“Frozen formulary” legislation refers to regulations proposed by state legislators that would prohibit a pharmacy benefit manager (PBM) or health plan from making certain changes to a prescription formulary midyear. Based on a recent analysis, Milliman estimates the proposed “frozen formulary”
To shed light on recent trends in payer coverage of biosimilars, this paper analyzes commercial medical benefit coverage and price trends for biosimilars and reference biologics over the period 2018–2021 in three disease areas: breast cancer and non-small cell lung
(Washington, D.C.) — In response to litigation brought by the Pharmaceutical Care Management Association (PCMA) challenging the Medicare Part D rebate rule, the Biden Administration agreed to postpone the effective date of the provisions of the rule relating to the elimination
PBM companies vary in size, geographic footprint, and service offerings, which creates a marketplace with a variety of options for health insurers, employers, labor unions, government programs, and other health plan sponsors. As of March 2023, there are 73 full-service
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