Drug Coverage

The frequency of drug manufacturer coupon utilization is associated with more market competition—but not patients’ out-of-pocket costs.

Despite having a highly differentiated clinical value proposition compared to branded, twice-nightly oxybates, Avadel is pricing Lumryz at $64.67 per gram or around $177,034 annually, which is on par with twice-nightly oxybate products that require chronic, middle-of-the-night awakening.

Over the last five years, both PBMs and drug manufacturers have implemented restrictions that put more of the costs for specialty medications on patients.

The study found that Medicare patients used low-benefit options more frequently than high-benefit options.

HyQvia is the first FDA-approved treatment for primary immunodeficiency (PI) available as a once-a-month subcutaneous injection. Other treatments for PI, while similarly effective, present a greater burden to patients, often requiring more frequent injections or more invasive routes of administration

Tirzepatide was associated with a greater reduction in hemoglobin A1c and body weight versus semaglutide. Though, with a current list price of $1,023 for a one-month supply of tirzepatide (Mounjaro; Lilly), is it worth it?

The combination of Padcev with Merck’s Keytruda has a potentially large market: approximately 8,000 to 9,000 U.S. patients would be eligible for this combination in the U.S.

The new feature automatically applies manufacturer-sponsored coupons directly to an eligible patient’s order. So far, just a few pharma companies have made their coupons available through Amazon.

Members of the Senate Finance Committee want to modernize the rules around PBM business practices to lower out-of-pocket costs and increase competition.

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.