Radar on Drug Benefits

Insurers Prepare to Pay For, Help Distribute COVID Vaccine With Chart: Coronavirus Vaccine Effort Gets Closer to Finish Line

As details continue to emerge about the availability of COVID-19 vaccines and how they will be administered, the role that payers will play in the process is becoming clearer. It’s imperative for health plans t...
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Biden May Have to Settle for Smaller Drug-Pricing Moves

As is the case for other flavors of health care reform, President-elect Joe Biden’s chance of passing substantial, transformative drug-pricing legislation is now highly dependent upon whether Democrats can eke out...
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PBM Revenues Offer Boost to Major Insurers in Third Quarter

Large insurer-affiliated PBMs saw strong results for the third quarter of 2020, in several cases driving revenues for parent companies that are grappling with various disruptive effects of the coronavirus pandemic. ...
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States Eye Expanded Drug Price Review Boards as Costs Rise

In response to rising drug prices, some states have launched prescription drug review boards designed to make medicines more affordable. So far, the boards control prices mainly for states’ Medicaid and state empl...
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Humana Expects Medicare PDP Membership ‘Headwind’ in 2021

Judging by executives’ comments during its third-quarter 2020 earnings conference call, Humana Inc. is finding it difficult to stand out in the fiercely competitive market for stand-alone Medicare Prescription Dru...
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Part D, Private Plan Spending Rises on Retail Specialty Drugs

Specialty drugs accounted for 37.7% of retail and mail-order prescription spending, net of rebates, in 2016 and 2017, according to a recent study published in Health Affairs. Average annual net spending on retail sp...
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News Briefs

✦ Pfizer Inc. and BioNTech SE’s coronavirus vaccine candidate has demonstrated 90% efficacy against COVID-19 in patients that have not had the disease, according to company researchers. The announcement was met ...
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Prime-Express Scripts Merger Looks Unlikely Despite New Deal

Prime Therapeutics, the PBM jointly owned by 18 Blue Cross Blue Shield plans, recently entered an agreement with Cigna Corp.-owned PBM Express Scripts to offer Blues plans the option of using Express Scripts’ mail...
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PDP Members Flock to Large Plans in 3.5-Star ‘Sweet Spot’ With Chart: Average PDP Star Rating Gets Minuscule Bump

Based on current enrollment figures, virtually every Medicare beneficiary who signs up for a stand-alone Prescription Drug Plan (PDP) in 2021 will be enrolled in a plan rated 3.5 stars or higher, CMS estimated recen...
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Costlier PDPs, Cheaper MA-PDs Opt Into Insulin Demonstration

In 2021, about half of enhanced stand-alone Prescription Drug Plans (PDPs) and a little more than a third of Medicare Advantage-Prescription Drug (MA-PD) plans will participate in a new demonstration that aims to lo...
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