MHE July 2022

The program started before specialty drugs became such a large expense for Medicare and its beneficiaries. Congress is considering legislation that would cap beneficiary out-of-pocket costs and require price discounts from manufacturers.

Novo Nordisk’s Saxenda (liraglutide) and Wegovy (semaglutide) are leading the way for a new crop of drugs that reduce appetite. But their cost-effectiveness is in question, and many payers are saying no to coverage — for now.

Some experts want to see more funding for hospice care in the home. Others say the advantages of hospice in a hospital or nursing home have been underrated.

Although the Oncology Care Model produced some positive results, the value-based care model cost Medicare money. Now attention is turning to its successor, the Enhancing Oncology Model.

The Big Three all set up group purchasing organizations recently, but some industry observers question the timing of the move and who will benefit.

As Congress considers legislation that would cap out-of-pocket costs for insulin, Walmart and Civica Rx are taking steps that could make less expensive versions of the diabetes medication more available.

Bispecific antibody therapies are also in development.