Timely Health Plan News and Commentary
Prescription drug costs are one of the fastest-moving parts of health care spending, and they are shaped by decisions made far from the pharmacy counter. Drug manufacturers set list prices. Pharmacy benefit managers (PBMs), the companies that administer drug benefits for health plans and employers, negotiate rebates and build formularies, the lists of drugs a plan covers. The U.S. Food and Drug Administration (FDA) approves new drugs, generics and biosimilars. Health plans then decide what members pay at the pharmacy.
This section covers drug pricing and coverage decisions, FDA approvals and recalls, PBM practices and reform, formulary changes, pharmacy industry news, and the self-pay and direct-to-consumer programs that manufacturers have launched for high-demand drugs such as GLP-1 medications for diabetes and weight loss. We also report on insulin pricing, specialty drugs, and the vaccines and therapies that health plans add to coverage.
For Medicare beneficiaries, Part D rules and the annual out-of-pocket cap determine what they pay for prescriptions; that coverage appears in our Medicare section. Legislative and regulatory action on drug pricing and PBMs is covered in Healthcare Policy and Law, and carrier pharmacy partnerships appear in Health Insurance Companies and Blue Cross Blue Shield. Clinical research and public health findings about medications are covered in Public Health and Research.
The latest prescription drug and pharmacy news appears below, newest first.
CVS Health plans to split into two publicly traded companies. Aetna, the CVS Caremark pharmacy benefit manager, CVS Specialty, Oak Street Health and Signify Health will stay together under the CVS Health name. The roughly 9,000 CVS stores, the mail pharmacy and MinuteClinic will become a separate company called CVS Pharmacy. The company announced the plan on November 4, 2026 and expects to finish it in the first half of 2028.
Novo Nordisk just pulled a move that every patient paying cash for GLP-1 treatment will notice. The company is rolling out an introductory self-pay price of $199 per month for Wegovy and Ozempic starter doses, and cutting ongoing self-pay pricing to $349 per month months earlier than expected.
Prescription drugs are becoming a financial strain for millions of Americans. Rising costs are leaving families to choose between paying rent, buying groceries, or filling life-saving prescriptions. Research shows that 27% of Americans skip prescriptions each month because they cannot afford them. Even more alarming, more than half of all adults filling prescriptions this year said the cost was a burden. One in three reported cutting back on basics like food and clothing just to pay for medicine. [Read more…]
Evio Pharmacy Solutions just landed a big-name partner in its push to fix the high cost of prescription drugs. Wellmark Blue Cross and Blue Shield is now an investor, becoming the sixth health plan to buy into Evio’s mission of making medication access smoother and more affordable. [Read more…]
Canadians are dedicating increasingly more time to navigating the complexities of accessing healthcare and benefits. From the time spent in doctor’s offices to completing benefit-related paperwork and waiting at pharmacies, a recent survey conducted by GreenShield has revealed that Canadians are spending 2.5 times more time managing their healthcare and benefits compared to the actual time spent during a doctor’s appointment. [Read more…]
EmpiRx Health applauds Blue Shield of California, a leading value-based PBM, for implementing the same model of pharmacy care. EmpiRx Health, the pioneer of value-based PBMs, announced a Four Point PBM Revolution Plan. The new plan aims to transform the PBM sector by placing the needs of the plan sponsors and members first, with value-driven pharmacy services. [Read more…]
EmpiRx Health has announced Ziad Rubaie’s appointment as Chief Growth Officer. This makes EmpiRx Health the only industry-focused pharmacy benefits manager (PBM) that values value. Rubaie joins EmpiRx Health’s leadership team during a period of rapid expansion. He will continue to build on the momentum while plan sponsors search for financially sustainable, clinically-based health benefits. [Read more…]
NRx Pharmaceuticals, Inc., (Nasdaq : NRXP, NRx Pharmaceuticals), a clinical-stage biopharmaceutical firm, announced today that the U.S. Food and Drug Administration denied the Breakthrough Therapy designation (BTD). The FDA denied ZYESAMI (r) (aviptadil). It emphasized the company’s NRX101 BTD compound for Bipolar Disorder associated with Suicidality and its NRX-101 BTD drug. Based on the positive findings of a subgroup analysis of patients treated with Aviptadil and placebo, and who had respiratory failure due to Critical COVID-19, the request for BTD was made. [Read more…]
RazorMetrics’ recent survey of consumers about drug costs revealed some unexpected results. Healthcare consumers still want their doctor to lead, despite the rise in savings apps driven by consumers. According to the survey, 80% of respondents said they would prefer that their doctor choose a lower-cost drug for them and make it happen automatically. [Read more…]
Douglas Pharmaceuticals Ltd (Douglas), a privately held New Zealand-headquartered pharmaceutical company, today announced positive top-line data from its multinational, randomized, placebo-controlled, double-blind Phase 2 study of R-107 designed to investigate the efficacy and safety of R-107 (ketamine 30, 60, 120 or 180 mg) versus placebo for TRD. The study was carried out in New Zealand and Australia, Singapore, Taiwan, and 2021. 168 patients were randomized. [Read more…]
Servatus Ltd is an unlisted Australian biopharmaceutical firm and global expert in the development and identification of new autoimmune therapies using live microbial biotherapeutics. It has received strong support from its sophisticated shareholders. [Read more…]
Today, the Muscular Dystrophy Association, I AM ALS and the ALS Association issued the following statement regarding today’s passage of ACT For ALS in Congress: [Read more…]
Express Scripts Canada Pharmacy is Canada’s first online pharmacy. It launched a marketing campaign to remind Canadians about their leadership in Canadian pharmacy expertise and their experience in the crowded Canadian market. [Read more…]
