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Perspectives on Blockchain Technology

August 22, 2019

Industry consultants from Milliman Inc. assert in a July 11 report that blockchain — which is described as a real-time digital ledger for building secure networks — “could potentially transform the relationship between payers, pharmaceutical manufacturers, wholesalers, and pharmacies by offering an alternative, transparent mechanism for processing, pricing, and validating prescription transactions.”

Using blockchain technology, payers and pharmacies would reduce the time they spend validating insurance coverage, making phone calls and managing data,

Industry consultants from Milliman Inc. assert in a July 11 report that blockchain — which is described as a real-time digital ledger for building secure networks — “could potentially transform the relationship between payers, pharmaceutical manufacturers, wholesalers, and pharmacies by offering an alternative, transparent mechanism for processing, pricing, and validating prescription transactions.”

Using blockchain technology, payers and pharmacies would reduce the time they spend validating insurance coverage, making phone calls and managing data, Milliman explains. The firm is urging PBMs to work to “evaluate a blockchain alternative now with an eye toward a more efficient drug financing system” capable of handling additional technology improvements, AIS Health reported.

“We’re just trying to get people thinking outside the box, and I believe blockchain has applications with supply chain management, claim-processing and transparency to the consumer,” says Brian Anderson, a principal for Milliman and co-author of the blockchain paper.

In the Milliman report, Anderson and his colleagues, Gregory Callahan and Michael DiPrima, note the current electronic approach to processing pharmacy claims is a sometimes opaque, centralized database management system managed by the PBM.

By contrast, blockchain’s database management system model would be decentralized. Milliman explains that means a distributed network of “nodes” would validate all transactions and would store data throughout the distributed network rather than in a centralized server.

The Milliman consultants conclude blockchain technology “appears to hold great promise for the PBM marketplace.” But they concede there are obstacles to overcome, explaining that while blockchain has shown great potential for security in cryptocurrency, its true potential in health care has not yet been evaluated.

Radar On Market Access: PBMs Offer High-Touch Care Management for Chronic Conditions

August 22, 2019

Though PBMs are most known for the influence they have on prescription drug costs, some firms are increasingly focused on offering high-touch condition management services that give them a more active role in patient care, AIS Health reported.

Though PBMs are most known for the influence they have on prescription drug costs, some firms are increasingly focused on offering high-touch condition management services that give them a more active role in patient care, AIS Health reported.

For specialty PBM AscellaHealth, LLC, that means harnessing a variety of resources to help better manage treatment for hemophilia, a notoriously expensive disease state.

Not only does the PBM leverage its specialty pharmacy network to obtain the best prices for hemophilia clotting factor, but it also uses technology to monitor medication dispensing in real time and provides clinical interventions when necessary, explains Mike Baldzicki, AscellaHealth’s executive vice president of growth and strategy.

“Managing cost and quality kind of go hand in hand in this regard,” adds Dea Belazi, the PBM’s CEO.

Meanwhile, CVS Health Corp. is expanding its Transform Diabetes Care program, which helps members of its PBM, Caremark, control their diabetes by providing technology-enabled, personalized support and coaching focused on improving medication adherence and controlling blood-sugar levels. As part of the expansion, the program will also focus on the prevention and early identification of diabetes as well as hypertension, which is twice as common in diabetes patients as the regular population.

While care-management programs are hardly a new concept in the health care industry, “the new part, I would say, is putting the PBM at kind of the center of these programs,” says Ashraf Shehata, a principal in KPMG’s health care life sciences advisory practice and the firm’s Global Healthcare Center of Excellence.

In the PBM space, firms are increasingly integrating traditional medication therapy management with connected medical devices “to help create a much more visible data and information stream around people’s ability to successfully accomplish their medication regimen,” he says.

Radar On Market Access: Employers Seek Health Plan, PBM Help to Drive Innovation

August 20, 2019

Large employers are increasingly leaning on their health plan and PBM partners to devise innovative solutions to health care challenges, according to the 2020 Large Employers’ Health Care Strategy and Plan Design Survey conducted by the National Business Group on Health (NBGH), AIS Health reported.

Large employers are increasingly leaning on their health plan and PBM partners to devise innovative solutions to health care challenges, according to the 2020 Large Employers’ Health Care Strategy and Plan Design Survey conducted by the National Business Group on Health (NBGH), AIS Health reported.

In the 2019 survey, 32% of large employers said they would take a “defer to partners approach” to drive health system change — implementing what their health plan and PBM present as the latest developments. For 2020, that share rose to 41%.

NBGH attributes that trend to a number of factors, Ellen Kelsay, NBGH’s chief strategy officer, said at a press briefing. One is that employers are “frustrated with the slow pace of change” in health care and are looking to their partners to speed it up. Most employers also lack the bandwidth to drive change on their own, she said.

What’s more, “many employers are looking for a way to streamline and consolidate their offerings,” Kelsay said, noting that the ecosystem of solutions that employers have at their disposal is “far too extensive.”

Employers are also turning to their health plan and PBM partners to figure out how to finance and manage high-cost therapies, NBGH President and CEO Brian Marcotte said at the briefing. The survey revealed that such high-cost therapies — like Novartis’ $2.1 million spinal muscular atrophy drug, Zolgensma — are employers’ No. 1 concern when it comes to managing their pharmacy benefit plans.

So how can health plans and PBMs meet employers’ desire for more help driving health care change?

They “can be proactive in reaching out to their clients to engage them on emerging trends and opportunities and propose solutions, rather than waiting for their clients to approach them,” Marcotte tells AIS Health via email.

MMIT Reality Check on Breast Cancer HER2- (Aug 2019)

August 16, 2019

According to our recent payer coverage analysis for breast cancer (HER2-) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for breast cancer (HER2-) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for breast cancer (HER2-) treatments shows that under the pharmacy benefit, about 48% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: In May 2019, the FDA approved Novartis’ Piqray (alpelisib) in combination with fulvestrant for the treatment of men and postmenopausal women with hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2-), PIK3CA-mutated, advanced or metastatic breast cancer as detected by an FDA-approved test whose disease progressed on or after endocrine therapy.

Trends That Matter for Medicare Part D Costs

August 15, 2019

A recently published study in Health Affairs shines a light on a peculiar quirk of the Medicare Part D benefit structure: For some high-priced specialty medications, seniors might pay less out-of-pocket for brand-name drugs than their generic counterparts.

A recently published study in Health Affairs shines a light on a peculiar quirk of the Medicare Part D benefit structure: For some high-priced specialty medications, seniors might pay less out-of-pocket for brand-name drugs than their generic counterparts.

The study found that, assuming a 61% discount between brand-name and generic drugs, Part D beneficiaries with prescriptions costing between $22,000 and $80,000 per year would have lower out-of-pocket spending if they use brand-name drugs over a generic, AIS Health reported.

The graphics below show the annual out-of-pocket savings associated with generic drugs and the median-point-of-sale price differences of brand-name drugs and their generic counterparts.