🚨 **Breaking News in Biosimilars** 🚨 Cigna's Evernorth Health Services is shaking things up again with $0 out-of-pocket biosimilars for Johnson & Johnson's **Stelara** (used for Crohn’s disease, ulcerative colitis, and plaque psoriasis). 🌿 This follows their replacement of AbbVie's **Humira** with **Cyltezo**. 📋 **Key Highlights:** - No cost for eligible patients through **Accredo**. - Helping save patients thousands per year! 💸 - Reducing barriers to life-changing treatments. #Stelara #Humira #Cyltezo #Biosimilars #Cigna #Evernorth #Accredo #PatientCare #Healthcare [Learn more](https://lnkd.in/dRs2HCib)
Cigna's Stelara biosimilars replace Humira
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People Using GLP-1 is 2X More Than 1st Reports 📈 GLP-1 Is Being Used For More Diseases... 🔽 JPMorgan Chase & Co. initially estimated up to 9% of the population, 30M people will be on #GLP1s by 2030. However, this could be low... ⤵ 💊 Drug companies have been finding it hard to get coverage for #Obesity with #insurance but studies are finding #benefits in other #diseases and there are hundreds of millions of Americans who have these... 👇 🔶 Diabetes - 38M people 🔶 Heart Disease - 121M people 🔶 Obesity - 108M people 🔶 Alzheimers - 7M people 🔶 Sleep Apnea - 39M people 🔶 Addiction - 47M people The popular drug is showing benefits in these areas and studies are underway. In fact, a study showed reduction in heart attacks and strokes by 20% which lead to #Medicare getting in the action 🖤 #Medicare recently approved Novo Nordisk Wegovy for #HeartDisease which equates to another 3.6M people (George Kaiser Family Foundation). A LOOK BEHIND THE NUMBERS #JPMorgan assumptions assumes 35% of diabetics using the drug and around 15M obese patients using GLP-1s by 2030. This does NOT take into account; ◼ Medicare ◼ Other Diseases ◼ Self Pay And many more... I am working on new estimates but I can tell you the actual number is more than 2X the original forecast of 7% and 9%... 📰 Look at Medicare... They are estimating coverage of 3.6M Americans on Medicare with Heart Disease and Overweight but there are 10M with Heart Disease and 13.7M are considered Obese and another 1.9M with Diabetes. _____________________________________________ 📌 Bottom Line, more people will be using GLP1's and related Drugs. The side effect of Lean Body Mass Loss will still apply to all even though people will use for different disease reasons. ❓ You Ready To Handle Members On GLP-1s? #WeGovy #Ozempic #Zeapbound #GLP1 #Diseases #MarketGrowth #VS
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With Electronic Prior Authorization integrated into your ePrescribing workflow, medications that require prior authorization are flagged, and providers can submit electronic PA requests within their workflows, streamlining the approval process. Check out this MedCity News article to learn how traditional prior authorizations can impact patients' timely access to Gastrointestinal care. #priorauthorization #ePA https://lnkd.in/gUKqWaDh
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❗ The American Diabetes Association has published its 2025 Standards of Care in Diabetes.¹ In the section titled “Improving Care and Promoting Health in Populations”, factors that can influence treatment decisions, such as insurance coverage and formulary design, are discussed. Disparities in care arising from these factors significantly affect patients' access to life-saving medications and resources. Impact of Insurance Coverage: 👉 High Out-of-Pocket Costs: Patients with high-deductible health plans often delay or skip necessary care, including refilling prescriptions for insulin or other medications like SGLT2 inhibitors, GLP-1 receptor agonists, or DPP-4 inhibitors. These delays can lead to poor blood sugar control. 👉 Gaps in Coverage: Many insurance plans do not cover advanced diabetes technologies, such as continuous glucose monitors (CGMs) or insulin pumps. These tools are vital for optimizing glycemic control but are inaccessible to many due to cost barriers. 👉 Medicaid Variability: Medicaid coverage varies widely between states, leading to geographic disparities. In non-expansion states, low-income individuals may fall into a coverage gap, leaving them uninsured and unable to afford diabetes care. Formulary Design Challenges: 👉 Tiered Formulary Structures: Formularies often categorize medications into tiers, with lower-cost generics on Tier 1 and more expensive branded medications on higher tiers. Life-changing medications like SGLT2 inhibitors or GLP-1 receptor agonists may fall into high-cost tiers, placing them out of reach for many patients. 👉 Step Therapy Requirements: Step therapy, also known as "fail first" protocols, requires patients to try and fail with less expensive medications before accessing more costly ones. This approach can delay effective treatment and adversely affect patient outcomes. 👉 Exclusion of Certain Medications: Some formularies may exclude essential medications, forcing patients to pay the full price or go without them. For example, innovations in diabetes care, such as dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonists, are frequently excluded or have minimal coverage. Ensuring equitable access to medications and technologies can greatly enhance outcomes for individuals with diabetes, minimizing complications and improving their quality of life. #PatientCare #HealthcareAccess #DiabetesAwareness
