From @CareMetx: 𝐁𝐞𝐲𝐨𝐧𝐝 𝐓𝐡𝐫𝐨𝐮𝐠𝐡𝐩𝐮𝐭: 𝐁𝐮𝐢𝐥𝐝𝐢𝐧𝐠 𝐑𝐞𝐯𝐞𝐫𝐢𝐟𝐢𝐜𝐚𝐭𝐢𝐨𝐧 𝐒𝐭𝐫𝐚𝐭𝐞𝐠𝐢𝐞𝐬 𝐓𝐡𝐚𝐭 𝐒𝐚𝐟𝐞𝐠𝐮𝐚𝐫𝐝 𝐀𝐜𝐜𝐞𝐬𝐬. Download: "Rethinking Annual Reverification: A Strategic, Multi-Layered Approach to Protecting Patient Access":

🚨 𝐏𝐁𝐌 𝐄𝐱𝐜𝐥𝐮𝐬𝐢𝐨𝐧𝐬 𝐇𝐢𝐭 𝐑𝐞𝐜𝐨𝐫𝐝 𝐇𝐢𝐠𝐡𝐬 𝐢𝐧 2025. The three largest PBMs are excluding more medications than ever before:.🔹 842 single-source brand-name drugs (with no generic or biosimilar alternatives).🔹 611 unique generics.🔹 37 unique biosimilars

𝐄𝐦𝐩𝐥𝐨𝐲𝐞𝐫𝐬 𝐀𝐫𝐞 𝐑𝐞𝐭𝐡𝐢𝐧𝐤𝐢𝐧𝐠 𝐏𝐁𝐌 𝐒𝐭𝐫𝐚𝐭𝐞𝐠𝐢𝐞𝐬—𝐁𝐮𝐭 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐖𝐨𝐧'𝐭 𝐒𝐡𝐚𝐫𝐞 𝐢𝐧 𝐃𝐢𝐬𝐜𝐨𝐮𝐧𝐭𝐬. 77% of employers consider managing the cost of GLP-1 medications “extremely/very important”—making it the top pharmacy benefit

🚨 2024 𝐆𝐫𝐨𝐬𝐬-𝐭𝐨-𝐍𝐞𝐭 𝐑𝐞𝐚𝐥𝐢𝐭𝐢𝐞𝐬 𝐚𝐭 9 𝐓𝐨𝐩 𝐃𝐫𝐮𝐠𝐦𝐚𝐤𝐞𝐫𝐬: 𝐀 𝐍𝐞𝐰 𝐄𝐫𝐚 𝐨𝐟 𝐌𝐚𝐫𝐤𝐞𝐭 𝐀𝐜𝐜𝐞𝐬𝐬. DCI analyzed brand-name drug pricing data from Bristol Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, Johnson & Johnson,

New @JNJInnovMed $JNJ report offers unprecedented transparency into #drug pricing & #GrossToNetBubble:.- $47.8 B in rebates, discounts & fees for 2024 (+11.7% vs. 2023) .- $14.7 B to comm'l payers & #PBMs (+9.7%).- $7.4 B to #340B providers (+23.3% !). ==>

From @InformaConnect: Informa Connect’s Medicaid Drug Rebate Program Summit. September 15-17, 2025 | Chicago, IL. *** Promo code for discount: 25DRCH10 ***. Details ==> #sponsored

𝐇𝐨𝐰 𝐅𝐨𝐫𝐦𝐮𝐥𝐚𝐫𝐲 𝐁𝐚𝐫𝐫𝐢𝐞𝐫𝐬 𝐃𝐞𝐫𝐚𝐢𝐥 𝐂𝐚𝐫𝐞 𝐟𝐨𝐫 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐏𝐚𝐫𝐭 𝐃 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬. New data from IQVIA paints a troubling picture:.➡️ After one year, 18% to 42% of new Medicare Part D patients still hadn’t gained approval for their originally

