Radar on Specialty Pharmacy
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Report Reveals Lower Satisfaction With Many PBMs’ Specialty Pharmacy Services
Overall satisfaction with PBMs remained the same from 2023 to 2024, representing a decade-long low, revealed a recent survey from the Pharmaceutical Strategies Group (PSG), an EPIC company. The 2024 Pharmacy Benefit Manager Customer Satisfaction Report also found that PBMs’ clients said they are generally less satisfied with specialty pharmacy services this year compared to the previous one.
PSG conducted the survey from May 10, 2024, through June 7, 2024, with 248 benefit leader respondents who were mainly from PSG’s proprietary database and who represented employers, health plans, health systems and unions/Taft-Hartley plans.
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New FDA Approvals: FDA Approves Tremfya for UC
Sept. 11: The FDA granted another indication to Johnson & Johnson Innovative Medicines’ Tremfya (guselkumab) for the treatment of adults with moderately to severely active ulcerative colitis. The agency initially approved the interleukin-23 (IL-23) antagonist on July 13, 2017. It is the third IL-23 inhibitor approved for the condition, following AbbVie Inc.’s Skyrizi (risankizumab-rzaa) and Lilly’s Omvoh (mirikizumab-mrkz). Dosing for the new indication starts at 200 mg via intravenous infusion over at least one hour at weeks zero, four and eight, and then maintenance dosing is 100 mg via subcutaneous injection at week 16 and every eight weeks thereafter or 200 mg at week 12 and every four weeks thereafter. Drugs.com lists the price of 100 mg/mL as more than $14,617.
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News Briefs: Draft NBPP Did Not Address Accumulators
HHS did not address copay accumulators in the 2026 proposed Notice of Benefit and Payment Parameters (NBPP), as patient advocacy groups had hoped it would. Rather, the agency said that it and the Departments of Labor and Treasury plan to issue a future notice of proposed rulemaking that addresses “the applicability of drug manufacturer support to the annual limitation on cost sharing.” Posted online on Oct. 4 and published in the Federal Register on Oct. 10, the proposed NBPP also did not align the use of copay maximizers, which declare certain drugs non-essential health benefits, in large group market plans and self-funded group plans with HHS’s stance barring the use of maximizers in nongrandfathered individual and small group market plans, as stated in the final 2025 NBPP.
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Optum Subsidiary Nuvaila Will Offer Biosimilars of Stelara, Humira
Optum Rx recently revealed that Optum Health Solution’s new biosimilars-focused, private-label subsidiary will join the other two big PBMs’ similar offerings. On Jan. 1, 2025, two Nuvaila-labeled biosimilars will be added to three of its commercial formularies — and for a $0 copay.
Amgen Inc.’s Wezlana (ustekinumab-auub), an interchangeable biosimilar of Stelara (ustekinumab) from Johnson & Johnson Innovative Medicine, will be added to Optum Rx’s commercial formulary on Jan. 1, 2025, the PBM revealed. The agent will be provided as a private-label product from Nuvaila — known as Wezlana for Nuvaila — and will be available in both high-wholesale acquisition cost and low-WAC versions.
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Evernorth Reveals Stelara Biosimilar Strategy, but Will Others Get Same Discount?
Ahead of the much-anticipated launch of the next wave of biosimilars for a high-cost specialty drug, The Cigna Group’s Evernorth Health Services has said that it will roll out a program to manage the drugs that is similar to one it first began offering this summer. But several aspects of the upcoming launch remain unclear, including whether the discount provided for the new drug will be available to all payers.
Evernorth revealed on Sept. 5 that it will offer an interchangeable biosimilar of Stelara (ustekinumab) from Johnson & Johnson Innovative Medicine for $0 for “eligible patients” of Accredo starting “early next year.” The agent will be produced by Quallent Pharmaceuticals, Cigna’s private-label subsidiary.
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