OTCs: Weighing whether benefit design or formulary tier is mosteffective
The blockbuster drugs of the 1990s came off patent, became generic,and now several of them have become available over-the-counter(OTC). Others are expected to join the ranks in the next few years.This shift, combined with the increasing focus on electronicmedical records (EMRs) for longitudinal patient medication profilesand continuing pressure on the healthcare industry to take costsout of the system, drives the following questions for health plans,employer groups and pharmacy benefit managers (PBMs): Should OTCdrugs be covered by a pharmacy plan? Is benefit design sufficientfor covering OTCs and monitoring therapeutic compliance? Shouldpharmacy and therapeutic (P&T) committees modify theirformularies to be OTC-aware, or should they actually include OTCson the formulary? If a plan does incorporate OTCs into theformulary, what are the criteria for inclusion or exclusion?
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.
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Upended: Can PBM Transparency Succeed?
March 6th 2024Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.
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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.
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The deliberate disconnection of Change Healthcare to ring fence a cyberattack entered its seventh day today. Prescribers are finding ways to get pharmacy claims processed, and UnitedHealth Group says disruption to the dispensing of prescriptions has been minimal. But independent pharmacies want more information and protection from financial consequences from pharmacy benefit managers.
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