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For 2020, the two largest pharmacy benefit managers —Express Scripts and the Caremark business of CVS Health—have again increased the number of drugs they have excluded from their standard formularies. The 2020 formulary exclusion lists are available below for your downloading pleasure...key takeaways from the 2020 lists:

1. The biggest PBMs have expanded exclusions.
2. PBMs are refining their formulary management of crucial specialty categories.
3. Indication-based formularies for inflammatory conditions are now routine.
4. PBMs are slowly adopting provider-administered biosimilars on their pharmacy benefit formularies.
5. Express Scripts and CVS Caremark both made patient-unfriendly exclusions in the Hepatitis C category...READ MORE

CEOs from the world’s largest pharmaceutical companies pitched ideas for lowering drug prices at the J.P. Morgan Healthcare Conference in San Francisco this week. None, however, offered to cut prices on any of their own drugs...Some of the executives, like Regeneron CEO Leonard Schleifer, suggested making changes to Medicare, the federal government’s health insurance plan for the elderly, by adding an out-of-pocket maximum for beneficiaries. Others, including Pfizer CEO Albert Bourla, supported passing rebates paid to pharmacy benefit managers through to consumers, arguing the current system drove up list prices and out-of-pocket costs...They also faulted hospitals and insurers. During a panel on drug pricing reform...Bristol-Myers Squibb CEO Giovanni Caforio and Roche CEO Bill Anderson blasted hospitals for marking up the price of medicines, sometimes by triple-digit percentages...READ MORE

Nicole Grassano, PTNN, Pharmacy Week in Review, this weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

Melinta Therapeutics, one of the few companies to recently bring a new antibiotic to market, filed for bankruptcy at the end of December. This news comes less than a year after another antibiotic developer, Achaogen, did the same thing...`More than 90% of antibiotics in the pipeline today are being developed by small companies like these, not by the pharmaceutical giants that once dominated the field. And with antibiotic prices low and profit margins narrow, many small companies just can’t stay afloat...just when the world needs more novel weapons in the fight against resistant pathogens, there are far too few in the pipeline. And although there are real scientific challenges in finding new antibiotics, the big drug companies have largely abandoned the field due to the low return on investment...READ MORE

While TV watchers saw more pharma brand in commercials in 2019, overall total category spending was flat...Pharma TV spending held steady in 2019, finishing the year with a total for the category at $3.79 billion, according to data from real-time TV ad tracker iSpot.tv. That's just a notch higher than the $3.73 billion tally in 2018 for pharma brand commercials...But there was one major jump—and one reason overall spending didn’t actually sink in 2019—and that's the big spending by AbbVie on TV ads for its anti-inflammatory Humira...READ MORE

Members of the former International Academy of Compounding Pharmacists voted in November 2019 to change the association’s name to the Alliance for Pharmacy Compounding (APC). As of January 1, 2020, the new name has become official...The APC is an advocate on a number of issues related to patient access to compounded medications, including: encouraging national academies and chapters to seek input from prescribers, and dispensers of compounded bioidentical hormone replacement therapy; appealing beyond-use date restrictions in the new USP <795> and <797> chapters; and proposing a “middle way” to the FDA on a memorandum of understanding regarding state level regulation of patient-specific compounded medications...READ MORE

Manufacturers recently announced list price increases for many brand-name drugs. The typical increase was about 5%. Judging by recent history, these moderately higher list prices will translate into another year of falling brand-name drug prices in 2020...This surprising conclusion comes from our analysis of SSR Health data on prices for more than 1,000 drugs...SSR Health data reveal that list prices for brand-name drugs rose by about 5% in 2019. However, net prices (after rebates and discounts) decreased by -3.1%. Drug makers discounted their brand-name drug list prices by an average of 45%…READ MORE

A Chinese OTC drugmaker gets the distinction of ringing in the new year as the first company to be slapped with an FDA warning letter...The FDA posted a warning letter this week for Huaian Zongheng Bio-Tech for its plant in Huaian, China, which it says makes over-the-counter drug products, many of them for children. It says the company ships them to the U.S. without testing ingredients or retained samples of the finished products to see if they meet specs...The FDA was particularly concerned over the fact that the company uses glycerin in some of its products, pointing out that the use of “glycerin contaminated with diethylene glycol has resulted in various lethal poisoning incidents in humans worldwide.”...READ MORE

Christina Mattina, welcome to This Week in Managed Care from the Managed Markets News Network

The U.S. Supreme Court will hear a case brought by Arkansas Attorney General Leslie Rutledge against the pharmacy benefit management (PBM) industry…PBMs act as middlemen between health insurance companies and pharmacies...pharmacies have complained that PBMs have been reimbursing them below their cost to acquire a drug...U.S. Solicitor General Noel Francisco recommended Dec. 5 that the Arkansas case – Rutledge v. Pharmaceutical Care Management Association...be heard by the U.S. Supreme Court. Rutledge has argued that more than 16% of rural pharmacies closed in recent years due to declining PBM payments on generic prescriptions causing Arkansans to be unable to receive necessary medications...READ MORE