PBMs

A Senate report finds GSK’s withdrawal of Flovent and shift to an authorized generic increased costs, restricted access and disrupted asthma care, while helping the company avoid Medicaid rebates, raising broader concerns over pricing loopholes.

Samsung Bioepis’ Ospomyv and Celltrion’s Stoboclo will be preferred on major US commercial formularies from April 2026, as CVS Caremark drops Prolia and another higher-cost brand, Forteo (teriparatide), to drive savings.

With the separation from its parent company now behind it, Samsung Bioepis celebrated its highest-ever annual revenues and outlined its vision of further growth.

ACC/AHA guidelines are reshaping US payer policies, expanding coverage and access to breakthrough cardiovascular therapies like SGLT2 and PCSK9 inhibitors. But costs, red tape, and uneven access still stand in the way.

Issues that had been concerns in Trump’s first term are realities now, but industry has also seen some successes. Trump’s personalistic style of governance means that larger firms may be at an advantage because of their greater flexibility to cut deals on individual products.

Arizona’s governor Katie Hobbs pointed to Trump’s One Big Beautiful Bill and other federal failures as she signed an executive order to increase access to medications in her state.

Facing rising costs and tighter regulations, PBMs and insurers are accelerating the shift to value-based drug coverage, demanding stronger proof of therapeutic and economic benefit from pharma.

Optum Rx, one of the largest PBMs in the US, declared it was the “first comprehensive, transparent pharmacy services company” after announcing several consumer-friendly changes.

Optum Rx, one of the largest PBMs in the US, declared itself as the “first comprehensive, transparent pharmacy services company” after announcing several consumer-friendly changes.

Chairman-designee Andrew Ferguson likely will continue the commission’s investigation of PBMs during the next administration.

Federal legislation on PBM reforms has stalled, but state efforts remain active. Illinois’ Healthcare Protection Act includes several other limits on insurer power, including prohibiting prior authorization for inpatient mental health care.

Dramatic transformation in the US Medicare Part D benefit design does not require any changes to CMS’ overall approach to reviewing formulary submissions from private drug plan sponsors, the agency says in its final guidance implementing the design changes for 2025.