Pass-Through Rebate Models Must Lower Costs to Catch On
With the Trump administration’s rebate rule delayed and possibly slated for repeal by Democrats in Congress, major changes in how the PBM industry distributes rebate revenue will have to come from the private sect...
As Authorized Generics Proliferate, Benefits Are Unclear
Pharmaceutical manufacturers likely will continue to turn to authorized generics — drugs produced by brand-name drugmakers without the brand label — as they face increased pushback against high drug prices, but ...
Diversified Insurers Remain Bullish on Pharmacy Holdings
Although the fourth quarter of 2020 brought financial challenges for some health insurers due to surging coronavirus infections, the pharmacy-focused divisions of those publicly traded firms seemed to provide a univ...
Biosimilar Uptake Is More Related to Practice Setting Than Patient, Physician Characteristics
Practice setting and hospital outpatient ownership status had the strongest associations with the adoption of the first three biosimilars launched in Medicare, according to a recent study published in JAMA Network O...
Humana Joins Cigna’s GPO For Commercial Members
Humana Inc. entered an agreement with Cigna Corp. to join a group purchasing organization (GPO) for prescription drugs called Ascent Health Services, a Switzerland-based subsidiary of Cigna’s Express Scripts PBM. ...
News Briefs
✦ Humana Inc. and its PBM and pharmacy subsidiaries, alongside Roche Diagnostics Corp. and Roche Diabetes Care, Inc., agreed to pay $12.5 million to settle a lawsuit that claimed they engaged in fraud and illegal ...
As States Carve Out Medicaid Drug Benefits, MCOs Push Back With Chart: States Take Varied Approaches to Rx Benefits in Medicaid
Beginning in April, California and New York will join a growing list of states that have opted to carve out prescription drug benefits from their Medicaid contracts with insurers, wagering that the state can do a be...
CMS Targets Protected Classes in Expanded Part D Demo
As one of its last actions under the Trump administration, CMS said it would give plan sponsors participating in its Medicare Part D Payment Modernization model more flexibility to slim down their formularies, even ...
Trump’s Last-Minute Medicare Part D Rule Could Stand
On Jan. 19, the last full day of the Trump administration, CMS finalized a grab-bag rule that includes several drug pricing components. Experts tell AIS Health that the rule could tie the Biden administration to asp...
Drugmakers Are Likely to See Vaccine Boost, Regulatory Risk
In the year ahead, the three main “developments to watch” in the branded pharmaceuticals sector will include COVID-19 vaccine scale-up and distribution, continued legislative and regulatory pushback against high...