Drug Coverage

Fran Gregory, Pharm.D., of Cardinal Health, talks about a survey of ophthalmologists and their concerns about using biosimilars for retinal conditions.

Beginning in 2025, people with Medicare Part D drug coverage will have the option to pay out-of-pocket costs in monthly payments spread out over the year.

iDose TR was approved to reduce intraocular pressure in patients with ocular hypertension or open-angle glaucoma. It has a wholesale acquisition cost of $13,950 per dose/implant.

CarelonRx will provide digital coaching and wellness tools and incorporate behavioral and social health screenings for members.

The economy and healthcare costs are the issues voters want to hear about going into the 2024 presidential election, finds a survey by KFF.

Avalere’s Kolton Gustafson talks about CMS’ new model for negotiating outcomes-based agreements for sickle cell gene therapies for patients in state Medicaid programs.

Payers now covering Hadlima include United Healthcare, Prime Therapeutics and associated Blues plans, and some managed Medicare organizations.

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.