Spotlight on Market Access

PBMs Are Major Bright Spot in 1Q Earnings for Cigna, CVS

For two of the largest diversified health care companies, their PBM divisions were a much-touted highlight in the firms’ first-quarter 2021 earnings reports and conference calls.

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Pandemic Fuels 13% National Medicaid Enrollment Growth

National Medicaid enrollment topped 83 million lives in April 2021, according to the latest update to AIS’s Directory of Health Plans. That’s an overall increase of 12.9% from the first quarter of 2020, a highly unusual growth pattern spurred by the COVID-19 pandemic. In 2019, Medicaid enrollment was on a downswing for the first time since the introduction of Medicaid expansion via the Affordable Care Act, but high unemployment rates fueled by the pandemic caused enrollment to soar in all 50 states, with an average increase of 182,000 beneficiaries per state.

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Most Payers Expect to Manage New MS Drug Ponvory to Label

Although there are more than 20 FDA-approved disease-modifying therapies for multiple sclerosis (MS), companies continue to bring new products onto the market. Zitter Insights found that the majority of payers expect to manage the newest entrant, the Janssen Pharmaceutical Companies of Johnson & Johnson’s Ponvory (ponesimod), to label.

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Research Shows COVID’s Impact on Health Care Has Lessened but Not Disappeared

When the COVID-19 pandemic struck and the U.S. essentially shut down, many people put off medical procedures as facilities didn’t have the capacity to see them and patients didn’t want to potentially expose themselves to COVID. A report from the IQVIA Institute for Human Data Science released in May 2020 examined the pandemic’s impact on the U.S. health care system, including huge drops in diagnostic screenings for cancer (SMA 6/1/20, p. 1). Now, more than a year later, data from the institute are showing that while numbers have improved, they have not returned to normal.

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Fotivda Approval Provides New Option for Certain People With Renal Cell Carcinoma

The renal cell carcinoma (RCC) therapeutic class boasts multiple agents, but a recent entrant is offering a new tool for certain patients. A Zitter Insights survey shows that the majority of oncologist respondents are likely to prescribe Aveo Oncology’s Fotivda (tivozanib) for advanced RCC.

On March 10, the FDA approved Fotivda for the treatment of adults with relapsed or refractory advanced RCC who have received at least two prior systemic therapies. It is the first FDA-approved therapy for this use.

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New Non-Stimulant ADHD Therapies Make Splash, Meet Payer Skepticism

In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them.

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Employers Eye Alternatives to Traditional PBMs in 2022 Selling Season

In a sign of pent-up demand as the COVID-19 pandemic winds down, a near-record number of companies likely will consider switching to a new PBM during the 2022 selling season that’s now underway, consultants and observers say.

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Join MMIT for the Meet the Expert Webinar Series

MMIT is holding a series of webinars on topics spanning the pharma and payer landscape. Please join us for an upcoming session or listen to a recording of a past program.

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Current Market Access to ADHD Therapies (Stimulants)

The FDA on April 2 approved Supernus Pharmaceuticals, Inc.’s Qelbree for the treatment of attention deficit hyperactivity disorder (ADHD) in patients aged 6 to 17. While Qelbree is the first non-stimulant to enter the ADHD market since 2010 (see story, p. 1), payers favor older, methylphenidate and amphetamine-based drugs, with all of these medications holding covered or better status for at least 50% of all insured lives under the pharmacy benefit. Among these therapies, Takeda Pharmaceutical Company’s Vyvanse is greatly advantaged, holding preferred status for 72% of all covered lives under the pharmacy benefit.

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Medicaid Gains, Commercial Losses Continue in DHP Update

AIS Health’s data team on May 4 updated the Directory of Health Plans subscriber dashboard and in-app spreadsheets with new enrollment numbers. This data primarily reflects fourth-quarter 2020 status but includes first-quarter 2021 lives for Medicare Advantage products and some Medicaid figures, based on availability at the state level.

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