Humana Medicare Advantage Plans Targeting Hemlibra, Herceptin Hylecta With Step Therapy
Fail first requirements for 2020 also target drugs for myelodysplastic syndrome and chronic obstructive pulmonary disease, building on the step therapy program launched by Humana in 2019.
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Inclisiran's price relative to existing PCSK9 drugs will be key determinant in payer acceptance. Novartis says pricing will be within cost effectiveness range estimated by ICER.
Biopharma manufacturers view implementation of management tool in Medicare Advantage plans with concern, urge US Centers for Medicare and Medicaid Services to withdraw permission for use of step therapy for Part B drugs.
With enactment of the drug pricing reform provisions in the Inflation Reduction Act, stakeholders now turn their attention to the implementing regulations that will be developed by the Centers for Medicare and Medicaid Services.