Drug Coverage

A Parkinson’s therapy, a treatment for seizures, a drug used in the treatment of heart failure, and a therapy for a rare disease have been removed from Prime’s Medicare formularies.

Capital Rx uses the NADAC model, which was developed by CMS for Medicare and Medicaid drug pricing.

Increased use of biosimilars could reduce Medicare Part D spending by 18% and beneficiaries’ out-of-pocket costs by 12%.

A literature review found an association between increased cost-sharing and lower patient adherence, which in turn could be associated with increased hospitalizations.

CMS’s final decision is that monoclonal antibodies to treat Alzheimer’s disease may only be covered in a randomized controlled trial conducted under an investigational new drug application.

Drew Mihalyo of Delta Care Rx discusses the company’s pass-through pharmacy pricing model.

Treatment with Zegalogue for severe hypoglycemia has the potential to save costs and reduce emergency department visits and hospitalizations.

A proof-of-concept study showed that patients can be successfully switched from Cosentyx to Taltz with similar outcomes and lower costs.

Karthik Ganesh, CEO of EmpiRx Health, discusses how its technology and clinical focus provide strategies for patient management that results in lower costs for clients.

The PBM has removed 20 products and added a half dozen new therapies, including several generics. The changes are effective April 1, 2022.

Medicare beneficiaries without subsidies were 35% to 50% less likely to fill their prescriptions for drugs used to treat cancers, immune system disorders, and high cholesterol.

AllianceRx Walgreens Prime study has found that patients taking Ocaliva may not be adherent to their treatment regimen for rare liver disease.

A disconnect exists between payers and patients with rare diseases about including patient input in the formulary process for orphan drugs.

Prior authorization and step therapy can impact compliance and outcomes, according to a survey by the Pharmaceutical Research and Manufacturers of America.

Xipere is a targeted treatment that is delivered via an injection to the back of the eye to treat macular edema associated with uveitis, a form of eye inflammation.

This real-world study found that patients who received Relistor SC during an emergency department visit for opioid induced constipation had lower costs and hospital lengths of stay.

Some generics have as much of a 10,000-times increase from the manufacturers weighted average manufacturers price to what a patient could pay at the pharmacy if they chose to pay the cash price.

The new code will be effective April 1, 2022.

Cystaran is a topical ophthalmic therapy that is used to treat a rare genetic disorder.

Del Doherty, co-founder of Prodigy Rx, discusses how the PBM aims to give payers control so they can lower costs and can improve clinical and return-to-work outcomes.

ICER analyzed two therapies — Cosela and plinabulin — to prevent chemotherapy-induced neutropenia and other myelosuppressive effects. Both moderately increased quality-adjusted life-years.

Allan Coukell, Civica’s senior vice president of public policy, discusses how the generic manufacturer is disrupting the market for insulins.

Evio Pharmacy Solutions plans to provide biosimilar alternatives for autoimmune and cancer therapeutics.

This expands commercial coverage to 118 million lives and Medicare coverage to 7.1 million lives.

Aadi Bioscience recently launched Fyarro, the first FDA-approved therapy to treat an ultra-rare sarcoma.

Generics are now available for the three therapies: Cystadane, Selzentry, and AmBisome.

Once approved, the insulins will be available to patients for no more than $30 per vial.

FDA approved Legend Biotech’s chimeric antigen receptor T-cell (CAR-T) treatment, Carvykti (ciltacabtagene autoleucel; cilta- cel), to treat relapsed or refractory multiple myeloma (RRMM) who have received four or more prior lines of therapy.

Despite the promise of savings billions of dollars in the United States, adoption of biosimilars has been slow. A roundtable discussion among employers highlighted some of the barriers, including formulary design and drug pricing and rebates.

The solution, available immediately to all large health plans, is meant to simplify care for patients with complex conditions.