2024 Prediction from Jeffrey Casberg, M.S., RPh

Casberg is Vice President of Clinical Pharmacy at IPD Analytics LLC and a member of the Managed Healthcare Executive editorial advisory board. He predicts that "payers will tighten" in 2024.

By MHE Staff | Original Article

We asked our readers and some members of our editorial advisory board to make predictions for 2024.

Here's what Jeffrey Casberg, M.S., RPh had to say: “There will be increased trend toward transparency in the pharmacy benefit management industry, but the net result will likely be little or no savings to employers or government payers.

Negotiated Medicare drug prices under the Inflation Reduction Act don’t go into effect until 2026. Even so, the prospect of negotiated prices will start to affect Medicare and commercial payers’ formulary management in 2024.

This will be the second year that Humira (adalimumab) biosimilars will be on the market. Compared to some high year two expectations, uptake will be lower than even modest prediction. With Wegovy (semaglutide) and Zepbound (tirzepatide) approved by the FDA and on the market, payers will be working to tighten glucagon-like peptide 1 (GLP-1) inhibitor coverage criteria in 2024 as utilization continues to ramp up.

We’re also going to see increased pressure on federal and state payers to cover weight loss drugs. The drug shortages have been a problem for several years, especially in the hospital space, and they will continue next year.

It is a problem with many different causes. None of them yield to easy answers and they won’t be solved in 2024.”