UnitedHealthcare Adds Deductibles to Medicare Part D for 2025
Oct 3, 2024 · The Institute for Clinical and Economic Review has identified five drugs — Biktarvy, Darzalex, Entresto, Cabometyx, and Xeljanz — with prices increases that are not supported by new clinical evidence, with a total of $815 million in added costs to U.S. payers in 2023.
Aetna Updates MA and Drug Programs for Medicare in 2025
Oct 1, 2024 · In 2025, Aetna, the health insurance company of CVS Health, has added several new programs to Medicare for 2025. Aetna will launch new Chronic Condition Special Needs Plans (C-SNPs) in Illinois (Chicago) and Pennsylvania (Philadelphia and Pittsburgh).
Beyond the Big Three PBMs - Managed Healthcare Executive
Dec 19, 2022 · By almost any measure, the PBM business is one dominated by the major players. In 2021, CVS Caremark led the industry, controlling 34% of total adjusted claims, followed by Express Scripts (25%) and Optum Rx (21%).
How Capitation Contracts Benefit Providers, Payers and Patients
May 11, 2023 · The Covid-19 pandemic triggered a dramatic decline in patient volume that devastated revenues for provider organizations operating under the fee-for-service (FFS) reimbursement model. In response, more provider organizations have adopted alternative payment models (APM) built around financial incentives to efficiently deliver high-quality care.
Evernorth is “Foundational” to Cigna’s Business
Feb 2, 2024 · The Cigna Group’s 2023 revenue grew to $195.3 billion, up 8% compared with 2022’s revenue of $180.6 billion. In the fourth quarter of 2023, Cigna’s revenue was up 12%, which company officials said in an earnings call reflects strong growth at both Evernorth Health Services and Cigna Healthcare.
Managed Healthcare Executive
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Express Scripts and Cigna Add Zepbound to Formularies
Effective Dec. 1, 2023, Lilly’s Zepbound (tirzepatide) was added to the national preferred formulary for Express Scripts and Cigna Healthcare.
The Next Generation of PBMs: New Technology, Simpler Business …
Aug 10, 2020 · Introduction. The COVID-19 pandemic has had a deep and profound impact on American businesses both large and small. As the country inches back to a “new normal,” business leaders have to deal with the cost of healthcare as a significant issue to their bottom line.
Gain a solid understanding of compendia and its impact on …
Jul 1, 2012 · The current compendia landscape, through constantly in flux, impacts everything from payer approval of off-label use to manufacturer patient access initiatives. Drug compendia, defined as summaries of drug information, affects coverage and reimbursement decisions for pharmaceuticals products, and as a result, it's important for pharmaceitucal manufacturers and healthcare providers to ...
The List of PBM Formulary Exclusions Got Longer in 2023
Mar 8, 2023 · In an analysis of drug formulary exclusions published last year in Health Science Journal, the authors noted that individuals with drug coverage governed by Express Scripts 2022 National Preferred Formulary were often left without access to any version of an excluded drug.“Overall, 42% of Express Scripts’ 2022 formulary exclusions mandate(d) a non–therapeutically equivalent medicine ...