Drug Coverage

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.

High-priced gene therapies challenge payers to provide access. They are watching the products to be approved the first half of this year.

In a real-world example, investigators found that lowered pricing of prescription drugs results in lower patient out-of-pocket costs, particularly for those patients with coinsurance.

In 2023, CVS executives expect revenue in pharmacy services to grow by 1% to 2% driven by generic and biosimilar launches.

In 2022, 12 states have enacted 19 pieces of legislation that put a variety of restrictions and requirements on pharmacy benefit managers (PBMs).

The real impact may not likely be seen until after July when additional biosimilars referencing Humira are launched.

Vizient is forecasting a 3.78% rise in pharmacy prices in hospitals and non-acute care facilities, reflecting increases in both prices and utilization.

Some PBMs will offer Amgen’s Amjevita biosimilar as a preferred product alongside Humira, but CVS Caremark said Humira will remain preferred and Amjevita will be placed on a non-preferred brand tier.

The collaboration between Cost Plus Drugs and OncoPower provides access to generic medications for patients with cancer integrated with OncoPower’s Pill Reminder tool.

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

Programs that do not count pharmaceutical company coupons and copay assistance toward deductibles have grown over the last five years, but states are stepping in to limit these programs.

Evio is launching a new pharmacy solution that leverages Flipt’s proprietary, cloud-based benefit administration and patient engagement platforms.

Three out of four health plans scored a “C” or an “F” because of utilization management restrictions they place on medication for autoimmune conditions.

The Inflation Reduction Act’s cap on annual out-of-pocket spending and changes to coverage gaps could save Medicare patients more than $1,000 on heart failure medications.

The Association for Accessible Medicines’ report indicates plans, especially those in Medicare, are slower to prefer first generics.

Amazon Prime members can access generic medications from an eligible list with free delivery for an additional $5 a month.

Price Edge compares direct-to-consumer pricing with insurance pricing for generic drugs. It is an optional product being offered to plans.

Dea Belazi of AscellaHealth talks about the challenges payers will face as they confront the high costs associated with specialty drugs.

Annual savings from biosimilars could be more $100 billion by 2026, according to IQVIA’s latest Global Use of Medicines report.