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AccendoWave - A Pain #Data Company Amid continued demand and coverage restrictions around GLP-1s, the prices of Novo Nordisk's Ozempic and Rybelsus have dropped significantly for individuals covered by Medicare and commercial insurance, according to a new report from HHS. Currently, Medicare Part D does not cover GLP-1s when used solely to treat obesity, only for managing Type 2 diabetes. In March 2024, Wegovy was approved to address cardiovascular events in patients with either obesity or who are overweight and have cardiovascular disease. Shortly after, CMS issued guidance allowing Part D plans to cover anti-obesity medications if they are approved for additional health benefits and used for those conditions. On Nov. 26, the Biden administration shared a proposal for Medicare and Medicaid to cover weight loss drugs for obesity. About a dozen state Medicaid programs already cover the drugs for that purpose.
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The rising costs of dialysis, driven by an influx of venture capital in the chronic kidney disease sector, have escalated significantly in recent years. This surge has profound implications for healthcare costs, health insurance premiums, and patient care quality. Venture capitalists view dialysis as a lucrative market due to its necessity for #CKD patients, yet this financial focus has contributed to higher expenses across the board. Impact on Dialysis Costs Recent data highlights a significant increase in the costs associated with dialysis treatment. According to a 2020 study from Guangzhou City, the average annual cost for patients on #hemodialysis was approximately $15,066, while peritoneal dialysis (#PD) was slightly lower at $12,840 (Zhang et al., 2020). This trend is mirrored across the globe, where dialysis costs have risen significantly since 2010, particularly in the U.S., where #Medicare spends over $35 billion annually on CKD-related care (Smith et al., 2011). In addition, venture capital-backed companies tend to consolidate dialysis centers, often leading to #monopolistic practices that drive up costs. As profit margins are prioritized, there is limited incentive to reduce expenses for patients. The rising cost of dialysis has also influenced health insurance premiums, especially in employer-sponsored plans. In 2023, the average annual premium for family coverage reached $23,968, a 7% increase from 2022 due to inflation and the higher costs of chronic disease management, including dialysis (Claxton et al., 2023). As #dialysis costs continue to climb, #insurance premiums follow suit, with the burden often falling on both employers and employees. This has resulted in an affordability gap, where patients, particularly those on public insurance, face rising out-of-pocket expenses, exacerbating the financial strain on families The primary focus on profitability in venture-capital-backed dialysis centers has led to concerns over patient care. Staffing reductions and cost-cutting measures often result in less time with healthcare providers, leading to poorer health outcomes. Research indicates that patients in such settings may experience delayed diagnoses and inadequate dialysis, increasing mortality rates, especially among low-income individuals #Advocacy efforts are now critical in addressing these rising costs and the quality of care in dialysis services. Groups like the American Association have called for reforms, including more stringent regulations on dialysis center operations, greater transparency in pricing, and improvements in patient-to-provider ratios to ensure better care. These organizations have also pushed for increased funding for research into cost-effective dialysis methods and better patient outcomes, advocating for policy changes that prioritize patient welfare over profit margins There is a solution: https://lnkd.in/e4Ch-sfX reach out for details and #reshare with your network
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Ozempic is becoming cheaper notes Becker's Healthcare Hospital Review. From a list price of $1,349 for Wegovy and $968 for both Ozempic and Rybelsus for one-month’s supply, after payer negotiations and rebates, the net prices for Ozempic and Rybelsus have decreased. $649 for Wegovy, $296 for Rybelsus, and $290 for Ozempic, suggesting in the U.S, net prices for GLP-1s are between 24% and 73% lower than list prices. A key question – why are the net prices of Wegovy and Ozempic so widely different – it is the same drug, semaglutide? Answers please… https://lnkd.in/epryr3dS.
