Humana Inc. and Anthem, Inc. are teaming up with hedge fund administrator SS&C Technologies Holdings, Inc. to create DomaniRx, a new joint venture that aims to offer a “best-in-class” PBM cloud-based claims adjudication platform. Humana will be the first customer for DomaniRx, the companies say, and industry observers predict a potential market among Blues plans and Medicare Advantage plans.
Insulin Copay Laws Are Unlikely to Impact Insurer Bottom Lines for Now
Seven states have moved this year to cap out-of-pocket expenses for diabetic patients’ insulin, a trend that should help a small group of people who generally are uninsured or have high-deductible plans and have struggled to afford their medication. But it is unlikely to expand beyond insulin or impact health plans’ bottom lines, industry observers say.
Part D Bid Will Fall in 2022, Reflecting Prior Years’ Trends
CMS’s annual release of Medicare Part D payment benchmarks and other bid-related information for the coming plan year tells pretty much the same story as in years past. The national average bid amount will continue to go down, while reinsurance amounts will continue to rise and premiums will see a slight increase.
A Closer Look at States’ Insulin Price Regulations
Earlier this month, Colorado signed into law a measure that caps total out-of-pocket spending on insulin for all diabetic patients. Under the bill, patients will pay no more than $100 for a month’s insulin supply. List prices for insulin have risen rapidly in recent years, and the average out-of-pocket cost of a full-year supply of insulin reached $613 for a privately insured patient and $1,288 for an uninsured patient, according to a Commonwealth Fund study based on Medical Expenditure Panel Survey from 2014 to 2017. To address the cost burden for diabetics, at least 17 states have implemented some type of monthly copayment cap for insulin. In addition, 46 states and the District of Columbia have insurance mandates related to diabetes coverage.
Payers Likely Will Manage Two New NSCLC Therapies to Label
Following May 2020’s seven FDA approvals in non-small cell lung cancer, May 2021 brought only a pair of new NSCLC agents. However, these two drugs are significant because they were the first to gain FDA approvals for their specific indications. According to Zitter Insights research, the drugs should have good uptake among payers.
Focus on Drug Prices Continues Amid Uncertainty Over Potential Changes
High prescription drug prices continue to be of concern at the federal level. Signaling the administration’s strongest action so far on drug pricing, President Joe Biden on July 9 unveiled his Executive Order on Promoting Competition in the American Economy. And earlier this month, HHS issued a proposed rule seeking to rescind the Most Favored Nation (MFN) drug price model, saying it instead was exploring value-based care options for the Medicare Part B program. However, it remains to be seen whether any significant changes are going to occur any time soon, say industry experts.
FDA Approves First Interchangeable Biosimilar; Impact Remains Uncertain
More than 10 years after the passage of the Biologics Price Competition and Innovation Act of 2009 (BPCIA) as part of the Affordable Care Act, the FDA finally has approved the first interchangeable biosimilar. But while many in the industry are hailing the move, at least one expert wonders whether interchangeables will hamstring use of biosimilars that do not have that designation.
Rezurock Is Approved in Graft vs. Host With More Transplant Agents in Pipeline
When patients receive an organ or tissue transplant, a critical part of their treatment involves therapies that are used to ensure neither their bodies nor the transplanted material rejects the new arrangement. While many first-line treatments given to this patient population are low-cost generics, experts say there is a robust pipeline of treatments in development, including a just-approved treatment for chronic graft vs. host disease (GVHD).
Biogen Alzheimer’s Approval Prompts Backlash, Could Bring Investigation
Aduhelm (aducanumab), the Biogen Inc. Alzheimer’s drug recently approved by the FDA, seems less and less likely to be dispensed to patients, as prominent providers, practitioner groups and experts have all publicly argued against doing so. Several health insurers have said they will not pay for the drug unless patients pass strict prior authorization standards — and the FDA approval itself could be in jeopardy as the agency’s acting commissioner has called for the HHS Office of Inspector General (OIG) to investigate the process that led to the approval.
Current Market Access to Graft vs. Host Disease Medications
The FDA on July 16 approved Kadmon Holdings, Inc.’s Rezurock for the treatment of chronic graft vs. host disease (GVHD) in patients 12 and older. The nod marks Kadmon’s first FDA-approved drug and makes Rezurock the first ROCK2 inhibitor in the GVHD market. While acute GVHD is typically managed using low-cost generic immunosuppressants and steroids (see story, p. 1), the chronic form of the disease is more difficult to treat, with the class including TNF inhibitors (Amgen Inc.’s Enbrel), JAK inhibitors (Incyte Corp.’s Jakafi), BTK inhibitors (Johnson & Johnson and AbbVie’s Imbruvica) and monoclonal antibodies (Roche and Biogen’s Rituxan, Amgen’s Ribani). Among the most advantaged therapies are Enbrel, Jakafi and Imbruvica, which hold covered or better status for 69%, 70% and 71% of all insured lives, respectively. The graphics below show how GVHD drugs are currently covered among commercial health plans, health exchanges and Medicare and Medicaid programs, plus their utilization management restrictions.