Drug Coverage

CarelonRx says it will be able provide optimal support for members because, as a PBM, it as able to communicate directly with members’ providers.

Zepbound, which was approved last month to treat obesity, is now available in U.S. pharmacies.

A new survey finds that more people are using semaglutide and other GLP-1 therapies to lose less than 15 pounds.

Although biosimilars have already generated savings for Medicare Part B programs and beneficiaries, opportunities for substantial reductions in spending remain, according to a report from the HHS.

Adzynma is a recombinant protein designed to replace the deficient ADAMTS13 enzyme to treat patients with the rare hereditary blood clotting disorder congenital thrombotic thrombocytopenic purpura

A recent report predicts there could be an increase in premiums for Medicare Part D prescription drug plans in California, Florida, New York, Pennsylvania and Texas.

A simulation study estimated the impact of biosimilar substitution on total cost of care and provider financial performance in the final performance period of the Oncology Care Model.

New biosimilars have been added and others removed from CVS Caremark’s standard formulary. One notable change is with the Humira biosimilars. The PBM has removed Amjevita and now prefers Hyrimoz and an unbranded biosimilar.

This is the latest offering by Express Scripts that aims to bring transparency to prescription drug costs.

Bimzelx is the first dual IL-17 A/F inhibitor to treat moderate-to-severe plaque psoriasis. It launches with a list price of $7,200 per syringe.

The results of a recent feasibility study on the outpatient administration of cell therapies is creating growing interest in whether home-based management may be possible in the future.

Beginning Jan. 1, 2024, Cigna Healthcare’s formulary changes mostly impact generics and biosimilars.

In her review of the specialty drug pipeline, Evernorth's Aimee Tharaldson said upcoming approvals for Crohn’s and colitis drugs could further shift the drug spend from the medical benefit to the pharmacy one.

Zurzuvae, the first oral therapy for postpartum depression, will launch in December.

Using an AI platform, Magellan Health was able to better support providers in prescribing behavioral health medications and addressing medication problems, which reduced pharmacy costs and increased adherence.

First in class, biosimilars, oncology drugs and even some generics have been added to Optum Rx’s list of exclusions for 2024.

The Institute for Clinical and Economic Review’s fair access report found that for the drugs assessed, formularies provided fair access, but it was difficult to determine how well that translates into real-world access and affordability for patients.

Express Scripts has also included the heart failure drug Inpefa on its Medicare formularies.

A poster from AMCP Nexus quantified tends in biosimilar coverage within Tufts Medical Center, finding that payer coverage of these products has increased but individual preferences among payers still varies.

The Humira biosimilar Yuflyma will be available through CarePartners specialty pharmacy business, which has 10 million plan members.

The mean lag time between FDA approval and insurance coverage for 89 cancer drugs ranged from 2.3 months to 8.2 months. But cancer drugs approved more recently were more likely to have shorter coverage lags.

The increase is close to inflation and wage growth but much steeper than the atypically small increase in 2022.

Researchers in this review suggest clinical trials of biosimilars include switching studies to assess the pharmacokinetics of the biosimilar candidate.

Whether Opill (norgestrel) truly broadens access to daily contraception will depend on Medicaid coverage, requirements under the ACA and pharmacist prescribing.

Yuflyma is on Ventegra’s public and private formulary on parity with the reference product Humira.

Insurers and PBMs now have to follow a 2020 rule in which accumulator programs can only be applied to brand name drugs that have generic equivalents available.

Inpefa is an inhibitor of both SGLT2 and SGLT1, approved to reduce the risk of cardiovascular death and hospitalization for heart failure in adults. The wholesale acquisition cost is $598 per month.

Patients who continued with their rheumatoid arthritis biologic medication tended to spend less on healthcare, had a lower chance of being hospitalized, and had shorter hospital stays.