CMS to scruntinize Medicare formularies

Neal Dave, executive director of Pharmacy at Texas Oncology, explained that medically related pharmacies are truly an integrated team.

In 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.

Cate Lockhart, executive director of the Biologics and Biosimilars Collective Intelligence Consortium, shared results yesterday of a survey that look at biosimilars on the pharmacy benefit side of coverage versus medical benefit. The survey also shared how payers and those on the pharmaceutical side are anticipating the introduction of Adalimumab (Humira®), as well as what to look for in the future of the biosimilar pipeline.

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.

Aside most of the 311 respondents to the 2023 Annual Managed Healthcare Executive Pharmacy Survey favoring PBMs, two-thirds indicated they favor restrictions on rebates and discounts so PBMs won’t favor drugs with high discounts. A similar proportion favor transparency rules that would require disclosure of rebates and discounts.

Results show that beliefs about biosimilars are mixed