Radar on Drug Benefits

New drugs are becoming less expensive to bring to market and more profitable at launch, according to a new Deloitte Ltd. white paper. “Cost to bring an asset to market has declined over the past three years, as peak sales forecasts increase,” the report says. “The combined cohort’s average cost to develop an asset was $2,006 million, a decrease of $370 million from 2020....This decrease in 2021 compared to 2020 is due mainly to the overall increase in the number of assets in the late-stage pipeline.” However, the report also notes that this figure is “an increase of $710 million from 2013.” In addition, the cycle time for drug development has increased, especially since the start of the pandemic.

New Hampshire is the latest state to settle its suit against Centene Corp, accepting $21 million from the Medicaid-focused carrier. More than a dozen states have sued the health insurer, accusing Centene of mismanaging their Medicaid programs’ pharmacy benefits. As with the other settlements, in the New Hampshire agreement Centene denied it was liable for any wrongdoing or violations of federal or state statute. The insurer has paid out more than $241 million in settlements with Arkansas, Illinois, Kansas, Mississippi and Ohio out of the $1.25 billion it set aside earlier this year to settle such suits.

Since the FDA greenlit the Alzheimer’s drug Aduhelm (aducanumab) in July under the accelerated approval program, concerns over the drug’s hefty price tag and overall effectiveness have been mounting. Now, the drug’s manufacturer, Biogen Inc., has cut the price approximately in half. One expert tells AIS Health that the move may cause private insurers to view the drug slightly more favorably, but they’re still likely to impose coverage restrictions on it. And a health plan trade group signaled that it isn’t impressed by the price cut.

After all, the furor surrounding Aduhelm is not all about price. “The clinical evidence that the FDA relied upon when approving the drug had various limitations, and the findings of the two clinical studies were conflicting,” James Chambers, Ph.D., MPharm., an associate professor at the Tufts Medical Center Institute for Clinical Research and Health Policy Studies, tells AIS Health via email.

Regeneron Pharmaceuticals’ monoclonal antibody treatment for COVID-19 has “diminished potency” when used against the omicron variant, while AstraZeneca plc’s antibody product “retained neutralizing activity” against the new variant. The antibody treatments remain the standard of care for unvaccinated COVID-19 patients with severe disease. Regeneron emphasized that its treatment is effective against the delta variant. However, omicron has become the dominant variant in recent days: the Associated Press reported 73% of new infections last week were omicron.

Centene Corp. will pay the state of Kansas $27.6 million, the fifth such settlement reached between the insurer and state Medicaid programs. More than a dozen states have sued the health insurer, accusing Centene of mismanaging their Medicaid programs’ pharmacy benefits. The insurer has paid out $214 million in settlements with Arkansas, Illinois, Mississippi and Ohio out of the $1.25 billion it set aside earlier this year to settle such suits. According to a press release from the office of Republican Kansas Attorney General Derek Schmidt, “In the settlement, Centene guarantees that it will improve transparency by providing the state with access to all data necessary to track pharmaceutical transactions, from the point of sale through reimbursement.” Centene is in the process of consolidating its $30 billion in pharmacy spend and hopes to bid out that business to one vendor in 2022.

Cigna Corp.’s Express Scripts is offering its health plan and employer clients a “first-of-its-kind” option to cover over-the-counter COVID-19 tests. Starting Jan. 1, 2022, members of participating plans will be able to choose an applicable COVID-19 test kit at a participating in-network pharmacy and show their Express Scripts member ID card at checkout to process the kit through their pharmacy benefit. Plans that opt into the new solution can set a copay for the COVID tests either at a discounted rate or $0. “Our new COVID-19 test kit solution creates more affordable and easily accessible testing options, ultimately contributing to safer communities and less disruption in our daily lives,” said Amy Bricker, president of Express Scripts.

Eli Lilly & Co. has announced plans to run a head-to-head clinical trial of its Alzheimer’s drug, donanemab, against Aduhelm (aducanumab), the controversial Biogen Inc. Alzheimer’s drug. Meanwhile, Aduhelm has continued to have what one expert calls “the worst drug launch ever,” after state Medicaid leaders told CMS they want no part of paying for the drug.

✦ During Centene Corp.’s Oct. 26 conference call to discuss third-quarter 2021 financial results, executives said the insurer will issue a request for proposals (RFP) in 2022 for PBM services. The move — which comes as Centene has been settling a spate of lawsuits filed by states over its PBM practices — is “going to be a huge opportunity for an external PBM,” Chief Financial Officer Drew Asher said during the company’s call with analysts.

CMS, in its recent release of 2022 star ratings for private Medicare plans, reported that the percentage of members in plans rated 4 stars and above rose for both Medicare Advantage Prescription Drug (MA-PD) plans and stand-alone Prescription Drug Plans (PDPs).

MA-PD plans’ performance is getting the most buzz — perhaps because an eye-popping 90% of current enrollees are in plans that will be rated 4 stars or higher in 2022, up from 77% of MA-PD enrollees in 2021. Still, PDPs’ year-over-year percentage increase of members in highly rated plans is also notable.

Prime Therapeutics LLC is launching a new kind of shopping experience for members of participating Blue Cross Blue Shield plans called MedsYourWay, and its first offering includes a home delivery option through Amazon Pharmacy.

Through the Amazon Pharmacy partnership, MedsYourWay gives consumers “simplified sign-up, real-time medication price displays and an integrated MedsYourWay prescription discount card administered by Inside Rx1,” according to a press release.

More than a year into the pandemic, a handful of vaccines have been authorized for the novel coronavirus in the U.S., yet there is still no cure for COVID-19. Researchers and doctors have been racing to find drugs and therapies that could treat the disease or prevent people from getting infected. Only one drug, Gilead Sciences’ Veklury (remdesivir), has been approved by the FDA, while several treatments received an emergency use authorization (EUA). Here’s a look at some of the key treatments/candidates currently in play: