Drug management

Drug pricing & markets, value-based pricing, cost control, real-world evidence for safety and effectiveness

Ed Silverman
Generic medicines are touted as a cost-saving tool, but formulary tactics stand in their way. A new report from the Association for Accessible Medicines says years can pass between FDA approval of a “first generic” and its inclusion on a majority of Part D plan formularies.
Thomas Reinke
The TNF inhibitors have ruled the roost, and Humira is the top selling drug in the world. But the interleukin inhibitors are challenging TNF inhibitor hegemony.
Timothy Kelley
C​ould drug prices be lowered by pegging them to what is paid in other countries? The Trump administration took a step in that direction last fall, when CMS floated a proposal to use international reference pricing (IRP)—average prices paid in a select group of other high-income nations—to limit…
Ed Silverman
After Ohio uncovered huge spreads, other states have taken a hard look at spread pricing in their Medicaid programs. U.S. senators and CMS are also getting into the act.
Thomas Reinke
Utilization management techniques for traditional medicines don’t translate to drugs covered by the medical benefit. Site-of-service programs show some promise, though.
Innovation ’19: Installment Plans for Drugs
Lola Butcher
An MIT-led collaboration is working on a pilot project on how to pay for Zolgensma—a $2.1 million gene therapy—in installments that are contingent on the drug living up to its curative promise.
Cover Story
Lola Butcher
Insurers and pharmaceutical companies want ICER to umpire debates about drug prices. But some question the cost-effectiveness calculations of the Boston not-for-profit and its dependence on QALYs.
The Payers’ Playbook
Joseph Burns
A newspaper series and a state audit put a spotlight on PBM practices in Ohio. Congress and other states are also looking more closely at what PBMs are delivering to Medicaid health plans.

A blueprint for high-volume, high-quality lung cancer screening that is detecting cancer earlier—and helping to save lives

Clinical Brief

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Summary of an Actuarial Analysis and Report