What we’re watching

FDA approval reflects statistical significance, not necessarily a clinically meaningful benefit for an individual patient. For patients being considered for therapy, confirm they meet the specific mild-stage criteria the trials studied, screen for APOE ε4 status where available, and ensure MRI…

Exdensur®'s twice-yearly dosing may reduce treatment burden for appropriate patients, but the more important question remains patient selection. Confirm eosinophilic phenotype, document exacerbation history, and ensure inhaled controller therapy has been optimized before escalating, twice-yearly…

when reviewing a migraine regimen that doesn't follow the standard prevention-first sequence, consider whether the irregularity reflects a patient-specific pattern that's working before assuming it represents a gap in care.

FDA approval of Leqembi and Kisunla does not settle the question of clinical value for individual patients. Plans considering coverage should weigh their limited observed benefit against ARIA risk, MRI monitoring requirements and the full medical cost of treatment.

As CGRP use and migraine drug costs rise, standard prior authorization rules may not consistently improve outcomes or spending. Plans need a strategy grounded in real utilization patterns and the individualized nature of migraine treatment.

New biologics offer important options for members with severe asthma, but high-cost therapy requires more than coverage. A sound PBM strategy confirms clinical fit, optimizes lower-cost treatment first where appropriate and monitors outcomes over time.