As part of long-awaited guidance that CMS issued to states on Jan. 30 outlining how they can test-drive a fixed federal Medicaid budget and more program flexibilities, the Trump administration invited states to try out something else that hasn’t been done before: implement a closed drug formulary for a portion of their Medicaid population.

With the cost of diabetes drugs still growing, PBMs and payers are looking for more innovative strategies to hold down costs. For some, that might include a strategy similar to the one recently unveiled by CVS Health Corp.’s Caremark unit. The plan, called RxZERO, offers a slimmer formulary for the diabetes drug class, but with no out-of-pocket costs for members. CVS says employers or insurers that pick this plan should expect to save about $30 annually per member.

The health care industry’s largest payers continue to make the case that they are gaining — or project to gain — substantial benefits from integrating PBM businesses.

In particular, Cigna Corp. expects its integration of PBM Express Scripts to drive substantial prescription claim growth in the coming year, and Humana Inc. projects cost savings from its recent acquisition of hospice-focused PBM Enclara Pharmacia Inc.

In its quarterly drug pipeline trends report, OptumRx projected that 2020 will see large numbers of drug approvals for oncology drugs and identified 11 drugs with the potential to be blockbusters in the United States.

OptumRx, which is owned by UnitedHealth Group, sorted the drugs likely to be approved this year into 17 treatment categories. Cancer-treating drugs were by far the most prevalent, with 44 likely approvals. Neurology followed with 29.