Peter Wehrwein

Sixteen states have banned a pharmacy benefit management practice that involves not counting the value of drug copay assistance from manufacturers toward patient deductibles.

Pfizer Inc. and Moderna Inc. have indicated that they are going to price their shots at between $110 and $130. The shots should still be free to individuals because of rules barring out-of-pocket costs for such vaccinations.

Spending on specialty drugs fueled a 11% increase in Medicaid drug spending from 2020 to 2021, says Magellan's seventh annual Medicaid Pharmacy Trend Report.

1 out 3 Medicaid patients who might have benefited from targeted therapy —mainly Tagrisso and Alecensa — for metastatic lung cancer did not receive it, according to estimates by a trio Harvard-affiliated researchers.

Biosimilars will have limited effect on the oncology drug expenditures, according to IQVIA. Spending on obesity drugs may increase tenfold, depending on guidelines and payer coverage.

Participation in the main Medicare Shared Savings Program is decreasing but 132 accountable care organizations with 2.1 million assigned beneficiaries are participating in the ACO REACH model this year.

Spending using net prices (prices after discounts and rebates are factored in) will grow between -1% and 2% between 2023 through 2027, say IQVIA analysts in the company's Global Use of Medicines report. Patent expiration and competition from generics and biosimilars and the healthcare-related provisions of the Inflation Reduction Act will push down spending, predict IQ.

CMS announced today that 456 accountable care organizations (ACOs) will participate in Medicare Shared Savings Plan program in 2023, a decrease from the 483 ACOs that participated last year. But 132 ACOs have signed up to participate in the ACO REACH, an increase from 99 last year.

Results reported today on the JAMA website show no benefit from repurposing the SSRI as a COVID-19 treatment drug. Earlier results suggesting that fluvoxamine might be an effective treatment were from trials conducted earlier in the pandemic when vaccines weren’t available and other variants were circulating.

In this debut podcast series of What's on Your Mind podcast, Perry Cohen, Pharm.D., CEO of The Pharmacy Group, recently shared his thoughts on the current state of healthcare and especially the management of pharmacy costs. This new monthly series brings listeners into the minds of Managed Healthcare Executive's® Editorial Advisory Board members. Cohen has decades of experience in managed care and has been on the editorial advisory board since 1994.

Leqembi's starting price is almost half of what Aduhelm's was and the FDA-approved label narrows use to people with early disease. But Medicare coverage restrictions may still apply and there is concern about a side effect called ARIA (amyloid related imaging abnormalities).

Manufacturers and payers will now be allowed to exchange information before a drug is approved by FDA.

But disparities among White, Black and Hispanic patients were largest among those with private insurance, according to findings reported in JAMA. The researchers speculate that differences in dealing with prior authorization may have widened disparities in the prescribing integrase strand transfer inhibitors (INSTIs).

Smaller and midsize pharmacy benefit managers are taking on Optum Rx, CVS Caremark and Express Scripts. They say they have better technology and are more transparent about their pricing.

A recently published review paper looked at microRNAs, which play a key role in gene expression. Much more research is needed, the researchers concluded, to fill in the gaps of how microRNAs might be used to monitor how people with multiple sclerosis (MS) response to the growing number of MS treatments.

Evidence that people with multiple sclerosis (MS) benefit from exercise is accumulating researchers should be careful about using standard definitions of exercise and start collecting and reporting data on adverse event, says the National MS physical wellness research working group.

Magellan Rx's businesses includes a 1.7-million member PBM. The deal is struck amid a long-time trend toward consolidation in the pharmacy benefit management industry.

Evidence that COVID-19 might affect male fertility is accumulating, although it is an incomplete picture and there is no final word on the subject. This study found a possible effect on concentration but not on sperm motility or morphology.

Results reported by CDC researchers show a sharp drop-off in HIV prevention and care services, such as preexposure prophylaxis prescriptions, in the second quarter of 2020 but then a rebound in third quarter.

Short-term manufacturing problems are happening as the demand for Adderall and other stimulant medications for ADHD have increased. Data from Arrive Health show a marked increase in ADHD medication prescriptions for people in their 30s.

AMCP CEO Susan A. Cantrell spoke with Managed Healthcare Executive® about Preapproval Information Exchange (PIE) Act of 2022, which would allow drug manufacturers to share information about a drug with payers before the drug is approved. Cantrell says passage of the PIE Act would speed up patient access to new medications.

Payers are bracing themselves for more ultra-expensive gene therapies.

Israeli researchers find more than a fivefold risk of developing systemic sclerosis among people with vitiligo.

The $8.9 billion deal comes on the heels of multibillion dollar healthcare acquisitions this year by Amazon and CVS Health. Will the spree continue?

Overall survival is considered a more definitive end point. But according to Vinay Prasad, M.D., M.P.H., and colleagues , drugs approved based on progression-free survival and overall response rate were priced higher than those approved based on overall survival.

If South Dakota voters approve a ballot initiative on Nov. 8, that will leave 11 states that have not expanded their Medicaid programs under the ACA.

The program reduced per-episode spending as intended, the researchers found. But those savings were offset by bonuses paid to hospitals for beating financial benchmarks, leading to a net loss.

The FDA approved Tecvayli (teclistamab) yesterday after approving two CAR-T therapies as late-line treatments for multiple myeloma earlier this year. Because it is ‘off the shelf,’ Tecvayli may have advantages over the CAR-T therapies, which are custom made for each patient and involve harvesting the patient's T cells.

Findings by researchers at Epic, the electronic health record company, show that the benefits extend to people ages 50-64.

Managing Editor of Managed Healthcare Executive, Peter Wehrwein, speaks with President of Value Evolutions and MHE Editorial Advisory Board Member, Doug Chaet, FACHE, about value-based care's current standing and CMS value-based trends vs commercial payer trends. Chaet also addressed the status of select payment models like bundled and episodic, and more.