Patients Turning to Illegal Pharmacies for Essential Medications
US patients are increasingly turning to illegal pharmacies due to high prescription drug prices and shortages of essential medications. The issue has grown in recent years, catching the eyes of officials at the US Food and Drug Administration. It is especially concerning for the attention deficit hyperactivity disorder drug Adderall, which is currently difficult to impossible to find at many legal pharmacies.
Exploring the Impact of PBMs on High Drug Prices
The US pays the highest amount per capita on prescription drugs than any other nation. Several factors interact to drive prices up in the nation. Since a major portion of pharmaceutical development occurs in the US, drugmakers argue high prices are necessary to offset research costs and promote exclusivity. In addition, pharmacy benefit managers (PBMs) play a large role in setting drug prices because they negotiate formularies and drug rebates.
Mark Cuban’s Pharmacy Offers Invokana
Mark Cuban’s Cost Plus Drug Company has announced it now offers Invokana, an SGLT-2 inhibitor used to manage diabetes. The mail-order pharmacy will now provide a total of three brand name versions of the drug, Invokana, Invokamet, and the combination therapy Invokamet XR, which pairs the drug with metformin.
UnitedHealthcare Drops 20% of Prior Authorizations and Introduces Gold-Card Program
The payer giant UnitedHealthcare announced plans to cut down on prior authorizations by introducing a new gold-card program. The gold-card program would be implemented nationwide and would cut the number of prior authorizations by 20%. Once implemented, the program will relieve a significant work burden for the provider groups involved.
Do Commercial Payers Rely on ICER Assessments During Specialty Drug Coverage Deliberations?
The Institute for Clinical and Economic Review (ICER) releases value assessment reports that determine cost-effectiveness ratios (CERs) for new and existing therapeutics. A newly published study in the Journal of Managed Care + Specialty Pharmacy, examines whether and how commercial insurance plans in the US incorporate these reports into their reimbursement decision-making process.
Eli Lilly Catches Up with Mounjaro Shortage
Eli Lilly announced it caught up on backorders for its obesity drug Mounjaro, drawing the end near for a shortage that’s persisted since last December. Some patients may still have to wait for the drug, but delays will likely drop to one to two days. The drug is still on the US Food and Drug Administration’s drug shortage supply list, which may change in the coming days.
Four Projections for Value-Based Drug Pricing Landscape in 2030
Panel speakers at the Abarca Forward pharmacy conference discussed their outlooks for value-based drug pricing models by the end of the decade, coming up with four main predictions going . The first prediction, from Lyfegen’s CEO Girisha Fernando, is that the healthcare industry will have largely adopted a value-based pricing approach to drug formularies.
In Search of a Better Specialty Pharmacy Experience for People with Chronic Illness
People living with chronic illness often have to jump through hoops to get the specialty medicines they need, with many expected to justify their prescriptions to payers and pharmacy benefit managers (PBMs) on a monthly basis. A new Med City News article covers how medically integrated dispensing (MID) can help patients and providers.
Improving Specialty Pharmacy IT to Improve Patient Outcomes
Health information technology (IT) has rapidly advanced over the past few decades, changing the specialty pharmacy industry. However, key inefficiencies remain that, if addressed, could help patients experience better health outcomes. In a new Pharmacy Times article, learn about these inefficiencies and possible solutions to them.
Amazon Launches RxPass Service for $5 Generic Drugs
Amazon has announced the launch of its RxPass service, a subscription-based prescription drug service that will ship certain generic medications to patients for $50 a month. The program includes over 50 generics and is integrated into existing Amazon Prime subscriptions. Drugs can be delivered monthly or once every three months, as requested.
Optum Rx Launches Tool to Match Patients with Cheapest Generic Drug Prices
The massive pharmacy benefit manager (PBM) Optum Rx has launched its Price Edge tool that promises to lower generic prescription drug prices to patients. Price Edge scans through prices and pairs patients with the most affordable generic that matches their prescription. Purchases will apply to patients’ deductibles and out of pocket maximums, the company says, and will be applied to members automatically.
FDA Makes Abortion Pill More Accessible Nationwide
In response to crackdowns on abortion rights in the US after Roe v. Wade was overturned, the Food and Drug Administration has changed risk evaluation and mitigation strategy (REMS) policies regarding Mifeprex, an abortion pill, that will increase patient access. The drug was formerly only available at registered clinics, but can now be dispensed at a pharmacy or by mail. It still requires a prescription, however, a potential barrier in many states.
