CER Daily Newsfeed

How to Evaluate GLP-1s and Medicare Costs? Here’s One Idea

(7/10, Soumi Saha and Somaieh McMullan, STAT+) comments “...The Centers for Medicare & Medicaid Services should create a new value-based care (VBC) payment pilot that would test coverage of GLP-1s on beneficiaries, while also addressing their cost in a way that doesn’t break budgets...Instead of applying a one-size-fits-all solution, a VBC model would allow CMS to target the right patients, hold providers accountable for outcomes, and control drug spending through shared savings incentives.” Subscription Required

ATOPP 2025: Pharmacy Innovation at the Intersection of EOM and Patient Access

(7/10, Kirollos S. Hanna, PharmD, BCPS, BCOP, FACCC, FAPO, Alana Hippensteele, Pharmacy Times) comments “...Pharmacists must evaluate therapies not only for efficacy and safety but also for cost-effectiveness. This involves leveraging real-world evidence, comparative effectiveness research, and pharmacoeconomic data to guide formulary decisions. When considering therapeutic substitutions, pharmacists should engage in shared decision-making with clinicians and patients to ensure that cost-saving measures do not compromise individualized care.” Full

Perspectives from the Healthcare Economist: Why CMS/AHIP’s Prior Authorization Changes Won’t Hurt Payers

(7/10, Kristy Piccinini, Jason Shafrin, The Evidence Base) comments “...If most physicians consistently practice evidence-based medicine and prescribe appropriately, then prior authorization is primarily an administrative burden that impedes access to necessary care. Conversely, if a significant portion of medical practice deviates from best practices or value-based care, then utilization management may serve an important quality improvement function.” Full

Regulatory Tracker: England's NICE Endorses Drugs from Lilly, BeOne

(7/10, Fraiser Kansteiner, Zoey Becker, Angus Liu, Kevin Dunleavy, Eric Sagonowsky, Fierce Pharma) reports “...The National Institute for Health and Care Excellence (NICE) has signed off on Omvoh in moderately to severely active Crohn’s in adults under three potential conditions: Patients will be able to access the treatment if their disease didn’t respond well enough or stopped responding to a previous biologic therapy; if a previous biologic drug wasn’t well tolerated; or if tumor necrosis factor (TNF)-alpha inhibitors are not suitable for that patient...” Full