News

Health insurance exchange formularies: Charting new waters in the world of formulary

New regulations in the Patient Protection and Affordable Care Act have led to the birth of essential health benefits. The Centers for Medicare and Medicaid Services’ (CMS) new division, the Center for Consumer Information and Insurance Oversight (CCIIO), is responsible for the oversight of the insurance offerings on the new health insurance exchanges, which have 10 required essential health benefit categories. One of these essential categories is prescription drugs. Prospective qualified health plans, prescription benefit managers, and consultant agencies have struggled through the legislation and guidance from CCIIO in an attempt to build benefits that meet the requirements. With elements of typical commercial offerings as well as those of Medicare Part D, there are many nuances that one must consider when building an exchange formulary and creating the surrounding benefit.

The risk of Guillain-Barré syndrome after influenza vaccination

Guillain-Barre syndrome (GBS) is an immune-mediated flaccid paralysis that can range from muscle weakness and tingling to respiratory paralysis requiring prolonged respiratory support and ventilation. Overall, GBS is a rare disease, with annual incidence averaging 1 to 2 cases per 100,000 individuals.1

Rate reality hard to pin down

Despite grim predictions of rate shock, older and sicker people will experience 'rate joy' in the exchanges

FDA investigating fingolimod after report of rare brain infection

In a Drug Safety Communication, FDA has reported that a patient in Europe being treated for multiple sclerosis and who had no history of using natalizumab (Tysabri) developed progressive multifocal leukoencephalopathy (PML) while taking fingolimod (Gilenya).

One in 10 Americans have taken someone else’s Rx

One in 10 Americans admit taking someone else’s Rx, according to an ongoing Reuters/psos online survey. About a quarter of those people used the prescription drugs to get high, according to the survey

Canadian Medical Association calls expanded pharmacist functions beneficial

Pharmacists in Canada were recently given broader responsibilities including, in certain provinces, prescribing privileges, vaccination abilities, and the ability to order and interpret laboratory tests. This newly expanded role for Canadian pharmacists can benefit both patients and physicians, according to an article in the Canadian Medical Association Journal.

Real-world performance becomes key in drug selection

Drug evaluation and selection models are changing. Safety and efficacy have become the starting point for consideration by many payers. What they really want to see is evidence of superior performance in real world patient populations.