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| 10 Industry-Changing Trends on the Pharmacy Benefit Horizon |
From the editors of AIS’s Drug Benefit News, Specialty Pharmacy News and Medicare Advantage News, who are uniquely qualified to evaluate the fast pace of change in the PBM industry, 10 Industry-Changing Trends on the Pharmacy Benefit Horizon identifies the major trends that are changing (or should soon alter) the shape of pharmacy benefit management:
- Value-Based Insurance Design
- The Surge in Generic Utilization
- Follow-on Biologics
- Personalized Medicine
- Comparative Effectiveness Research
- Plans Tighten Formularies
- Changing Medicare and Medicaid Reimbursement Rates
- Emerging Pricing Methodologies
- Rise in Rx Discount Programs
- Drug Importation
With details of the actions that are setting industry trends — from Wal-Mart’s $4 generics program to Obama administration proposals — 10 Industry-Changing Trends on the Pharmacy Benefit Horizon will help you position yourself for the future of pharmacy benefit management. Order your copy today!
Table
of Contents
Value-Based Insurance Design
- N.C. Blues Waive Copays for Generic Chronic Meds;
‘Value-Based’ Rx Benefits Are Growing
- Demand Grows for Value-Based Rx Plans; As Insurers Expand Offerings, ROI Is Elusive
- Insurers Roll Out Value-Based Rx Plans, Tap Growing Demand
- UM Tweaks Value-Based Rx Drug Benefit Offerings Based On ‘Validating’ Research
The Surge in Generic Utilization
- Generic Rx Copays Are Steady or Dropping; Wal-Mart’s $4 Generics Seen as Factor
- More PBMs Tout ‘Drug Mix’ as One Rx Consultant Urges Scrutiny
- If Generics Are Always a Cheaper Option, Why Do Some PBMs and Plans Push Brands?
- PBMs Allegedly Manipulate Definition of ‘Brand’ and ‘Generic’ at Payers’ Expense
- Rx Definition Blur Said to Be ‘Nefarious,’ but Not Necessarily Illegal
- Wal-Mart’s Expanded Generic Rx Plan Not Seen as Threat to PBMs
- Enhanced Generic Drug Sampling Aims to Counter Pharma’s Influence in MD Offices
- Prime Therapeutics’ Drug Trend Echoes Other Low PBM Drug Trends
- More Chains, PBMs Offer Cheap Generics; Rx Payers Ponder Impact
- In Their Own Words: $4 Generics Hurt Mail Rx, Van Antwerp Says
- WellPoint to Offer New Generics Program That Has Brand Options
- PBMs Take New Steps to Push Generics
Follow-on Biologics
- Follow-on Biologic Legislation Receives Boost as BIO, President Bush Support Passage
- CBO: FOBs May Save $25 Billion In 10-Year U.S. Biologics Costs
- Study Finds Follow-on Biologics Law Could Save $25 Billion Over 10 Years
- Waxman Counsel Offers Follow-on Biologics Measure
‘Must Haves’
- Teva Reportedly Will File BLA With FDA for Biosimilar in 2009
- Bills Renew Effort to Bring Biosimilars to U.S., but Many Compromises Are Needed
Personalized Medicine
- Personalized Medicine, Exclusive Distribution Highlight Conference
- Agency Report Urges Expansion of Genetic Testing Oversight
- Promise of Personalized Rx Is Tangible, but Barriers Remain, Including ROI Issues
- Change in Reimbursement Is Needed for Personalized Medicine to Be Successful
- States Crack Down on DTC Genetic Tests Amid Calls for Oversight
- Success of Personalized Medicine Is Tied to Data, Collaboration
- Medco, FDA Enter Into Alliance to Study Impact of Genetic Testing
- In Their Own Words: Vogenberg Describes Impact of Biomarkers
- Genotype Testing Is Crucial to Course of Therapy
- One-Third of Plans Say They May Cover Genetic Testing Within Five Years
- Personalized Rx Gains Expected in 2009; More Rx Approvals Seen With Genetic Tests
- As Research in Genetic Testing Booms, Health Plans Should Create Guidelines
- Some Plans Take the Lead in Covering KRAS Testing, With Handful Making It Part of PA
- ImClone, Amgen Are Trying to Address KRAS Data With FDA
- Personalized Medicine Is Growing; Plans Need Policies for Coverage
Comparative Effectiveness Research
- Industry Leaders Predict Rise in Comparative Effectiveness
- New Administration Will Address Range of Potential Pharma Changes
- Stimulus Bill Will Dedicate Billions to Comparative Effectiveness Research
- Comparative Effectiveness Plan Stokes Concern for Future Rx R&D
- CER Focus Should Be on Clinical Efficacy, But Will Plans Focus on Costs for Coverage?
