News

Timothy Mizak and Nicole Bulochnik of Abarca talked about how can PBMs help payers manage costs through a hybrid network model that leverages value-based and other innovative drug contracts at the Pharmacy Benefit Management Institute (PBMI) annual meeting in Orlando.

Executives at Arrive Health and OptumRx say they have ironed out many of the problems with real-time benefit checks, which delivers out-of-pocket cost and prior approval information at the time a prescription is being written.

Jeffrey A. Shaman, Ph.D., chief science officer at Coriell Life Sciences, talked about how pharmacogenomics can inform medication management.

Nicole Bulochnik, Vice President of Drug Pricing and Network Strategy at Abarca Health delivers her presentation, "PBM-Payer Partnerships: Insight into Alternative Cost Management Strategies Across Common PBM Levels," during this year's PBMI National Annual Conference in Orlando, FL.

Thus far, value-based contracts for prescription drugs has not been transformative because of the scalability challenge for payers, explained Gregory Warren, FSA, FCA, MAAA, partner and consulting actuary with Axene Health Partners.

Greg Warren, partner and consulting actuary at Axene Health Partners, discussed the many solutions that have been put forth to address the prescription drug challenges that could bring value to healthcare.

Cate Lockhart, MS, PharmD, PhD, Executive Director at the Biologics and Biosimilars Collective Intelligence Consortium covers her presentation "New mAbs on the Block: A Rocking Research Update on Biosimilar Uptake and Benefit Design" which she delivered at this year's PBMI national conference.

Kali Panagos, Pharm.D., of ARMSRx discussed ways that pharmacy benefit managers are coping with specialty drug spending.

Some of the evidence for digital therapeutic suffers from selection bias and relatively short studies, panelists at the Pharmacy Benefit Management Institute said today. They also discussed making the flood of data from the digital therapeutics accessible and useful to payers and clinicians.

Doug Long, vice president, industry relations IQVIA, talk about the growth of the specialty medication market and the impact of biosimilars that are expected to be introduced next year.

Brandon Newman, an industry veteran, also listed the specialty drug spend, collaboration and real-time optimization as the pharmacy benefit management trends to watch.

A Texas judge ruled that coverage for HIV pre-exposure prophylaxis (PrEP) violates religious freedom but there is concern that cancer screenings and other preventive services could be affected.

In COVID-19 news, the FDA indicated Eiger’s treatment not supported by data. An advisory committee switched its vote to yes for new ALS drug. The FDA approved Stimufend, a biosimilar to Neulasta, as well as Imfinzi for biliary tract cancer, a longer-lasting treatment for frown lines, an oral suspension for gastric ulcers, and generics of Revlimid. The agency accepted applications for novel dry eye disease and alopecia therapies. Additionally, Seres completed rolling BLA for microbiome therapeutic.

In a second committee meeting, FDA advisors supported approval of AMX0035 after the company presented additional analysis of phase 2 data of AMX0035 to treat patients with ALS. The Prescription Drug User Fee Act (PDUFA) target action date is Sept. 29, 2022.

Risk adjustment is a central feature of value-based care, but it can be abused. Natural language processing can make the process efficient and steer it clear of fraud and other problems.

A national study in Germany identified the baseline characteristics of patients with moderate-to-severe atopic dermatitis (AD) to understand how they are usually treated with Dupixent in the real world.

In COVID-19 news, the FDA authorized updated boosters. The agency also approved several new therapies, including Xenpozyme for a rare genetic disorder, and Pemazyre for myeloid/lymphoid neoplasms, Spevigo for rare type of psoriasis flare. The FDA also expanded Imbruvica’s indication for young children with GVHD and granted priority review for weekly hemophilia A therapy.

Therapeutic goals of reducing eosinophil counts below a certain level in eosinophilic esophagitis (EoE) has a marginal benefit for the impact on quality of life and treatment burden.

In this week's episode, MHE Editor Briana Contreras and Managing Editor Peter Wehrwein met with CIO of Prime Therapeutics, Jim Graham to discuss the process of an organization’s digital transformation from a traditional Pharmacy Benefit Manager to a complete data-driven drug management system. Graham addressed the risks an organization may come across to successfully transition to this system, but also mentioned the benefits to come.

CIO of Prime Therapeutics, Jim Graham, discusses with MHE how to successfully reach digital transformation in healthcare from a traditional PBM.

Telemedicine has skyrocketed during the COVID-19 pandemic, but what actions are needed for more patients to have equitable, fair access to genetics services via telegenetics?

This year, health plans need to focus on the following smart, “no regret” investments in the enrollment process that have low risk, high reward, and ultimately deliver an exceptional member experience while simultaneously reducing costs and improving data quality.

Kaiser Family Foundation research shows that an 8% increase in enrollment from 2021 to 2022.

In COVID-19 news, both Pfizer and Moderna have submitted applications for an updated booster vaccine, and the FDA grants EUA for Novavax vaccine for adolescents. The agency also approved rapid-acting Auvelity for major depression, expanded Imbruvica for young children with GVHD, expanded use of Omnipod 5 for younger children, and accepted an NDA for GSK’s myelofibrosis drug.

The nearly $19 million boost comes after the Inflation Reduction Act extended enhanced premium tax credits for ACA marketplaces policies through 2025.

Twenty percent of nurse managers are considering leaving the profession, and amid unprecedented burnout and turnover among nurses at all levels, there’s increased urgency for healthcare organizations to develop a formal nurse manager succession plan

Back from a brief hiatus, MHE brings you a brand new episode of Tuning In to the C-Suite podcast where Editor Briana Contreras had the pleasure of speaking with Lissy Hu, president of Connected Care Networks at WellSky. Lissy and Briana discussed the shift to home-based care and where it stands after becoming much more of a norm three years into COVID-19. They also addressed the benefits and challenges of home-based care from a payer and patient’s perspective, as well as the cost of this service as its demand rises.