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Research has shown that patients with inflammatory bowel disease, including ulcerative colitis, treated with TNF-alpha blockers have a lower antibody response and a shorter duration of immunity than those who receive integrin receptor antagonists, such as Entyvio (vedolizumab), or no medication at all.

There is a huge opportunity for savings from the recently launched Humira biosimilars and others expected to reach the market in the next few years. But plans and PBMs will need to step into the role that pharmaceutical manufacturers once did in supporting patients and prescribers.

At the 2023 PBMI Annual National Conference in Orlando, Ellen Feeney, director of Clinical Pharmacy Strategies at Highmark discusses how these new programs payers are using to control medication costs work, and shares how costs of the GLP-1s should be managed.

Ittai Dayan, M.D., M.P.H., co-founder and CEO of Rhino Health, is one of 12 winners in this year's Emerging Leaders in Healthcare feature. In this video interview, Dayan not only shares a good read for healthcare professionals, but also a turning point that changed his career trajectory and even a guilty pleasure of his — which involves finishing a scoop or more of his son's ice cream.

Ozempic (semaglutide) is second only to Humira (adalimumab) in sales, according to the IQVIA vice president of industry relations and a frequent speaker at conference. And for newly launched drugs, sales figures for Mounjaro (tirzepatide) are second only to what they were for Harvoni (ledipasvir and sofosbuvir), a hepatitis C antiviral, when the hepatitis C antivirals were new.

In an observational cohort study published in the September 2023 issue of The Lancet, Jiangwei Sun, Ph.D., from the Karolinska Institutet in Stockholm, Sweden, and his colleagues compared statin users with non-statin users to determine the risk of colorectal cancer in patients with IBD.

Kyna Fong, Ph.D., CEO and co-founder, Elation Health, the clinical-first technology platform for high-value primary care, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Payers are trying to figure out how to provide access to patients who would benefit from weight loss drugs such as semaglutide but also control costs.

As cell- and gene-based therapies become available for new and expanded indications with a higher incidence of patients, payers will be challenged to find ways to provide access to patients.

At this year's PBMI Annual National Conference in Orlando Ben Urick, principal health outcomes researcher at Prime Therapeutics, shared methods for medical cost savings through adherence improvement using integrated medical and pharmacy claims data.

Greg Baker, CEO of AffirmedRx, one of the many new, smaller pharmacy benefit managers (PBMs) challenging the status quo, listed the eight things that employers should know about their PBM. Baker planned to share six key points at the 2023 PBMI National Annual Conference in Orlando, but shared two more with conference goers.

Sampson Davis, M.D., an emergency medicine physician and best-selling author, says a tailored approach is needed.

Ittai Dayan, M.D., M.P.H., co-founder and CEO of Rhino Health, connecting the world’s disparate health data with federated computing, in order to unlock insight and create powerful artificial intelligence, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Case and care management can help health plans cope with seven-figure cell and gene therapies, according to panelists at the Pharmacy Benefit Management Institute’s annual meeting.

Alina M. Czekai, M.P.H., vice president, value-based care strategy, Cohere Health, is one of 12 winners in this year's Emerging Leaders in Healthcare feature. In this video interview, Czekai shares a turning point that changed her career trajectory, recommends a good read for healthcare professionals, and even spills her guilty pleasure: some time with the "Real Housewives" and a glass of red wine.

The keynote speaker for the three-day meeting in Orlando is Sampson Davis, M.D., an emergency medicine physician in New Jersey, an inspirational speaker and co-author of three best-selling books.

Alina Czekai, M.P.H., vice president of value-based care strategy at Cohere Health, a patient-centric, digital health company committed to streamlining the prior authorization process, is one of the 12 up-and-coming leaders in healthcare included in the annual Managed Healthcare Executive feature.

Healthcare beyond the doors of the doctor’s office has the potential to offer more care to more people. But payers need to think about how to ensure that care is consistent. Regardless of the setting, care decisions must be based on evidence-based content and supported with strong patient education.

The FDA has approved Reblozyl as first-line treatment in MDS-related anemia and the first generics of ADHD drug Vyvanse. The agency also issued a CRL for bevacizumab to treat wet AMD. Additionally, two companies have submitted supplemental applications. These include Janssen, which is seeking full approval for Balversa for urothelial carcinoma, and AbbVie, which is seeking approval of Skyrizi for ulcerative colitis.

A special registration process could strike the right balance between increasing access to the drug used to treat opioid use disorder while limiting diversion and possible misuse, say an MHE editorial advisory board member and two co-authors.

Magellan Rx Management has begun providing a multi-state solution in which they negotiate with drug manufacturers for value-based contracts for high-cost gene and cell therapies.

In this opinion piece, Karen shares some of the critical issues related to re-enrolling members subject to Medicaid redetermination and covers some of the most important critical success factors for organizations seeking to optimize their response.

Proponents hailed yesterday's announcement of the first 10 drugs subject to Medicare "maximum fair price" starting in 2026 as ushering in an era of lower drug prices and a political victory over pharma. Critics said it is price controls masquerading as negotiation and would smother innovation in one of the most innovative industries in the U.S.

Topping the list is Eliquis, which accounted for $16.48 billion in spending for the 3.7 million people in Medicare Part D who take the blood thinner.

By customizing collaborative models of at-home care to the health needs of the community and the business needs of key stakeholders, organizations can develop an innovative model that achieves mutual goals while strengthening health outcomes, access, and satisfaction.