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These include disruption to the now-booming biosimilar market, the prospects of physician/hospital vertical integration that will raise commercial healthcare costs and expand 340B, and the need for complex new processes to administer the IRA's lower pharmacy reimbursements.
In this issue: CVS disassociates itself from its chain pharmacy association Payers are paying attention to ICER Benefits of the biosimilar boom A fantastic takedown of health insurance deductibles Plus, I join the Advisory Board of Alto Pharmacy. P.S. Join my nearly 30,000 (!) LinkedIn followers for daily links to neat stuff.
These include disruption to the now-booming biosimilar market, the prospects of physician/hospital vertical integration that will raise commercial healthcare costs and expand 340B, and the need for complex new processes to administer the IRA's lower pharmacy reimbursements.
The Humira biosimilar market has arrived! This month, nine biosimilar versions of adalimumab launched in the U.S. Surprisingly, two PBMs—Express Scripts and OptumRx—will each offer at least one low-list-price biosimilar option on their main national formularies.
Since I published the article below in July 2023 , there have been three notable market develpoments: IQVIA has reported that as as of mid-2023, there was almost no adoption of Amgen's Amjevita, the first Humira biosimilar. Boehringer-Ingelheim launched an unbranded, low WAC version of its interchangeable biosimilar.
BiosimilarsBiosimilars, while highly similar to their reference biopharmaceuticals, offer distinct advantages that position them as preferred therapeutic options in many cases. This is because biosimilars are not new drugs but highly similar versions of already approved therapies with established safety and efficacy profiles.
This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook. Below, I highlight four takeaways from this year’s lists, including a look at biosimilar insulin and the forthcoming biosimilar competition for Humira.
For 2023, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again increased the number of drugs they exclude from their standard formularies. Each exclusion list now contains about 600 products.
For 2024, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again each excluded 600 or more drugs from their standard formularies. This year, Humira and its 13 biosimilars will provide the most intriguing formulary drama.
Pharmacies and Pharmacy Benefit Managers , available for purchase and immediate download. Pharmacies and Pharmacy Benefit Managers , our 14th edition, provides a comprehensive, fact-based, and non-partisan tool for understanding the entire U.S. I am pleased to announce our new 2023 Economic Report on U.S.
Pharmacies and Pharmacy Benefit Managers. Pharmacies and Pharmacy Benefit Managers is a definitive, nonpartisan resource that includes the most current information about pharmacy dispensing channels, third-party payers, pharmacy benefit managers (PBMs), patients’ financial contributions, government regulations, and much more.
Informa Connect's Hub and Specialty Pharmacy Models West. September 14-15, 2022 Sheraton San Diego Hotel & Marina | San Diego, CA www.informaconnect.com/hub-specialty-pharmacy-west. Delivered as a Hybrid Event. Drug Channels readers will save 10% off the current registration rate when they use code 22DC10 *.
CVS Health frightens all but one Humira biosimilar maker away from its formulary. Mark Cuban Cost Plus Drug Company conjures a partnership with Alto Pharmacy. The gross-to-net bubble for anti-obesity GLP-1 drugs walks among us. Penn Medicine gorges on the 340B program.
CVS Health has finally revealed its strategy for biosimilars of AbbVie’s Humira. Rather than announce multiple biosimilars for its pharmacy benefit manager (PBM) formulary, the company will instead launch Cordavis, a new subsidiary that will market a private label, low-list-price version of Sandoz’ Hyrimoz.
One update: CVS Caremark's 2024 formulary for patient-administered autoimmune products prefers: Humira Hyrimoz (the high WAC Sandoz biosimilar) adalimumab-adaz (the unbranded, low WAC Sandoz biosimilar) Perhaps coincidentally, Sandoz products are marketed by Cordavis, the new business described in today's rerun.
Time to pack away the bathing suit and get serious again—with these curated curiosities combed from the now-barren Drug Channels beach: OptumRx joins the PBM GPO game Pharmacy DIR fees hit $11 billion A terrific resource on state biosimilar laws Patient views on utilization management Plus, my social media success…from a (print) newspaper ad!
This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook. So far, it appears that PBMs are neither preferring Amgen's Humira biosimilar nor embracing the low-list/low-rebate version.
on key specialty pharmacy trends Evidence for biosimilar-to-biosimilar switching Plus, Dr. Glaucomflecken takes on PBMs! P.S. Join my more than 31,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter , where I have more than 15,000 followers.
It’s the biosimilar boom! Recent posts have covered: Walgreens’ new direction; controversary over independent pharmacy counting; insurer consolidation; retail pharmacy M&A; drug pricing policy; Prime Therapeutics; 340B contract pharmacy litigation; pharmaceutical antitrust; oncology care model; and Peter Bach’s nuptials.
April is over, so it's time to hop into this month’s selection of noteworthy news: CVS Health’s formulary boosts a Humira biosimilar An insurer ditches buy-and-bill to save money for plans—but maybe not for patients?
Along with sunshine and fine weather, this vernal equinox has ushered in a crop of new and noteworthy stories: Health inequities in utilization management Insurers compute big white bagging savings The biosimilar boom accelerates The patient upside of manufacturers’ copay support Whoa. CVS Health takes the red pill.
Saket discusses market access and contracting strategies for medical benefit products when pharmacy benefit biosimilar therapies launch. Today’s guest post comes from Saket Patel, Consultant, Advisory Services at MMIT. He then describes how to automate formulary and medical policies to protect manufacturers from overpayment.