- CER May Represent Opportunity for Specialty Pharmacies
Plans Tighten Formularies
- Hundreds of ‘Unapproved’ Rx Drugs Were Removed From 2008 Part D Formularies
- Consultants Urge Pharmaceutical Payers to Take Control of Formularies, Rx Tools
- PDPs Cover Fewer Drugs, Offer More Tiers, Raise Copays on Brands in 2009 Offerings
- Plans Tighten Rx Formularies, Put Brand Drugs on Defensive
Changing Medicare and Medicaid Reimbursement Rates
- OIG Weighs In on Reimbursements; CMS Says Part D Drives Spending
- Rx Drug Costs Called 30% Higher in Part D; Medicaid Pricing Levels Sought by Waxman
- CMS’s Proposed Rule on ‘Lock-in Pricing’ Draws PCMA’s Opposition, Prime’s Support
- PBMs Are Relieved CMS’s ‘Lock-in Pricing’ Final Rule Exempts Retiree Drug Subsidy
- Move to PBM Pass-Through Pricing May Accelerate Following CMS Rule
- President’s Budget Would Extend Drug Rebates to Medicaid Plans
- Initiatives to Lower Rx Drug Costs in N.C., Washington State Draw Pharmacists’ Ire
- Part D Plans Must Scrutinize PBM Contracts Ahead of
Lock-in Rule
Emerging Pricing Methodologies
- BSC Offers Aggregate Tiered Fee Schedule for In-Office Injectables
- Judge Slashes Number of Drugs Set for AWP Rollback Under First DataBank Settlement
- First DataBank Amends AWP Deal; Suit Could Yield Payers Billions
- PBMs, Health Plans Would Have to Revisit Thousands of Pacts After AWP Settlement
- Landmark Drug AWP Settlement Is Finalized; Pricing Rollback May Save Rx Payers $1.5 Billon
- In Their Own Words: AWP Future Is Mulled by Segal Rx Consultant
- Medicaid Rx Directors Try New Innovations to Continue Savings
- Caterpillar/Wal-Mart Rx Drug Benefit Pilot Scraps AWP, Uses Drug Cost-Plus Pricing
- Chattanooga, Tenn., Rx Benefit to Save City Millions of Dollars
- OIG: Part B Opportunities for Both Cost Savings, Penalties Exist
Rise in Rx Discount Programs
- PBMs’ Rx Discount Cards Said to Yield Niche Business, Aid Access
- FTC Clears Kaiser’s Rx Model in Proposed Fee-for-Service Plan
- CVS Caremark Joins Others in Offering Discount Rx Program
- Drug Discount Card Use Soars in Weak Economy
- Rx Discount Program Developments
Drug Importation
- Part D Negotiations, Rx Reimports Saw Support From Obama, McCain
- Removal of Ranbaxy Generic Rxs Is Not Likely to Have Major Impact
- Obama Administration Pushes Rx Imports; PBMs and Pharmacies Stand to Benefit
Written
By
This book was written by the editorial staff of AIS.
Written
For
- Managers of HMOs, PPOs and other managed care companies
- Purchasers, employers, pharmacy benefit companies
- Managers in the pharmaceutical industry
- Pharmacy and medical directors at health plans
- Executives at specialty pharmacy and home infusion providers and PBMs
- Reimbursement and marketing directors at pharmaceutical and biotech manufacturers
- Benefit consultants and brokers
- Private-equity and venture-capital firms
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Related
Publications
Drug Benefit News
Specialty Pharmacy News
2000-2009 Survey Results: Pharmacy Benefit Trends & Data
Specialty Pharmacy: Stakeholders, Strategies and Markets
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