Formulary guidance and transparency from P&T to point of care

Judy Packer Tursman

Senior Reporter, Health Plan Weekly and Radar on Drug Benefits

Recent Posts

Radar On Market Access: PhRMA, Feds Spar Over Where To Place Drug Pricing Details

Posted by Judy Packer Tursman on Nov 6, 2018

The 15th of October turned into a day of dueling proposals on the best way for pharmaceutical manufacturers to provide consumers with more information on medication prices. America’s Health Insurance Plans (AHIP) tells AIS Health that it sees merit in the federal government’s approach, while the pharma industry’s plan falls short.

It began with a pre-emptive strike in the morning when the Pharmaceutical Research and Manufacturers Association of America (PhRMA), stressing its commitment to price transparency, issued a press release.

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Topics: Industry Trends, Specialty, Provider

Radar On Market Access: Prime’s New Formulary Excludes Many Drugs Just Added in 2018

Posted by Judy Packer Tursman on Oct 11, 2018

Against the backdrop of giant PBMs' megadeals, mid-sized PBMs such as Prime Therapeutics LLC are strategizing to remain competitive. As part of its effort, Prime tells AIS Health it intends to exclude dozens of drugs from its formulary effective Jan. 1 — and most of the drugs being eliminated only entered the market in 2018.
Prime's national NetResults Formulary is eliminating 30 to 35 drugs, for a total of 303 exclusions, for 2019, says David Lassen, Pharm.D., chief clinical officer of the PBM, which is collectively owned by 18 Blue Cross and Blue Shield plans.
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Topics: Industry Trends, Payer, Specialty, Market Access

Radar On Market Access: Payers Wait for Gilead’s HCV Generics to Hit Market Soon

Posted by Judy Packer Tursman on Oct 2, 2018

Many payers likely are keeping a close eye on how the pharma industry reacts to Gilead Sciences, Inc.'s Sept. 24 announcement that it intends to soon launch steeply discounted generic versions of two of its chronic hepatitis C virus (HCV) drugs. The biopharma company says these generics will become available in January 2019 in the U.S. — a move that PBM Express Scripts Holding Co. describes as a win for payers and patients alike, AIS Health reported. 
According to Gilead, its newly created subsidiary, Asegua Therapeutics, will sell authorized generics of Harvoni and Epclusa "at a list price of $24,000 for the most common course of therapy."
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Topics: Industry Trends, Payer, Specialty, Provider, Data & Analytics

Trends That Matter for 2019 PBMs' Exclusions

Posted by Judy Packer Tursman on Sep 27, 2018

Leading pharmacy benefit managers (PBMs) recently released updates to their 2019 national formularies. As of Jan. 1, Express Scripts Holding Co. will introduce 48 new formulary exclusions in its 2019 National Preferred Formulary (NPF), which the PBM says will help drive out waste, AIS Health reported.

Adam Fein, Ph.D., president of Pembroke Consulting, Inc. and CEO of Drug Channels Institute, notes that Express Scripts, for the first time, excluded products in two specialty categories: HIV antiretrovirals and Factor VIII recombinant products for hemophilia treatment.

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Topics: Specialty, Industry Trends, Branding & Marketing, Data & Analytics