Spotlight on Market Access

Evernorth Trend Report Shows Varied Pandemic Impacts

In the 2020 Drug Trend Report recently released by Evernorth (see infographic, p. 3), the Cigna Corp. division added yet another chapter to the growing volume of data detailing the profound effects that the COVID-19 pandemic has had on health care.

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Cigna: Pandemic Led to Fewer New Scripts, Better Adherence

In its 2020 Drug Trend Report, Cigna Corp. division Evernorth said total drug costs rose 4% for its commercial plans, including both utilization and unit costs. The COVID-19 pandemic led to an across-the-board decline in the percentage of new medication users as well as improved adherence among people taking medications for chronic conditions. Among the top 15 therapy classes ranked by per-member per-year spend for the commercial plans, inflammatory conditions remained the top of the list, at $241.34 PMPY average spending, followed by diabetes at $145.24.

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Xolair OK for Self-Injection Will Help Keep People Safe at Home

As the COVID-19 pandemic continues, many people — particularly those with certain preexisting conditions such as moderate to severe asthma — are trying to stay home and avoid places where they could be exposed to the virus, including health care provider offices. The FDA’s recent approval of self-administration of Roche Group member Genentech USA, Inc. and Novartis Pharmaceuticals Corp.’s Xolair (omalizumab) will assist in that effort. Payers and providers expect in-home self-administration to increase this year due to the pandemic, according to Zitter Insights.

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People on Specialty Drugs May Need to Alter Dosing When Getting COVID Vaccine

Many people taking specialty medications, such as people with cancer, are immunocompromised, and specialty drugs themselves can cause drug-induced immunosuppression. As COVID-19 vaccines roll out, it may be unclear how those products could impact people taking specialty therapies. At least two medical societies, however, have released recommendations around modifications to treatment regimens when a person receives a COVID vaccine, as well as the delay of the vaccine itself. Industry experts say that all stakeholders have a role to play in making sure people getting vaccinated do so in the most effective, safest way possible.

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FDA Approves New Long-Acting HIV Regimen That Could Help Adherence

The FDA recently approved the first long-acting regimen for the treatment of HIV in adults. The dosing schedule could help with adherence in a condition where that is particularly crucial. However, some potential challenges exist with the medication, including whether health plans actually will cover it.

On Jan. 21, the FDA approved ViiV Healthcare’s Cabenuva (cabotegravir and rilpivirine) for the treatment of HIV-1 infection in adults to replace a current antiretroviral regimen in people who are virologically suppressed on it with no history of treatment failure and no known or suspected resistance to either cabotegravir or rilpivirine.

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One-Third of U.S. Adults Delayed or Skipped Health Care During Pandemic

More than one in three nonelderly adults reported delaying or forgoing at least one type of health care service because of concerns about being exposed to the coronavirus or because a provider limited services during the pandemic, according to an Urban Institute study. Rates of delayed or forgone care were particularly high among adults with mental health conditions. Dental care was the most common type of health care adults chose to postpone or skip. The study also suggested that almost 33% of the adults who delayed or went without care reported a negative effect on their health, ability to work or ability to perform other daily activities.

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How Will the Biden Administration Handle Copay Accumulator Programs?

Thanks to recent regulatory moves as well as the increasing prevalence of copay accumulator/maximizer programs, the tactics that payers use to counter drug manufacturer copay assistance continue to be a controversial topic in the health care sector. However, it’s still unclear how the Biden administration will approach the issue, industry experts say, so stakeholders on both sides of the debate should prepare for more uncertainty.

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Ohio Selects New Single Medicaid PBM, Sues One of Current Vendors

Ohio recently cleared a key hurdle in its plan to revamp how Medicaid enrollees’ pharmacy benefits are managed, choosing Gainwell Technologies as the single PBM that will replace big-name firms including Cigna Corp.’s Express Scripts, CVS Heath Corp.’s Caremark, UnitedHealth Group’s OptumRx and Centene Corp.’s Envolve Pharmacy Solutions.

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Ohio Medicaid Drug Lives by Payer and PBM, as of March 2021

Ohio’s 2.4 million Medicaid drug lives are currently managed by five PBMs, which contract with both the state and its managed care plans. Gainwell Technologies will take over as the state’s single PBM in 2022, the beginning of a 7.5-year contract. Ohio is also rebidding its Medicaid managed care contracts for 2022, but it’s unclear when awards will be unveiled.

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MMIT Launches Indication Briefs for 18 Therapeutic Areas

Understanding a therapeutic area can be challenging, and more so because the health care ecosystem is constantly evolving. Payers are continually seeking innovative ways to contain costs on drug spend, regulators are implementing strategies to better control the pharma industry, and prescribers are facing administrative burdens associated with getting a patient on therapy — all while new and innovative treatments are coming to market.

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