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This Forbes article compares the potential benefits (and cost savings) of GLP-1 medications with their costs. Undeniably, prices for medications like Ozempic and Wegovy are high - nearly $1000 per month - and many patients pay at least a portion of that bill out of pocket. At the same time, research continues to show the long-term health benefits of these medications, particularly for individuals with diabetes or obesity. From the article: "[T]his focus on immediate cost overlooks the broader perspective and fails to consider how much more expensive healthcare delivery could get if diabetes and obesity are not treated as effectively as they can be. It’s like failing to fix a leaky roof because of the cost, while ignoring the possibility of extensive water damage and astronomical repair costs if left untreated. Just as a roof that’s periodically checked and maintained prevents more severe and costly damage in the future, GLP-1 treatment can help manage chronic conditions like diabetes and obesity, avoiding more significant healthcare costs down the road."
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CMS Moved to Expand Obesity Drug Coverage. Private Insurers Need to Step Up. Obesity is a chronic disease affecting over 40% of U.S. adults and 16% worldwide, yet effective treatments like GLP-1 medications remain inaccessible for many due to high costs, insurance exclusions, and stigma. A recent White House proposal to expand Medicare and Medicaid coverage is a promising step, potentially reducing financial barriers for millions. However, broader change is needed, including private insurance alignment and affordability efforts from pharmaceutical companies. Treating obesity as a disease, not a personal failure, is vital for public health and economic sustainability. #clinicalresearch #cms #healthinsurance #obesity #patientcare #science #Lilly
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The next frontier. Pharma companies using channel strategy to meet unmet needs for better patient care. DTC now has a whole new meaning!
Today, we announced that Ro is working with Eli Lilly and Company to make Zepbound single dose vials available through Ro https://lnkd.in/ekn4hETX By integrating Ro’s platform with LillyDirect, we’re making it easy for eligible patients to access authentic, FDA-approved medication and to get the high-quality care and support they need to achieve their health goals. This integrated Zepbound single-dose vial experience helps remove barriers and supports ongoing care management, treatment adherence, and individualized journeys. Just another example of how Ro is fighting for patients!
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Wow! New partnership in the weight care arena as Ro partners with Eli Lilly and Company to offer Zepbound single dose vials through Ro, enabled by Lilly's Direct to consumer LillyDirect platform. This enables consumers to have more options - easier access to prescriptions and branded medication at a lower cost than the standard prescription without the potential risks of using compounded medication. (Sort of a meet in the middle option.) Also interesting to see LillyDirect expand the number of partners it's working with in the obesity space. Originally just Form Health, now Form Health, 9amHealth, Gifthealth, and Ro! If you're interested in learning more about obesity care (including compounding), check out our recent webinar, Weight Debates, linked in the comments. #weightcare #obesitycare #glp1s
Today, we announced that Ro is working with Eli Lilly and Company to make Zepbound single dose vials available through Ro https://lnkd.in/ekn4hETX By integrating Ro’s platform with LillyDirect, we’re making it easy for eligible patients to access authentic, FDA-approved medication and to get the high-quality care and support they need to achieve their health goals. This integrated Zepbound single-dose vial experience helps remove barriers and supports ongoing care management, treatment adherence, and individualized journeys. Just another example of how Ro is fighting for patients!
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