Pharmaceutical industry observers say CVS Health’s creation of Cordavis, a new biosimilar drugs company, is part of a strategy to make its move into this market as profitable as possible.

In this month’s episode, we dive into some of the recent executive appointments occurring in the healthcare sector, as well as layoffs affecting the industry. We also hear from Danny Sanchez, who recently became the new CEO of EmpiRx Health, a value-based pharmacy benefit manager.

For the first time ever, CMS is preparing to negotiate prices for drugs paid for by Medicare. This has sparked a huge debate — will the creation of this taxpayer-funded drug negotiation infrastructure be a failed experiment, or will it become the standard for the future of drug pricing in this country? Jason Borschow, president and CEO of Abarca Health, says it’s the latter.

Panelists at a recent healthcare conference expressed optimism about the automation technology that health plans, pharmacy benefit managers and providers can adopt to facilitate real-time data sharing. They said that such technology has potential to improve medication adherence, reduce costs and save time for both providers and payers.

Through the partnership, the organizations are launching EmsanaRx Plus. The product supplements employers’ current pharmacy benefit offerings and provides access to Cost Plus Drugs’ discounted medications.

Following an investigation, the AG claimed Express Scripts, “billed and obtained payment for prescription drugs from payers of workers’ compensation claims in excess of amounts permitted by Massachusetts laws and regulations,” according to court documents. 

Centene is swapping CVS Caremark with Express Scripts. A recent survey that measured benefit leaders’ satisfaction with their PBMs found that Express Scripts performed better than CVS Caremark.

A trade association for PBMs says that state PBM regulations in Oklahoma are preempted by federal ERISA and Medicare regulations.

The company touts its personalized approach to helping patients who need the most support with medications, like those who are managing multiple health conditions.

With its ruling to maintain the status quo, the FTC has decided to take a back-seat and force independent pharmacies to fend for themselves in their on-going fight to secure access to fair prices that allow them to stay in business and continue to serve their local communities and the well-being of their patients.  

The current landscape heading into 2022 will keep pharmacy benefits under the microscope. Plan sponsors will evaluate their PBM’s pricing model to determine if their contract will deliver predictable costs, more opportunities for increased savings and improved care for their members.

After Capital Rx’s former medical director of pharmacy services got a job offer at CVS, the PBM startup claimed he couldn’t work there because of a noncompete agreement. CVS recently sued the company, saying its non-compete clause was unenforceable.

The hedge fund administrator SS&C Technologies Holdings will be the majority stakeholder, while the two payers will each hold a minority interest in the joint venture, dubbed DomaniRx. The company will develop a claims adjudication platform to support its operations.

Understanding the medication supply chain, coupled with predictive analytics, will allow hospital pharmacies to be better equipped for any resurgence of the pandemic in their areas.

Anthem’s newly formed PBM, IngenioRx, acquired pharmacy startup Zipdrug. The company facilitates in-home drug delivery and helps health plans track medication adherence.

PBMs who are transparent, offer formularies that reduce wasteful spending and have experience in specialty pharmacy are better poised to meet the needs of plan sponsors and ensure the most affordable drug coverage options.

Express Scripts will offer payers a curated list of technology and software-enabled applications and devices that have been vetted for safety, effectiveness and usability.

On an earnings call, Cigna CEO David Cordani seemed largely nonplussed about the potential rule’s impact on the company’s bottom line, even after the insurer’s blockbuster acquisition of Express Scripts.

Boston, Massachusetts-based WithMe Health launched out of stealth with $20 million in funding and Oak HC/FT Partner Chris Price at the helm.

Previously the company’s customers were required to pick up their medication at one of Blink’s participating pharmacy partners after purchasing the items online.

The PBM will incorporate cost-per-QALY analyses from ICER, but the program also drew some criticism.