In this issue: The State of Specialty Pharmacy 2021 How health plans profit—and patients lose—from insulin A fantastic new analysis of the gross-to-net bubble Reconsidering Amazon P.S. Please join the nearly 13,000 consumers of my daily commentary and links to neat stuff at @DrugChannels on Twitter. Happy Thanksgiving, everyone!
For 2022, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)— increased the number of drugs they excluded from their standard formularies. Each exclusion list contains 400 to 500 products. Let me know what you think by commenting below or on social media.
In this issue: The State of Specialty Pharmacy 2021 How health plans profit—and patients lose—from insulin A fantastic new analysis of the gross-to-net bubble CVS acknowledges how its PBM profits from 340B Reconsidering Amazon P.S. You can also find my daily posts on LinkedIn , where I have more than 21,000 followers.
Food and Drug Administration approved the first interchangeable biosimilar insulin product, indicated to improve glycemic control in adults and pediatric patients with Type 1 diabetes mellitus and in adults with Type 2 diabetes mellitus. Semglee (insulin glargine-yfgn) is the first interchangeable biosimilar product approved in the U.S.
For 2022, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)— increased the number of drugs they excluded from their standard formularies. Click here to see the original post and comments from January 2022.
In this issue: The State of Specialty Pharmacy 2021 How health plans profit—and patients lose—from insulin A fantastic new analysis of the gross-to-net bubble CVS acknowledges how its PBM profits from 340B Reconsidering Amazon Plus, the FDA preps you for Thursday with a regulatory soup review. Happy Thanksgiving, everyone!
Houck — Separate decisions by federal district courts in Texas and Puerto Rico in the past two months provide cautionary tales for every pharmacy and wholesale distributor dispensing or distributing controlled substances. This post examines the Zarzamora pharmacy and prescribing red flags decision. d/b/a CVS/Pharmacy, Nos.
WHAT YOU WILL LEARN In 2023, the Inflation Reduction Act of 2022 (IRA) began to alter the Medicare Part D program and trigger changes in beneficiary out-of-pocket spending, drug prices, pharmacy economics, and market access strategies. Pharmacies and Pharmacy Benefit Managers.
The 2024 formularies described below should boost biosimilar adoption. As a new Biosimilar Council report shows , Humira retained 99% of market share in late 2023, despite being more expensive than its biosimilars. This year, Humira and its 14 biosimilars will provide the most intriguing formulary drama.
While we wait for the Phillies turnaround, let’s oil up our gloves, lace up our cleats, and run the bases around this month's biggest hits: Foul ball : OptumRx prefers higher prices for the first Humira biosimilar Strikeout : Copay accumulators hurt health equity Bench warmer : Surprise?
Sink your fangs into Amgen’s fantastic new report on the biosimilar boom Wicked! Mark Cuban tells ghost stories about PBMs. Walgreens terrifies Wall Street with its 340B losses. Physicians think payers cast evil utilization management spells. Plus, Walgreens launches a refreshing new wellness service.
Fein will share his latest thinking on a wide range of topics, including: Retail and specialty pharmacy trends Vertical integration and consolidation The Inflation Reduction Act of 2022 The Medicare Part D Redesign Biosimilars Discount cards and cash-pay pharmacies The growing impact of hospitals and health systems The 340B Drug Pricing Program Federal (..)
Before you venture outside for your lockdown barbeque, check out these noteworthy items off the Drug Channels grill: Payers predict how COVID-19 will affect formularies Our analysis of the 2020 retail-to-mail shift AmerisourceBergen profiles biosimilars Plus, CVS pharmacy offers a clever way to measure appropriate social distancing.
Initially, drug manufacturers were required to offer these discounts only to the in-house pharmacies of covered entities. In 2010, the Health Resources and Services Administration (HRSA) authorized covered entities to contract with an unlimited number of retail pharmacies to fill prescriptions for their patients.
Pharmacy Transformation Leader of Blue Shield of California as he leads a comprehensive discussion on the PBM landscape over the last year, and delves into the evolving trends and emerging challenges shaping the current industry today. What can be learned from the economic landscape of biosimilars and specialty therapeutics?
Fein will share his latest thinking and projections on a wide range of topics, including: Commercial implications of the Inflation Reduction Act Vertical integration and consolidation trends Update on Humira biosimilars PBM strategies and the outlook for state and federal legislation What’s next for discount cards and cash-pay pharmacies Impact of (..)
Before you declare your (socially-distanced) independence, get up close and personal with these Drug Channels fireworks: CVS launches a new GPO for its PBM CMS rethinks copay accumulators Here’s how GoodRx makes money Supermarkets face pharmacy challenges Plus, powerful and important comments from Ken Frazier, CEO of Merck.
By Faraz Siddiqui — As drug manufacturers battle the Health Resources and Services Administration (“HRSA”) in federal courts over the role of 340B contract pharmacies, an Eighth Circuit decision to uphold a 2021 Arkansas law may render those cases inconsequential in that state. Code Ann. § 23-92-604(c)(1), (2) (Act 1103). Decision at 8-9.
In this issue: Rebate rule redux Most Favored Nation and healthcare benchmarking Amazon’s pharmacy customer opportunity Drug spending realities updated GPO consolidation Plus, I congratulate Dirk Rodgers of RxTrace on his retirement. Before you stretch your stomach, stretch your mind with this extra-stuffed helping of food for thought.
Don’t miss the chance to unite with colleagues and master the complexities of pharmacy and distribution models to accelerate patient access! View the agenda to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/trade for further details and to register.
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