Highlights
- Evernorth announces transition to “transparent, rebate-free” pricing model
- Federal government launches direct-to-consumer website TrumpRx
- California passes Senate Bill 41, introduces new PBM regulations in the state
U.S. Food and Drug Administration (FDA) approvals and launches
- Uzedy (long-acting risperidone) receives additional indication to treat Bipolar I disorder.
- Jascayd (nerandomilast) is approved to treat idiopathic pulmonary fibrosis.
- Libtayo (cemiplimab-rwlc) is approved as the first immunotherapy for adjuvant treatment of cutaneous squamous cell carcinoma, a type of skin cancer.
- Rhapsido (remibrutinib) is approved to treat chronic spontaneous urticaria resistant to antihistamine treatment.
News
Evernorth announces transition to “transparent, rebate-free” pricing model
- The pricing model will become the standard option available to all Evernorth’s pharmacy benefits clients, including self-funded clients, in 2028.
- Evernorth also announced that its members will pay the lowest available cost for medicines, “whether it is the Evernorth negotiated price, their copay, or a cash discount price.”
Federal government launches direct-to-consumer website TrumpRx
- The website is currently non-operational but is listed as “coming soon in January 2026.”
- According to the whitehouse.gov website, currently partnered manufacturers include Pfizer, AstraZeneca, and EMD Serono.
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California passes Senate Bill 41, introduces new PBM regulations in the state
- The bill enacts several PBM regulations, including the prohibition of steerage toward PBM-affiliated pharmacies, the banning of spread pricing, and the negotiation of “exclusive arrangements with manufacturers.”
Colorado becomes first state to cap the price of a prescription drug
- The state set an upper payment limit for autoimmune drug Enbrel (etanercept) of $583.59 per unit for both government agencies and commercial plans that provide health insurance for state residents.
- The effective date of the regulation is currently set for January 1, 2027.
Manufacturers launch new wave of direct-to-consumer drug platforms
- The AmgenNow program gives consumers access to cholesterol drug Repatha (evocolumab) at a monthly price of $239, touted as the lowest available price among economically developed countries.
- Novartis and Boehringer Ingelheim are launching programs for Cosentyx (secukinumab) and Spiriva Respimat (tiotropium), respectively.
Centers for Disease Control and Prevention (CDC) updates immunization guidelines
- The updates pertain to COVID-19, chickenpox, and measles, mumps, and rubella vaccinations.
- COVID-19 vaccinations currently do not require a prescription; a proposal to require a prescription was rejected by a narrow margin by the Advisory Committee on Immunization Practices.
Fifteen states coordinate to form Governors Public Health Alliance
- The Alliance’s purpose is to “strengthen emergency preparedness, improve communication, share data and expertise, and ensure states and territories can respond quickly and consistently to emerging health threats.”
Pacific Business Group on Health (PBGH) launches Health Care Data Demonstration Project to promote transparency in drug pricing
- The tools combine data from five large employers to estimate what a “fair price” for a drug or service should be compared to what an employer actually paid.
- The group also published a white paper detailing key market price findings and data quality findings.
Study finds significant cost differences between sites of care, health insurers across 13 common procedures
- The study found that hospital outpatient departments were associated with 78% higher costs compared to ambulatory surgical centers.
- The study also found wide variations in costs depending on insurer, even within identical sites of care.
Study finds direct-to-consumer pharmacy associated with higher out-of-pocket costs but significantly lower overall costs
- The study compared drug pricing from Mark Cuban Cost Plus Drug Company with pricing from several commercial insurance plans.