Drug Coverage

Most of the brands that have been removed fall into the categories of hormonal therapies, pain and inflammatory conditions or skin conditions or high blood pressure/heart medications.

Arash Sadeghi, Pharm.D., discusses three drugs in development, which treat a rare kidney disease, hemophilia B, and an advanced form of age-related macular degeneration.

The lack of competition and the vertical integration of PBMs and insurers can have a negative impact on patients’ access to and cost of prescription drugs, AMA said.

A real-world study by the PBM shows major benefits from the new cystic fibrosis drug when it comes to hospitalizations and pulmonary exacerbations. But total cost of care of patients tripled because the drug is expensive.

The Amgen Biosimilars Trend Report found that competition is lowering prices of biosimilars but the largest PBMs are inconsistent in their management of these products.

Regence implemented a preferred infliximab biosimilar strategy and was able to achieve more than 90% adoption.

In total, CVS Caremark has removed 26 products and added 31 products effective Jan. 1, 2023.

Ashley Jenne, managing director, strategy and business development at Evernorth, discusses the evolution of the PBM’s digital health formulary.

In 2023, Capital Blue Cross members will be able to use their insurance cards at Mark Cuban Cost Plus Drugs. This is the first time the online pharmacy will accept insurance.

EmpiRx Health CEO Karthik Ganesh discusses how the PBM was able to decrease mental health drug spending at a time when utilization is increasing.

UnitedHealthcare is moving more drugs to the lower-cost tiers in its Medicare Advantage plans. Other plans will have $0 copays and insulin at a $25 copay.

The online pharmacy has added 12 new products and lowered the costs of 39 medications.

SIGA indicated that $5.1 million of oral Tpoxx is targeted for delivery in 2022.

All plans have $0 copay options for select medications purchased through preferred home delivery.

Humana’s 2023 Medicare pharmacy benefits updates include $0 copays, simplified access to prescriptions and Veteran’s focused-plans that add pharmacy benefits.

The retailer indicated that Express Scripts’ drug pricing model is unstainable for Kroger and its customers.

A new formulary design will be offered on the Value Script and Value Plus plans; it will contain medications used to treat diabetes and will cost only $11 per 30-day supply.

Jing Yang from IQVIA discusses how national payers are using formulary exclusions for oncology therapeutics.

In 2021, patients in the United States received 6.4 billion prescriptions, 91% of which were generic and biosimilar medicines.

Carl Black, pharmacist-in-charge at Optum Rx, talks about how the PBM has decreased dispensed opioids by 62% since 2018.

Rightway offers access to generic drugs offered by Cost Plus Drug through its mobile app.

But researchers found that only a small percentage of plans use available real-world evidence studies and economic evaluations in their coverage policies.

An Avalere review finds that the proportion of generic drugs covered on lower tiers (with generally lower out-of-pocket costs for patients) in Part D plans have decreased.

Hospitalization, disability, having private high-deductible, Medicare Advantage, or no coverage were risk factors associated with medical debt.

Approved in May 2022, Tibsovo is the first therapy targeting cancer metabolism for older patients with newly diagnosed IDH1-mutated acute myeloid leukemia.

The additions include apps to help people better manage their sleep issues, anxiety, alcohol and opioid use disorders, and inflammatory conditions.

Jeffrey A. Shaman, Ph.D., chief science officer at Coriell Life Sciences, talked about how pharmacogenomics can inform medication management.

Kali Panagos, Pharm.D., at ARMSRx, discusses the growing trend of copay assistance programs and alternative funding solutions that can help provide access to expensive specialty therapies.

Because of a generic is now available, Toviaz has been removed and up-tiered on Prime’s Medicare formularies.

Prime Therapeutics’ predictive model was able to identify members with high breast cancer pharmacy and medical claims to help clients better manage drug spend.