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Bringing Humira (Its Price) Down a Peg

The TNF-α blocker is the world’s top-selling drug, by revenue. It faces biosimilar competition in Europe, but it will be four years before it’s challenged in the U.S.

A Conversation with Gary Lyman, MD: Biosimilars and the Search for the Cure To Cancer Treatment’s Financial Toxicity

The price of biologics can ruin cancer patients financially, this leading oncology expert reminds us. Biosimilars may help, but we need more of them on the market.

FDA’s Gottlieb Aims To End Biosimilars Groundhog Day

The FDA commissioner has an 11-step ‘action plan’ to get biosimilars out of a repeat mode of unrealized potential. But issues like interchangeability still need clarifying if biosimilars are to have a major effect on drug expenditures.

Why Biosimilars Can Never Be Identical To Originators–and Why They Don’t Need To Be

They are ‘living’ molecules, and there is variability among lots, even in the reference products. The key issue is whether the variability has any clinical significance. So far, it hasn’t.

Show Us (the U.S.) the Savings

Biosimilars are saving money but not in the U.S., where companies have used a variety of stalling tactics. Now Pfizer and others are accusing Johnson & Johnson of withholding rebates to fend off biosimilar competition to Remicade.

Assessing the Legal and Practical Implications of Copay Accumulator and Maximizer Programs

Drug manufacturers have relied on coupons to promote access to branded drugs by reducing patients’ out-of-pocket costs. Insurers and PBMs, on the other hand, have opposed coupons because they undermine the effectiveness of cost-sharing requirements and benefit designs that incentivize cost-effective drug prescribing and purchasing choices.

How Medicare Advantage Plans Are Paid: The Devils–and the Insights–Are in the Details

Is MA a ripoff of taxpayers, a godsend for integrated, cost-effective care, or somehow both? You can’t take a stand on this question from 30,000 feet. So let us guide you through the valley of details.

HRT Has an Uncertainty Problem. Does Compounding Make It Worse?

The pendulum has swung back and forth on hormone replacement therapy. Bespoke and supposed more ‘natural’ hormone combinations put together by compounding pharmacists have become popular. Mainstream endocrinologists see compounding as risky, partly because the practitioners who prescribe it may not see the dangers.

U.S. Women’s Health: Not So Great

In another international comparison, the health status of American women lags behind that of women in other developed countries.

More Sunshine, Say Some PBM Forecasts. More of the Dark Arts, Say Others.

 

Recent mergers didn’t quiet the growing frustration and concern employers, pharmacists, consumer advocates, state legislators, and some members of Congress have with the PBMs’ lack of transparency. There are still so many questions, and getting answers anytime soon will be a chore.

 

Tis Most Excellent: Union, Mount Sinai Find Happiness in Center of Excellence

 

The Service Employees International Union Local 32BJ three years ago named Mount Sinai Health System as a preferred provider for participants and started a direct contract for those needing hip and knee replacement surgeries. In health care there are not many examples where each party succeeds. This is one of them.

 

What We Talk About When We Talk About Value-Based Care

There is near-universal consensus that “value-based care” is a good and worthy objective. In any instance when unanimity embraces an idea, a thoughtful person might ask whether there’s true agreement or perhaps just a cone of vagueness that accommodates a variety of opinions and lets eyes of the…

The Medicare Advantage Advantage–For Insurers, It’s a Sweet Deal, Indeed!

While researchers see flaws in the MA program, the federal government seems content to pay insurers billions of dollars in bonuses each year—at least for now.

Walmart Came a-Calling. Emory Answered.

 

Unlike most payer–provider relationships, the parties took a go-slow approach. The plan was offered only to employees who worked in a subset of Walmart and Sam’s Club outlets and lived or worked near Emory providers, and Walmart did not set premium levels to incentivize workers to choose the Emory ACO.

 

Air Ambulance Turbulence: Consolidation, Cost Shifting, and Surprise Billing

It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over network issues. One consequence: Surprise billing that leaves patients owing tens of thousands of dollars.