𝐓𝐡𝐞 𝐂𝐨𝐥𝐥𝐚𝐩𝐬𝐞 𝐨𝐟 𝐒𝐭𝐚𝐧𝐝-𝐀𝐥𝐨𝐧𝐞 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐏𝐚𝐫𝐭 𝐃 𝐏𝐥𝐚𝐧𝐬: 𝐖𝐡𝐚𝐭 𝐂𝐨𝐦𝐞𝐬 𝐍𝐞𝐱𝐭?. Ever since the IRA was passed, we've been pointing out the ever-growing unintended consequences of this hastily-passed law. One of the most significant

A troubling trend: Large insurers are denying a greater share of prescription drug claims. The usual suspects: @Cigna , @Aetna , @UHC , @ElevanceHealth , @Humana . Caveats: Limited visibility into methodology or the reasons for denial. Source: @KomodoHealth @nytimes

Payer-operated practices are gaining in U.S. primary care. Vertically integrated insurers now account for 4.2% of total primary care in 2023, up from 0.8% in 2016. 👇In 3 large counties, Optum alone controls 35%–45% of primary care. 👉

💊 340𝐁 𝐂𝐨𝐯𝐞𝐫𝐞𝐝 𝐄𝐧𝐭𝐢𝐭𝐢𝐞𝐬 𝐒𝐭𝐢𝐥𝐥 𝐍𝐨𝐭 𝐏𝐚𝐬𝐬𝐢𝐧𝐠 𝐃𝐢𝐬𝐜𝐨𝐮𝐧𝐭𝐬 𝐭𝐨 𝐍𝐞𝐞𝐝𝐲 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬. Yikes! Only 3% to 5% of branded 340B prescriptions at retail and mail-order contract pharmacies were filled using a 340B drug discount card. That’s

📉 𝐆𝐫𝐨𝐬𝐬-𝐭𝐨-𝐍𝐞𝐭 𝐁𝐮𝐛𝐛𝐥𝐞 𝐇𝐢𝐭𝐬 $356𝐁 𝐢𝐧 2024—𝐁𝐮𝐭 𝐆𝐫𝐨𝐰𝐭𝐡 𝐒𝐥𝐨𝐰𝐬 𝐭𝐨 10-𝐘𝐞𝐚𝐫 𝐋𝐨𝐰. In 2024, gross-to-net reductions for brand-name drugs reached a record $356 billion. But the growth rate was the slowest in at least 10 years. Is the bubble

Do self-funded employers really want government-driven PBM reform? @Mercer argues that state PBM laws "reduce employer autonomy" and "may increase costs.” That’s why many plan sponsors aren’t lobbying Congress to regulate PBMs on their behalf. 👉

🚨 𝐓𝐫𝐨𝐮𝐛𝐥𝐢𝐧𝐠 𝐍𝐞𝐰 𝐃𝐚𝐭𝐚 𝐨𝐧 𝐆𝐞𝐧𝐞𝐫𝐢𝐜 𝐃𝐫𝐮𝐠 𝐀𝐩𝐩𝐫𝐨𝐯𝐚𝐥𝐬 & 𝐋𝐚𝐮𝐧𝐜𝐡𝐞𝐬. IQVIA’s latest analysis of ANDA approvals highlights a serious breakdown in getting lower-cost generics to patients:. ✅ Only 63% of approved generics have actually launched

💊 𝐏𝐫𝐞𝐬𝐜𝐫𝐢𝐩𝐭𝐢𝐨𝐧 𝐏𝐫𝐢𝐜𝐞 𝐓𝐫𝐚𝐧𝐬𝐩𝐚𝐫𝐞𝐧𝐜𝐲 ≠ 𝐈𝐦𝐩𝐚𝐜𝐭?. A real-time prescription benefit (RTPB) tool should help patients and physicians make better medication decisions. But in a study of 2.8 million patients, implementation of RTPB tools did not lead

From @EVERSANAcompany: Rewriting the Access Script: A Pharmacist’s View on the Rise of Direct-to-Patient. Learn more about EVERSANA’s Direct-to-Patient solution: Read the article: #sponsored

Another biosimilar barrier? More than 1 in 8 patients who switched to a Humira biosimilar ended up switching back to original product. Switching back more common among older adults, women, & patients with RA and ankylosing spondylitis. Truveta Research

“We think rebates are stupid… but under 340B, our PBM doesn’t touch it… and we are paying full price for the drug.” Shawn Gremminger @ntlalliancehlth. Must-read article: