Express Scripts has passed judgment for 2016. Some 20 new meds, including some closely watched products like Vivus' weight-loss med Qsymia, won't be covered on the pharmacy benefits manager's 2016 preferred formulary.
Vocal pharma-pricing critic Express Scripts added another 10 drugs to its list of excluded meds for 2016. With 80 drugs now ineligible for routine reimbursement, the pharmacy benefits manager says it has excluded about $1.3 billion worth of costs. The new National Preferred Formulary can apply to up to 25 million members.
Last week, Sanofi revealed a $14,600 sticker for new PCSK9 med Praluent that far exceeded the price tag analysts expected. And unsurprisingly, leading PBM and vocal price critic Express Scripts is none too thrilled about it.
Novartis has said it's planning to offer an outcomes-based plan for its new blockbuster-in-the-making to secure payers' favor. But skeptics see some kinks in the plan--and the CMO at leading PBM Express is one of them.
Cancer drug spending is up. Cancer drug prices are way up. And as a new Express Scripts report shows, spending on each cancer patient is mounting; it's among the reasons why a growing number of individual patients account for $100,000-plus in annual drug spending. And a few big drugs made big contributions to that rise.
Pay for performance is a byword in executive pay. It's not unprecedented in pharma, what with European cost watchdogs and their hard line against pricey cancer meds. But it's not part of the drug-coverage equation in the U.S.--for now.
A small but growing number of patients is racking up big drug bills in the U.S. On a per-patient basis, it's staggering: Some 576,000 Americans generated more than $50,000 in prescription drug costs each last year, according to a report from Express Scripts. And nearly 140,000 of them totted up drug bills of $100,000 or more.
U.S. patients are racking up big annual drug costs like never before. According to a report from the pharmacy benefits manager Express Scripts, more than a half-million patients in the U.S. had medication costs of more than $50,000 last year, up by 63% from 2013 totals. And the number who used more than $100,000 worth of drugs grew even more--to 139,000 in 2014 from 47,000 in 2013.
An Express Scripts unit agreed to settle claims with the U.S. Department of Justice that it participated in a scheme with Novartis that ended in improper government reimbursements. And if the DOJ has its way, the settlement could lead to more legal action against Novartis in a separate suit.
Express Scripts has been warning about a crackdown on cancer drug spending. Now, it's talking about how.