PBMs help clients manage spending on specialty drugs | States restrict Medicaid coverage of opioid painkillers | Ryan's ACA replacement outline might be a model for Trump
November 23, 2016
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PBMs help clients manage spending on specialty drugs
PBMs are using tools to save money for their clients, such as utilization management, adherence assistance programs and spending caps on certain drugs, all of which help employers manage rising specialty-drug prices.
Workforce online (11/22) 
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Legislative & Regulatory News
States restrict Medicaid coverage of opioid painkillers
Forty-six Medicaid programs cap prescriptions for opioid pain drugs, 45 require prior authorization, 42 require proof of medical need and 32 have step-therapy rules.
STAT (11/23) 
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Ryan's ACA replacement outline might be a model for Trump
While President-elect Donald Trump has not yet provided specifics for his plans to replace the Affordable Care Act, House Speaker Paul Ryan, R-Wis., released a 37-page outline in June that might serve as a model. The proposal would lift the mandate to purchase health insurance, retain some level of tax credits to assist consumers with costs, protect people with pre-existing conditions and prioritize high-deductible plans with health savings accounts.
National Public Radio (11/21) 
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House closes in on 21st Century Cures Act
House negotiators said they are close to agreement on the 21st Century Cures Act and want to pass a bill that can also be approved in the Senate to avoid the need for a conference committee. The NIH stands to gain $4 billion to $5 billion, including $1 billion each for the Cancer Moonshot, Precision Medicine Initiative and BRAIN Initiative.
Politico (11/21) 
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TennCare requests budget bump to cover rising drug prices
Tennessee's Medicaid program, TennCare, is requesting a budget increase of 6% for 2018 to cover rising drug costs.
The Tennessean (Nashville) (tiered subscription model) (11/22) 
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Drug Industry Spotlight
Lilly Alzheimer's drug fails clinical trial
Eli Lilly halted a large-scale trial of the drug solanezumab after it failed to achieve significant results in slowing cognitive decline in patients with mild Alzheimer's symptoms. Solanezumab is an antibody intended to reduce the buildup of amyloid plaques in the brain.
The New York Times (free-article access for SmartBrief readers) (11/23),  The Wall Street Journal (tiered subscription model) (11/23) 
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Study: Leukemia pills becoming less cost-effective
Oral medications for chronic lymphocytic leukemia are effective, but costs could increase by as much as 310% to $604,000 by 2025 for treating each patient over a lifetime. The costs could limit access and adherence, according to a study in The Journal of Clinical Oncology.
STAT (11/21) 
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Sanofi's diabetes drug wins FDA nod
The FDA has approved Sanofi's Soliqua 100/33, or insulin glargine and lixisenatide injection, as a treatment for type 2 diabetes in adults whose disease is not adequately managed on basal insulin or lixisenatide. The drug will be available as a single prefilled pen in January.
eMPR.com (11/22) 
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Allergan buys Alzheimer's disease drug developer
Washington, D.C.-based Chase Pharmaceuticals has been purchased by Allergan for an upfront payment of $125 million. Allergan will also pay milestone fees related to Chase's lead candidate for Alzheimer's disease, CPC-201, which is expected to enter a late-stage study next year.
BioCentury (11/22) 
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Editor's Note
SmartBrief will not publish Thursday, Friday
In observance of Thanksgiving in the US, SmartBrief will not publish Thursday and Friday. Publication will resume Monday.
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Birds sing after a storm. Why shouldn't people feel as free to delight in whatever sunlight remains to them?
Rose Kennedy,
philanthropist
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About PCMA
PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 266 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D. PCMA is dedicated to enhancing the proven tools and techniques pioneered by PBMs that generate savings and access for consumers and payors.

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