Nov 25, 2024 · CVS Caremark has removed several diabetes drugs favor of newer products and generics, and is even favoring an insulin infusion system developed by a company that was cofounded by Alan Lotvin, a former executive at CVS Health.

Oct 3, 2024 · UnitedHealthcare is adding deductibles to Part D prescriptions on certain formulary tiers as a result of plan design changes from the Inflation Reduction Act.

Jul 16, 2024 · For the second quarter of 2024, UnitedHealth’s earnings reached $98.9 billion, up almost $6 billion from the same quarter last year. The increase, company executives said, reflect growth at Optum and UnitedHealthcare. Second quarter adjusted earnings from operations were $8.7 billion and include business disruption from the Change Healthcare cyberattack.

Sep 16, 2024 · Prime, headquartered in Eagan, Minnesota, is one of six largest pharmacy benefit managers (PBMs) in the country, an industry that has come under increasing criticism and scrutiny for its business practices and vertical and horizontal consolidation trends.

Apr 16, 2024 · Many of the new rules Congress is considering in the still-fluid pharmacy benefit management (PBM) legislation would add reporting requirements to meet transparency goals but wouldn’t fundamentally disrupt the industry’s business practices.

Effective Dec. 1, 2023, Lilly’s Zepbound (tirzepatide) was added to the national preferred formulary for Express Scripts and Cigna Healthcare.

Jun 4, 2024 · Health insurance, like any insurance, is about pooling risk and paying premiums to create some financial cushion against costly events. For years, though, many large employers — what constitutes large means varies, but it’s typically 500 or more employees — have self-insured, meaning they have taken on the responsibility of setting funds aside to pay healthcare claims instead of a health ...

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.

Dec 9, 2024 · Suzetrigine, a non-opioid currently being reviewed by U.S. regulators to treat acute pain, would provide small savings and help patients avoid the use of opioids, according to a draft evidence report from the Institute Clinical and Economic Review (ICER).

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%).