Drug Coverage

Specialty medicines are now 53% of spending, up from 27% in 2010 and driven by growth in autoimmune and oncology therapies.

If a patient does not remain on the drug for at least three months due to effectiveness or tolerability, a significant portion of the drug cost will be refunded to Point32Health.

Treating and managing patients with paroxysmal nocturnal hemoglobinuria is expensive and requires constant surveillance by the provider and health plan.

AmerisourceBergen/Xcenda survey finds payers believe biosimilars provide costs savings, and they are expected to continuing contracting with manufacturers.

Express Scripts will put the first interchangeable biosimilar insulin on its National Preferred Formulary and exclude Lantus, the reference product.

Most of the solutions have established systems to track patient outcomes over time, and several include performance guarantees as part of their solution.

This is the second specialty pharmacy selected to distribute Tavneos, a first-in-class, oral therapy to treat a group of autoimmune diseases characterized by inflammation and damage to small blood vessels.

The FDA has approved Tavneos, a first-in-class, oral therapy to treat a group of autoimmune diseases characterized by inflammation and damage to small blood vessels.

Drugs with accelerated approval represent a larger amount of Medicaid drug spending relative to their use.

Compared with Keytruda, Libtayo resulted in an incremental gain of 3.44 life-years and incremental cost-effectiveness ratio of $130,329 per quality-adjusted life-year.

Investigators found only small differences in the change in LDL-C levels in the incentive groups versus the control group

Gavreto treats patients with advanced lung care and Arcalyst treats patients with recurrent pericarditis.

Blue Plans will now have an additional home delivery option that they can choose to offer their members.

Talicia treats H. pylori infection, a risk factor for stomach cancer; Twirla is a hormonal contraceptive.

Three products, including Pfizer’s smoking cessation product Chantix, have been removed because generics are now available.

Aetna, Cigna and UnitedHealthcare are enhancing their Medicare pharmacy benefits, including offering insulin for a copay of no more than $35 for a 30-day supply.

Given together, bamlanivimab and etesevimab have an emergency use authorization from the FDA to both treat COVID-19 and prevent infection in those who have been exposed.

Effective Oct. 1, 2021, Aetna has added several cancer drugs to its formulary and has updated exclusions and nonpreferred products.

Comprehensive medication management aided by AI clinical decision support can result in a large return on investment in a high-risk population. In this study, every dollar that was invested resulted in $12 in savings or cost avoidance.

Trudhesa was approved in September to treat migraine.

The enzyme replacement therapy treats Pompe disease, a rare genetic disorder that affects children.

Effective Jan. 1 2022, the move brings the price to 2008 levels.

Prices paid by Veterans Affairs were the lowest and were 50% to 60% below list prices.

Amgen’s Biosimilar Trend Report finds that biosimilars have been introduced at a price that is generally 15% to 37% lower than the reference product.

Shifting cancer patients to the physician setting for administration of cancer therapies could save insurers $1.28 billion.

Takeda Oncology’s Exkivity treats non-small lung cancer in patients with EGFR exon 20 insertion mutations.

Effective October 1, 2021, CMS will reimburse for the infusion product when dispensed in the outpatient setting.

Regeneron also announced an expanded contract with the U.S. government for the purchase of additional doses of REGEN-COV.

The plan will cover administration of the booster for those with cancer or who are immunocompromised.

Alinia and Sutent have been removed from the drug lists because of the introduction of generic therapies.