Drug prices
Finally! Humira’s biosimilars also hit the us market!
Humira was first marketed in 2002 and was protected in the US market until 2023, thanks to AbbVie’s use of two strategies :
Andre Wencker
September 21, 2023
Transparency-in-Coverage (TiC) Final Rules and No Surprises Act: Find your way in the regulatory maze
In a time of labor shortage, it’s then important for the employer to make the most of the dollars spent offering these benefits.
The No Surprises Act, signed into law on December 27, 2020, and a part of Title I of the CAA 2021, requires health plans and self-insured employers to maintain up to date in-network provider directories and to disclose detailed pricing and cost-sharing information to consumers and other stakeholders.
The Transparency-in-Coverage (TiC) Final Rules, jointly issued by three administrations in November 2020, are now part of Title II of the same CAA 2021. They take two approaches to make pricing information publicly accessible:
The machine-readable file requirements are applicable for plan years beginning on or after January 1, 2022, but law enforcement by HHS has been delayed to July 1., 2022.
As of today, only a very small percentage (4%!) of hospitals have made these data publicly available, and CMS postponed the implementation date to July 1, 2022.
As of today, only a very small percentage (4%!) of hospitals have made these data publicly available, and CMS postponed the implementation date to July 1, 2022.
In fact, most employers will have to work with vendors to ensure compliance, particularly with regards to two major issues:
There is another, more thorough approach to consider: digital self-serve tools won’t work for all consumers. Presenting complex concepts like bundled care and cumulative treatment limitations will raise questions. And hence, providing human support —clinical and benefits experts who can help individuals navigate not just cost of care transparency, but their entire personal health journey— will be very helpful while not mandatory.
This can be a way to turn these new regulations into a tool to better manage costs while enhancing the experience of plan members. As you probably know, costs are concentrated on a small number of high-spending plan members.
A priority of any cost containment solution is to look at the specific needs of “Top-spenders.”
Helping these persons better utilize what the plan has to offer, providing them with the information they need to make informed choices could be the solution to make the best out of what many consider a new regulatory burden, adding to a very complex legislative body.
Humira was first marketed in 2002 and was protected in the US market until 2023, thanks to AbbVie’s use of two strategies :
After wrapping up the 2023 enrollment, employers are now planning their next moves to mitigate the continuously growing healthcare costs impacting their plans. This is particularly true for pharmacy costs.
PhRMA, a Big Pharma lobbying group, released an advertising touting that drug prices were not fueling inflation. To prove it, they produce the graphic below.
Care2Care secured a strategic partnership with an innovative, transparent, 100% pass-through PBM.
Adding to our expertise in international drug sourcing, we expand our offer to the full pharmacy benefit management.
