Drug Coverage

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.

Patient advocates discussed the difficulties that formulary policies and lack of transparency place on those with chronic disease at an ICER sponsored webinar.

The Inflation Reduction Act’s cap on out-of-pocket costs for insulin is likely to improve outcomes for almost half of Medicare’s insulin users.

While ICER found that overall major payer coverage policies are in line with the organization’s fair access criteria, many payers do not provide adequate transparency into clinical coverage criteria.

A new membership program, SmartRx, offers consumers savings on prescriptions, as well as office visits, eye care, vaccines and pet meds.

Lawsuit accuses the companies of using unlawful, unfair, and deceptive practices.

Optum Rx’s Humira biosimilar strategy for 2023 was set up to allow for the most value in the first year, said CEO Heather Cianfrocco.

CMS officials plan to engage with the public for feedback and insights as they implement the Medicare Drug Price Negotiation Program.

With this partnership, employers and their members using RxPreferred for their pharmacy benefit will have access to all medications available through Cost Plus Drugs.

Soleo Health will distribute Leqembi, the newly approved Alzheimer's therapy, to provider offices and infusion centers, as well as administer it across its own ambulatory infusions centers.

Synergie Medication Collective, which launches this month, is focused on improving affordability and access to gene therapies, infusible cancer drugs and other medications administered in a clinical setting.

List prices of 450 medications have increased 5% overall at the beginning of 2023. More price hikes are expected.

An integrated approach helped Regence drive conversion to biosimilars with a 95% member utilization.

Among the most-read stories about PBMs include Transcarent and Prescryptive Health teaming up for employer pharmacy; Kroger Health ending agreement with Express Scripts; Mark Cuban Cost Plus Drugs teaming up with EmsanaRx and Vivio Health; and Abarca Health takes on a challenging implementation.

Drug coverage decisions and new offerings from OptumRx, Caremark, Cigna and Wellcare made the list of the top-read drug coverage news in 2022.

ICER analysts remain uncertain about using amyloid removal as a surrogate marker for clinical benefit in Alzheimer’s disease.

Rezlidhia is an oral, small molecule inhibitor of mutated IDH1 that was approved by the FDA to treat patients with relapsed or refractory acute myeloid leukemia.

The monoclonal antibodies that treat patients with multiple sclerosis would have to be priced more than 50% lower to meet the common standards of cost-effectiveness, according to the Institute for Clinical and Economic Review.