Over the next 20 years, expect to see funky formularies and new drug benefit designs to manage costs
NATIONAL REPORTS-Though a two-tier formulary for generics and brand-name drugs was cutting edge 20 years ago, this decade has given rise to the three-tier formulary, according to Perry Cohen, president of The Pharmacy Group. He predicts the third tier will likely expand within the next 20 years.
"Specialty health benefits will deal mostly with drugs that are currently in tier four and five, because they are specialty drugs that cost perhaps $10,000 a year," says Cohen. "So, over the next 20 years you're going to see traditional drugs covered under a three-tier copay system, but that third tier is going to get more funky."
"So the incidence is really small, the drugs are expensive, and they need a lot of case management to go with it, such as tracking, use, genetic testing-and all those things are going to lead to a third category of health benefits, called specialty health benefits."
In addition, Cohen says the market is moving from drug formulary management toward drug utilization management.
A Conversation With Greg Baker, RPh, CEO of AffirmedRx
March 31st 2024Greg Baker, CEO of AffirmedRx, describes his early career, shares some of his critical opinions about the pharmacy benefit management (PBM) industry and how, in his view, his company is offering a better alternative.
Read More
David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
Listen
Florida Gets the OK. But Will Drug Importation from Canada Actually Happen?
March 5th 2024Canadian health officials warn that maintaining a drug supply for Canadians is their priority. The staunch opposition of the U.S. pharmaceutical industry may also be an obstacle to imports from north of the border.
Read More
Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization’s innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company.
Listen
What Payers Need to Know As Retail Pharmacies Move Into Primary Care
September 6th 2023Healthcare 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.
Read More