Drug Coverage

Rebates, falling prices, and rebate walls, where drug manufacturers agree to a certain price in exchange for an exclusive contract with payers, limit competition and create a dynamic of misaligned incentives.

The Inflation Reduction Act has helped to close some of the gaps in insurance coverage for vaccines, including some of the newly approved ones.

Voquezna is a potassium-competitive acid blocker, which has a mechanism similar to proton pump inhibitors but with a more rapid action. It has a list price of $650 for a 30-count bottle.

In three states — California, Florida, and Texas — more than 100,000 Part D enrollees exceeded $2,000 in spending on prescription drugs in 2021, finds a new analysis from KFF.

CVS’s Health Services segment — which includes its PBM CVS Caremark — now accounts for more than half of CVS’s total revenue.

Although HHS is no longer managing the distribution of COVID-19 drugs, Secretary Xavier Becerra has been closely monitoring distribution of the antivirals Paxlovid and Lagevrio.

Although most older adults support Medicare coverage of medications for weight loss drugs, only one in three favor paying more in premiums for this coverage, finds University of Michigan survey.

The bulk of Cigna’s $195.3 billion 2023 revenue comes from Evernorth. And Cigna is positioning itself to grow Evernorth even more.

The sale, valued at about $576.5 million, is part of Rite Aid’s restructuring plan after filing for bankruptcy in October 2023.

New research finds that in 2022, U.S. prices across all drugs were almost three times higher than in other countries.

Biogen will focus its resources on Leqembi and research of other treatments for Alzheimer’s disease.

CVS Caremark will continue to manage specialty drug benefits for Tyson Foods.

Joseph M. Shields talks about the formation of Transparency-Rx and its goals of achieving PBM reform that focuses on “corrective steps to address the misalignment in the marketplace to ensure that there’s competition and choice.”

Coverage of contraceptives and contraceptive care without cost-sharing is required under the Affordable Care Act.

Current treatments for urea cycle disorders, which causes ammonia to build up in the blood, have a bitter taste and smell. Pheburane was developed with a special coating that masks the taste of sodium phenylbutyrate. It has a list price of $4,375 per bottle.

Peter Rubin of No Patient Left Behind worries that patients may not see benefits, either in lowered costs or continued investment in new therapies, from drug price negotiations required under the Inflation Reduction Act.

Airsupra is an anti-inflammatory rescue medication that can treat the symptoms of asthma while helping to prevent an attack.

A 2020 rule stands in which copay assistance from pharmaceutical companies counts toward deductibles for brand name drugs without a generic competition.

IQVIA’s most recent Global Use of Medicines report projected that market introductions of new biosimilar and generic drugs will increase projected losses for originator products from $111 billion to $192 billion over the next five years.

Adstiladrin delivers a gene that encodes for the interferon alpha-2b protein, and it provides an option for those at high risk of recurrence and metastatic bladder cancer.

Less flexible plans, such as health maintenance organizations, are more likely to use biosimilar therapies than more flexible plans.

Vevye is a water- and preservative-free solution of cyclosporine, which allows for improved bioavailability.

Clients are cautious about how the cost in “cost-plus” programs is determined, how rebates factor in and the benchmarks used, says Navitus’s Brent Eberle.

The transaction is valued at about $575 million. The sale is part of Rite Aid’s restructuring plan after filing for bankruptcy in October 2023.

CVS Caremark has entered into an agreement with AbbVie, the manufacturer of Humira, to supply Cordavis with Humira to develop a cobranded product. Cordavis is a CVS company developing private label therapies.

Zilbrysq has a list price $1,047.19 for a 23 mg syringe. It is UCB’s second treatment for patients with myasthenia gravis.

Nonprescription RiVive was approved in July 2023 to reverse opioid overdose. Harm Reduction is donating 200 doses to Remedy Alliance for distribution.