Demand for behavioral healthcare has surged, increasing costs for health plans and employers as millions of Americans deal with mental illness, substance use disorders and access challenges.
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Nearly half of payers not covering GLP-1s for obesity say no price would change their minds on coverage, citing high costs, poor adherence, and weight regain concerns, finds a new survey by PSG.
A decision on Alvotech’s BLA for AVT16 could come as soon as the first quarter of 2027, but Entyvio’s patent doesn’t expire until 2032.
Romidepsin is approved to treat adults with cutaneous T-cell lymphoma. Ameal’s generic has received designation for 180 days of exclusivity.
Afrezza is an inhaled insulin and the first needle-free insulin option for children with diabetes.
Hepcludex is an antiviral to treat adults living with chronic hepatitis D virus infection, a serious liver disease that occurs as a co-infection in people with chronic hepatitis B virus.
By targeting a specific pathway, the mineralocorticoid receptor, Kerendia is able to stop the cascade of inflammation and fibrosis that leads to kidney disease.
Milliman’s Medical Index finds delivery system consolidation, specialty drug growth, and site-of-care shifts are contributing to employee healthcare costs.
GLP-1 medications, especially for diabetes, will remain an influential cost driver in drug spending this year, supported by broader prescriber adoption and patient demand.
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Immgolis and Immgolis Intri have the same indications as Simponi and Simponi Aria, treating patients with rheumatoid arthritis and ulcerative colitis. The biosimilars will be available in the fourth quarter of this year.
Navitus clients saw prescription drug costs rise 8.4% in 2025, driven by specialty medications, GLP-1s, oncology and dermatology spending.
Optum Rx will shift to flat, per-member fees by 2027, eliminating spread pricing and passing 100% of drug rebates directly to clients.
A survey from the Business Group on Health finds that employers covering GLP-1 weight loss drugs are reconsidering that coverage in 2027 due to high costs.
MedImpact’s Arpit Patel argues that a focus on net costs instead of rebates could save money for both payers and patients.
CVS Caremark instead will favor the biosimilars Pyzchiva and Yesintek and provide the anti-arthritis drugs for a $0 copay.
Cigna will exit the ACA individual exchange market by 2027 and has already launched Evernorth Signature Pharmacy Benefits Services, a rebate-free PBM model, which will become the standard model for all clients in 2028.
Andrew Mellin, M.D., discusses Surescripts’ pilot program for prior authorization system, which pulls clinical data from EHRs and matches it against payer criteria.
Rebates aren’t disappearing, but PSG's 2026 survey suggests payers increasingly favor lower net costs, biosimilars and price transparency over traditional specialty drug rebate programs.
This action follows an Executive Order issued earlier this week to speed review of psychedelic drugs that have shown potential to treat serious mental health issues
Major health insurers say they have cut prior authorizations, but the AMA says physicians report that the burden of prior authorization remains high.
Regeneron is making Otarmeni, which treats patients with biallelic variants in the OTOF gene, available at no cost. This is the second therapy that was approved under the FDA’s new National Priority Voucher program.
In an earning call, UnitedHealth Group executives, including CEO Stephen Hemsley, discussed the company’s strategy, which is focused value-based care, its Medicare Advantage programs transparency, AI and its transparency efforts.
PBMs have launched clinical programs pairing GLP-1 prescriptions with pharmacist coaching, nutrition support, behavioral health partnerships, and digital tools to improve adherence and outcomes.
Yuvezzi treats presbyopia, or blurry vision due to aging, and is available at retail pharmacies or PHIL, an ePharmacy platform.
Novo Nordisk is offering the subscriptions through telehealth providers Ro, WeightWatchers and LifeMD. Others are expected to follow.
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