Drug Coverage

The suit alleges that Express Scripts, Prime and Prime customer Humana Pharmacy Solutions are able to share drug pricing and rebate information to increase prices for insulins, biologics and cancer drugs.

Out-of-pockets costs were higher among those using branded or more recently launched drugs.

RxBenefits helps patients in self-funded plans find and apply for alternative sources of funding for specialty medicines and facilitates enrollment.

The proposed legislation, sponsored by Sens. Chuck Grassley and Maria Cantwell, aims to increase transparency of PBM business practices.

The company also will establish a $35 cap on out-of-pocket costs for Lantus for all patients with commercial insurance.

The patient groups say the insurer is cutting off access to important medications. The Tennessee Blues plans say many of the drugs that it excluded from coverage have zero utilization.

Medicare Part B beneficiaries are expected to save between $2 and $390 per average dose starting April 1, 2023.

The lower prices will take effect on Jan. 1, 2024, on both pre-filled pens and vials of basal, bolus and pre-mix insulins, including Levemir, Novolin, NovoLog and NovoLog Mix 70/30.

The VA’s guidelines would exclude anyone who has had a stroke or seizure within the last year, as well as those who have MRIs that show evidence of microhemmorrhages, aneurysms, lesions or tumors.

Aponvie is the first intravenous version of aprepitant adults to prevent postoperative nausea and vomiting.

Iheezo, approved in September 2022, is an ocular surface anesthesia used during cataract surgeries.

Radicava ORS will be available with a national prior authorization process in place.

Payers are looking to pharmaceutical companies for innovative partnerships that provide patient access, positive clinical outcomes and reduced costs in specialty disease areas, AmerisourceBergen finds.

The majority of consumers surveyed by Let My Doctor Decide support reforms to improve access and affordability.

Leqembi would need a 66% to 19% discount from its wholesale acquisition cost of $26,500 a year to fall within commonly used cost-effectiveness thresholds.

The price cuts apply to Lilly’s nonbranded insulin, Humalog, Humulin and its Lantus biosimilar.

Investigators found an association between ICER’s value assessments and how U.S. commercial health plans cover specialty drugs.

The ads focus on how PBMs promote competition in the prescription drug marketplace and provide choice for employers.

Bruce Feinberg, D.O., of Cardinal Health, said significantly changes are on the horizon for biosimilars, but physician comfort with and use of biosimilars will depend on things beyond their control, including formulary placement and utilization management efforts.

CMS said it will cover monoclonal antibodies to treat Alzheimer’s disease if they are approved through the standard review process and not through an accelerated approval.

The U.S. public health emergency response to COVID-19 ends May 11, 2023, and the transition to more traditional healthcare coverage will begin later this year.

At a placeholder price of $19,000, resmetirom would produce cost savings, says the drug evaluation group. Obeticholic acid’s price would need to be slashed to meet a commonly used cost-effectiveness threshold.

Cuban, of "Shark Tank' fame and owner of the Dallas Mavericks, called drugs prices ‘insane’ and used some profanity when talking pharmacy benefit managers at the annual meeting of the Association for Accessible Medicines yesterday. Cuban has co-founded an online pharmacy that he says will make drug prices lower and transparent.

Navitus will be accessing the Humira biosimilar Amjevita through the lower wholesale acquisition cost option.

Senators want more insight into PBM practices and the role they play in the healthcare ecosystem.

Abarca's Nicole (Gupta) Bulochnik, Pharm.D., talks about how personalized medicine could be integrated into value-based care to accelerate uptake.

Javier Gonzalez, Pharm.D., at Abarca Health, talks about how value-based pricing arrangements can align incentives among stakeholders for specialty disease management.

The branded therapies were removed in favor of generics effective April 2023. CVS Caremark also added 13 generics to its Performance Drug List.

The hearing will discuss the role of PBMs in healthcare and the Pharmacy Benefit Manager Transparency Act, legislation that has been submitted by Sens. Maria Cantwell and Chuck Grassley.

No list price was provided for Rebyota but Ferring is offering copay and patient assistance programs.