Federal investigators target payments to formularies, docs

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.

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.

Tony Little, ND, VP of Solutions Architecture at Prescryptive Health, shares how the organization is tackling one of the biggest barriers to prescription adherence — cost — through a digital app, among the other barriers patients face.

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.

7 of them launched during the first several days of July, joining Amgen's Amjevita in the suddenly crowded market of Humira competitors. Pfizer’s Abrilada is the only FDA-approved Humira biosimilar that hasn’t launched.

The Sandoz's and Boehinger Ingelheim's Humira biosimilars will join Amgen's Amjevita on the formulary of UnitedHealth Group's PBM. Cyltezo may have a marketing edge because of its interchangeability designation.