Drug Coverage

Seven of the 10 top selling drugs with high price increases lack the clinical evidence to justify those increases.

Cigna and Express Scripts have not yet made a decision about which of the Humira biosimilars will be included but they will evaluate all products in the coming months.

Doctors surveyed by the Association for Clinical Oncology said payer prior authorization can cause disease progression and loss of life.

The reference to “maximum fair price” in the act bodes poorly for manufacturers and suggests more of a take-it-or-leave-it situation rather than a negotiation where clinical evidence would be the prevailing factor in determining price.

Tzield addresses the underlying cause of the disease, where the immune system destroys the insulin producing cells in the pancreas. It is administered by intravenous infusion once daily for 14 consecutive days.

OptumRx will offer Amjevita and two other biosimilars alongside Humira. OptumRx is the first PBM to make public its plans for the seven Humira biosimilars that could be introduced in 2023.

Launched in August, Zoryve is a once-daily, steroid-free cream and is the first topical PDE4 inhibitor approved to treat plaque psoriasis in patients 12 years of age or older.

OptumRx now requires prior authorization for 16 products, including 11 that are used to treat patients with diabetes.

A 10-day implementation has given the team at Abarca Health the opportunity to challenge how they manage implementations in general.

Snezana Mahon, Pharm.D., Transcarent’s chief operating officer, discusses the company’s efforts to provide a seamless and interconnected pharmacy ecosystem.

Bebtelovimab is used to treat COVID-19, but omicron subvariants BQ.1 and BQ.1.1 may be resistant, the FDA said.

Subscribers will be able to compare medications through Amazon and pay either their insurance copay price or the price from Prime Therapeutics’ MedsYourWay discount card.

Expanding pharmacist prescriber authority for HIV PrEP medications significantly increased PrEP use.

Wendy Barnes and Mark Campbell of RxBenefits discuss the company’s survey, which finds employers are curious about solutions to manage both specialty drug spend and the potential volatility that comes with employees who may be diagnosed with cancer and other high-dollar conditions.

The changes were made because generics are now available; the change impacts specific client formularies.

Mikkael A. Sekeres, M.D., University of Miami Health System, discusses his latest book Drugs and the FDA and the use of accelerated approvals based on surrogate endpoints.

A study of Oregon pharmacies finds there is significant disparities in reimbursement between the pharmacies, particularly in already disadvantaged communities.

Express Scripts will manage pharmacy benefits for about 20 million Centene members.

Renee Dua, M.D., chief strategy officer at Renee, discusses the digital health assistant and its subscription-based services for generic drugs.

One of the drivers of a lowered payer satisfaction is the public perception of PBMs, said Morgan Lee, Ph.D., of PSG.

The arrangement allows Vivio customers to stop overpaying for drugs, the company said.

Escalating costs are hitting patients hard. CMS price negotiation and the $2,000 cap on Part D out-of-pocket expenses should benefit many patients with Medicare coverage.

Most of the brands that have been removed fall into the categories of hormonal therapies, pain and inflammatory conditions or skin conditions or high blood pressure/heart medications.

Arash Sadeghi, Pharm.D., discusses three drugs in development, which treat a rare kidney disease, hemophilia B, and an advanced form of age-related macular degeneration.

The lack of competition and the vertical integration of PBMs and insurers can have a negative impact on patients’ access to and cost of prescription drugs, AMA said.

A real-world study by the PBM shows major benefits from the new cystic fibrosis drug when it comes to hospitalizations and pulmonary exacerbations. But total cost of care of patients tripled because the drug is expensive.

The Amgen Biosimilars Trend Report found that competition is lowering prices of biosimilars but the largest PBMs are inconsistent in their management of these products.

Regence implemented a preferred infliximab biosimilar strategy and was able to achieve more than 90% adoption.

In total, CVS Caremark has removed 26 products and added 31 products effective Jan. 1, 2023.

Ashley Jenne, managing director, strategy and business development at Evernorth, discusses the evolution of the PBM’s digital health formulary.