Federal investigators target payments to formularies, docs

A Senate Finance Committee hearing yesterday was the latest in a series of hearings and announcements featuring sharp condemnation of the business practices of the large pharmacy benefit managers.

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.

The Academy of Managed Care Pharmacy is throwing its support behind federal legislation that would create a Medicare benefit category for prescription digital therapeutics.

Briana Contreras, associate editor of Managed Healthcare Executive, spoke with Josh Benner, founder and CEO of RxAnte, in this latest episode of Tuning In to the C-Suite podcast. In the conversation, Benner addressed the issue of medication misuse among patients based on access, demographics and more, as well as its solutions. The two also talked about the role technology has on the future of pharmacy and how solutions provided through RxAnte can assist plans to improve their CMS Start rating measures.

Coverage decisions about prescription digital therapeutics may take payers out of their comfort zones and require new processes and subject matter experts, according to members of a panel at the AMCP annual meeting. But P&T committees are likely to still be central to the process.

They are the trendy way to lose weight and payers have been noticing an increase in GLP-1 claims. An analysis of the pharmacy and healthcare claims of a small commercial health plan in Texas documents the growth in the off-label usage of the GLP-1s, such as Ozempic, for weight loss.