. It is UCB’s second treatment for patients with myasthenia gravis.
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