Managed Healthcare Executive Top PBM Articles of 2022
Managed Healthcare Executive has covered pharmacy benefit managers (PBMs) extensively over the past year, as the industry and its practices face increasing scrutiny. In a new compilation, the Managed Healthcare Executive staff share their most viewed articles about PBMs in 2022. The first is about the 3 titans in the industry.
Custom Health Announces Medication Adherence Pilot with L.A. Care Plan
Custom Health has announced a partnership with L.A. Care Plan to help promote better health outcomes through medication adherence, which hovers around 50% in the US. This imperils health outcomes, which the partnership intends to address with an in-home drug dispensing device alongside remote access to support from a pharmacist.
Cash-Only Pharmacy Offers Novel Model to Reduce Drug Prices for Patients
The small-town pharmacy Honest Rx explicitly does not take health insurance, a practice the owner says helps his patients save money on their medicines. The Virginia pharmacist says that dealing with pharmacy benefit managers (PBMs) and payer organizations slows down his practice and separates him from his patients, whom he generally charges wholesale cost + 20% + a dispensing fee.
Moving to a New PBM Model to Change, and Save, the Industry
With pharmacy benefit manager attracting growing public and governmental scrutiny, the industry has to move past current models that hurt patients while lining their pockets. In a new two part article on Forbes, Seth Joseph discusses the issues facing the industry and ways it can move forward to better, more equitable models. Part one explains PBMs and recent problematic shifts in the industry.
Eli Lilly and US HHS at Odds Over 340B Program in Federal Court
The US Department of Health and Human Services (HHS) and Eli Lilly butted heads in a recent federal appeals court hearing over the agency’s 340B drug discount program, which requires that drugmakers give discounts on certain drugs to pharmacies that serve underprivileged communities. Lilly has refused to sell discounted drugs to several pharmacies that have contracts with the 340B program. The pharma giant, which has reported record profits in recent years, says that the law doesn’t require them to serve all such pharmacies.
CVS Health Enters the Clinical Trial Space
Researchers are increasingly eyeing pharmacies as recruitment sites for clinical trials due to their proximity to a wide range of patients. To capitalize on this growing opportunity, CVS Health will begin to host clinical trial recruitment at its numerous sites across the US. In a new article on Applied Clinical Trials, Moe Alsumidaie sits down with Jill Pellegrino, VP of recruitment and real-world evidence (RWE) at CVS Health Clinical Trial Services to talk about the move.
Managed Care Pharmacists in High Demand
Panel speakers at this year’s Academy of Managed Care Pharmacy Nexus meeting highlighted the abundance of opportunities for managed care pharmacists. Managed care pharmacists are responsible for coordinating efforts of pharmacy networks and investigating drug utilization trends. The speakers noted that opportunities are opening up as the managed care industry expands.
OptimizeRX’s AI-Based RWE Platform Shows Positive Results for Patient Engagement Application
The medical point-of-care tech company OptimizeRx has announced positive results from the implementation of its artificial intelligence-based (AI) real-world evidence (RWE) platform. A specialty pharmacy company used OptimizeRX’s platform to help identify potential applicable patients using electronic health record (EHR) data and inform their providers of available treatments.
Study Finds Involving Pharmacists in Hemophilia Care Results in Better Outcomes and Lower Costs
Hemophilia care often comes with a high price tag and requires a multidisciplinary care team. A newly published paper in The Permanente Journal finds that adding a pharmacist to the team can help improve outcomes and lower costs. The study examined 15 medical providers that actively involved pharmacists in hemophilia care, having them check in with patients between visits and ordering specialty lab tests.
Using Patient-Centered Care Through Pharmacies for Better Health Outcomes
Patient-centered care is one option to help improve health outcomes , but implementation through primary care is held back by the number of patients who avoid or cannot access preventative care. In a new Drugstore News article by Nicholas Turos, VP of business development at Babson Diagnostics, pharmacies are a prime spot to deliver personalized care.
Calling Them “Vanity Drugs,” Some Insurers Refuse to Cover New Anti-Obesity Drugs
In an interview with Pharmacy Times, Ron Lanton III, Esq., principal at Lanton Law, discussed why insurers are refusing to [...]
PBMs Face Growing Public Scrutiny
As the role of pharmacy benefit managers (PBMs) in healthcare grows increasingly important, so does the scrutiny of the industry. [...]
NASP Supports Biden Administration’s Rx Drug Cost-cutting Measures for Seniors but Seeks Protections for Pharmacies
Sheila Arquette, RPh, CEO and President of the National Association of Specialty Pharmacy (NASP), has praised efforts by the Biden [...]