HomTex produces 3-ply disposable masks and reusable cloth masks, which it provides to the US Capitol, and shortly will create NIOSH N-95 masks at a brand new plant in Selma, Alabama. HomTex is now set to have the biggest potential in the US to make 100 per cent made-in-America masks with centers in Cullman and Mobile, Alabama; Tennessee; South Carolina; and North Carolina. [Read more…]
Dentists are highly capable to administer vaccines, and this choice will enlarge the vaccine supply and reach more people throughout the nation, particularly those residing in health professional shortage areas. [Read more…]
The Health Transformation Alliance (HTA)has reached a major milestone in 2020. In the four years since the HTA was formed, the cooperative has saved its member companies $1 billion in healthcare costs. [Read more…]
QuoteWizard® has published a report last week evaluating each state for administering the COVID-19 vaccine after initial distribution. [Read more…]
Providence Therapeutics has announced that Health Canada has provided a Notice of Authorization for its Clinical Trial Application. [Read more…]
Aurobindo Pharma Limited (NSE: AUROPHARMA) (BSE: 524804) (Reuters: ARBN.NS) (Bloomberg: ARBP:IN) and COVAXX, a US-based company, have entered into an Exclusive License Agreement to develop, commercialize and manufacture UB-612, the first Multitope Peptide-based Vaccine to fight COVID-19, for India and the United Nations Children’s Fund (UNICEF) agency. [Read more…]
The Russian Direct Investment Fund (RDIF, Russia’s sovereign wealth fund) announces the delivery of the first batch of 300,000 doses of Sputnik V, the world’s first registered vaccine against coronavirus, to Argentina. [Read more…]
INOVIO (NASDAQ:INO), a biotechnology company focused on bringing to market precisely designed DNA medicines to treat and protect people from infectious diseases and cancer, has announced the publication of peer-reviewed Phase 1 clinical data from the first cohort of 40 participants for its COVID-19 DNA vaccine candidate, INO-4800, in EClinicalMedicine, an open access clinical journal published by The Lancet. [Read more…]
Here are the Top 10 COVID-19 Vaccine Questions and Answers that we have compiled, with help from Ontario’s doctors: [Read more…]
“COVID-19 has severely impacted communities and families around Florida, And the cost is growing quickly. Together with the FDA’s emergency use approval of fresh COVID-19 vaccines, it is essential that people get broad vaccination throughout the state when you can help protect ourselves and our nearest and dearest,” explained Pat Geraghty, Florida Blue president and CEO. [Read more…]
WASHINGTON, April 28, 2020 /PRNewswire/ — County Executives of America (CEA) announced plans to begin distributing free prescription assistance cards across the country today. The free program is provided through a partnership with United Networks of America (UNA). Similar programs launched by UNA have resulted in over $10 Billion in healthcare savings. [Read more…]
NASHVILLE, Tenn., April 23, 2020 /PRNewswire/ — AdhereHealth announced today it is expanding the company’s industry-leading technology platform into the commercial health insurance market to address the nation’s growing medication adherence challenge. [Read more…]
SAN DIEGO, March 4, 2020 /PRNewswire/ — MedCrypt Inc., the proactive healthcare security provider, today announced Seth Carmody as the new vice president of regulatory strategy. Prior to MedCrypt, Carmody worked as the cybersecurity program manager in the Office of the Center Director, Emergency Preparedness/Operations & Medical Countermeasures, within the U.S. Food and Drug Administration (FDA)’s Center for Devices and Radiological Health (CDRH). Carmody brings over eight years of experience in guiding medical device cybersecurity regulatory strategy as well as managing regulatory response to cybersecurity matters. [Read more…]
ARLINGTON, Va., March 4, 2020 /PRNewswire/ — Today, Governor Michelle Lujan Grisham of New Mexico signed legislation capping monthly copayments for insulin at $25, making New Mexico the third state to enact a co-pay cap—with the lowest dollar amount for a co-pay cap introduced at the state level to date. Insulin affordability is a critical issue facing millions of Americans, with the price of insulin nearly tripling between 2002 and 2013. The American Diabetes Association (ADA) applauds Governor Michelle Lujan Grisham and bill sponsors Senator Daniel A. Ivey-Soto and Representative Micaela Lara Cadena for their leadership on this urgently needed legislation to provide relief from the burden of high insulin costs for people living with diabetes in New Mexico. [Read more…]
Avella will distribute naloxone, a powerful therapy used to treat opioid overdoses, as part of an innovative new program designed to improve access to the drug. The program allows individuals and family members in certain states to simply contact the pharmacy and order the drug by phone, with no physician prescription needed. In these circumstances, one of Avella’s pharmacists will actually supply the prescription if they determine that EVZIO® (naloxone HCl injection) or another naloxone therapy is appropriate. [Read more…]
Majorly, chronic myelogenous leukemia (CML) occurs in adults, however, it sometimes occurs in children as well. However, targeted drugs called Tyrosine-Kinase Inhibitors (TKIs) have been effective in providing long-term survival rates. Meanwhile, the Food and Drug Administration (FDA) has recently approved dasatinib (Sprycel) for the treatment of chronic myelogenous leukemia in children. As the chronic myeloid leukemia is more aggressive in younger patients, the approval of drugs can help in effective treatment. [Read more…]
Upsher-Smith Laboratories, LLC. (Upsher-Smith) today announced the launch of KLOR-CON® Powder (Potassium Chloride) for oral solution, 20 mEq. The Company received approval of an abbreviated new drug application (ANDA) from the U.S. Food and Drug Administration (FDA) for this product, which will be marketed and distributed by Upsher-Smith. Sandoz, Inc. will continue as the licensed marketer and distributor in the U.S. for the balance of the KLOR-CON® line of potassium products. [Read more…]