For 2019, we again aim our magnifying glass at the annual trend reports from the largest pharmacy benefit managers (PBMs): CVS Health, Express Scripts, and Prime Therapeutics. (See their report links below.)

Once again, we find that commercial drug spending did not race higher—contrary to what you keep hearing from journalists and politicians. Spending rose by less than 3% in 2019, continuing a multiyear trend of slow growth. At some plan sponsors, total drug spending even declined. For specialty drugs, higher utilization—not drug costs—was again the biggest factor driving specialty spending growth.

The two largest PBMs—CVS Health’s Caremark and Cigna’s Express Scripts—have each partnered with secretive and independent private companies to operate specialty drug maximizer programs for their plan sponsor clients. What’s more, at least one of these private companies earns fees equal to 25% of the manufacturer’s copay support program.

Health insurer Anthem is increasing membership thanks to seniors signing up to Medicare Advantage while benefitting financially from the launch of its own pharmacy benefit management company, IngenioRx.

Amazon is making a bigger move into pharmacy by moving thousands of employees and their prescription benefits to a new cloud-based pharmacy benefit manager, RxAdvance, and Amazon’s own PillPack online pharmacy.

Payers from the US may not include digital therapeutics products on formularies for another five years, according to a report.

Healthcare services firm Icon conducted in-depth interviews with 10 pharmacy and medical directors from health plans and pharmacy benefit managers in the US, to gauge their thoughts on reimbursing digital therapeutics (DTx).

State Sen. Dean Burke, R-Bainbridge, has introduced a bill that aims to shed light on prices that pharmacy benefits managers negotiate with pharmaceutical companies and pharmacies, and to ensure that patients are able to get the drugs when they need them. The legislation is Senate Bill 313.

Novo Nordisk’s new diabetes pill, Rybelsus, will be covered by Express Scripts Holding Co, one of the largest U.S. pharmacy benefit managers, the Danish drugmaker said on Friday.

For 2020, the two largest pharmacy benefit managers (PBMs)—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.

The U.S. Supreme Court announced Friday that it has decided to review a case concerning whether individual states – in this case Arkansas -- have the legal right to regulate how pharmacy benefit managers (PBMs) reimburse pharmacies.

Consider the boom in pharmacies operated by physician practices. The growth in oral and patient self-injectable specialty drugs has encouraged physicians to dispense these products from their offices and clinics. For example, almost half of all oncology practices now dispense specialty drugs to their patients.