Data & Analytics

Radar On Market Access: Study Examines Effects of Strategies in SBS Management

May 23, 2019

People with short bowel syndrome (SBS) need a high-touch approach to be effectively managed. Option Care Enterprises, Inc. has a nutritional support team providing clinical interventions, and it recently released a study showing that this approach can save millions of dollars in costs per year, AIS Health reported.

People with short bowel syndrome (SBS) need a high-touch approach to be effectively managed. Option Care Enterprises, Inc. has a nutritional support team providing clinical interventions, and it recently released a study showing that this approach can save millions of dollars in costs per year, AIS Health reported.

People with SBS have a hard time absorbing nutrients and maintaining hydration and electrolyte balance, and diarrhea is common. Dehydration is a common, even fatal, aspect of this condition, and it often results in hospitalization with an average three-day length of stay.

Patients who are released from the hospital and receiving home parenteral support often are readmitted due to dehydration. Option Care has nutrition support teams that include a registered dietitian, nurse and pharmacist to manage these patients, including assessing whether they are getting the appropriate home parenteral nutrition volume.

Researchers evaluated 116 people with a diagnosis of SBS who were at least 18 years old and started on home parenteral nutrition between June 1, 2017, and June 1, 2018.

Of the 116 patients, 14 were readmitted to the hospital within two weeks of being discharged, but none of those readmissions was due to dehydration. Sixty-three interventions — all of them increases in parenteral nutrition volume — were made during the four weeks following discharge.

Researchers assumed an average three-day hospitalization for each of those 63 adjustments, resulting in an estimated 189 hospital days saved in the first month after discharge. With each hospital day costing $2,000, this translates into $378,000 in health care dollars saved in the first month. Projected annual hospital days saved were 2,268, and projected annual health care dollars saved were more than $4.5 million.

According to Mary Englert, area lead, nutrition support dietitian at Option Care and co-author of the study, “it is important to constantly assess each patient’s estimated fluid needs, especially in the early post-surgical phase of their treatment.”

Beyond the financial savings from avoiding a readmission, patients are not at risk of acquiring a hospital-acquired infection, which itself also can be costly. Their quality of life is better as well, says Englert.

This study, she tells AIS Health, demonstrates that “proactive interventions by nutrition support clinicians resulted in a reduction in unplanned hospital admissions for dehydration, therefore reducing costs that would have otherwise been incurred by less careful monitoring.”

Radar On Market Access: Use of Biologics, Biosimilars Showed Rapid Uptake in 2018

May 16, 2019

Almost 5.8 billion prescriptions were dispensed in the United States in 2018, an increase of 2.7% over the previous year, according to the IQVIA Institute for Human Data Science’s report Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023, AIS Health reported.

Almost 5.8 billion prescriptions were dispensed in the United States in 2018, an increase of 2.7% over the previous year, according to the IQVIA Institute for Human Data Science’s report Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023, AIS Health reported.

Retail and mail pharmacies dispensed 127 million specialty prescriptions last year, an increase of 15 million since 2014. In 2018, for the second year in a row, specialty prescription volume grew more than 5% although the medicines accounted for only 2.2% of prescriptions overall. With an increase in the availability of oral and self-injected specialty therapies, these drugs “are increasingly dispensed through retail pharmacies,” said Murray Aitken, executive director of the institute, during a May 6 press call.

Researchers found that there has been rapid uptake of the programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) inhibitors. In 2014, following the FDA approval of Merck & Co., Inc.’s Keytruda (pembrolizumab) in September, there were 2,403 people treated with an immuno- oncology checkpoint inhibitor. That number rose to 212,473 in 2018, with six products on the market boasting numerous indications.

The use of biosimilars — which the institute defines on a broader basis than only those therapies approved through the 351(k) pathway — “in terms of volume is still modest,” said Aitken, with these therapies representing less than 2% of the total biologics market in 2018. But in those areas where a biosimilar is available, “there is reasonably rapid uptake.”

Radar On Market Access: CBO Says Proposed Rebate Rule Will Cost Government $177B

May 14, 2019

When HHS unveiled a proposed rule in late January aimed at eliminating drug rebates in Medicare Part D and Medicaid managed care, the proposal was met with mixed responses. A recently released score from the Congressional Budget Office (CBO) calls into question whether the administration chooses to move forward with the proposal in its current form, AIS Health reported.

When HHS unveiled a proposed rule in late January aimed at eliminating drug rebates in Medicare Part D and Medicaid managed care, the proposal was met with mixed responses. A recently released score from the Congressional Budget Office (CBO) calls into question whether the administration chooses to move forward with the proposal in its current form, AIS Health reported.

The proposal would do away with the safe harbor protection in the anti-kickback statute for rebates negotiated between manufacturers and PBMs starting Jan. 1, 2020.

In the CBO’s report, the agency projects that if the rule is implemented as proposed, it will increase federal spending by approximately $177 billion from 2020 to 2029. Of that total, spending on Medicare Part D premiums would increase by about $170 billion. Without rebates to keep premiums low, beneficiaries would face higher premiums. The agency anticipates that “rather than lowering list prices, manufacturers would offer the negotiated discounts in the form of chargebacks,” which are shared with beneficiaries via a manufacturer payment to a pharmacy.

The report, however, also concludes that “no current system could both meet the proposed rule’s standards and facilitate chargebacks.”

If “rebates could no longer be paid to PBMs in Medicare Part D,” but “systems are not available to support retail pharmacy chargebacks,…this would be an untenable situation,” says Elan Rubinstein, Pharm.D., principal at EB Rubinstein Associates, making it “reasonable to delay” the proposed implementation date.

“The increase in premiums was expected by many, but the growth in federal spending was somewhat surprising given that lower upfront prices would generally benefit the end payer, which in this case is the federal government,” says Jeremy Schafer, Pharm.D., senior vie president, director, access experience team at Precision for Value. “It seems changing the safe harbor may not accomplish patient savings or reduced government spending as hoped for by the administration.”

Trends That Matter for Colorectal Cancer Medications

May 9, 2019

As innovations in digital capabilities continue to be used with various health care products, Proteus Digital Health, Inc. is developing a suite of what it terms digital medicines. And while the company has been working on such products for a few years, it recently came out with the first such product within the oncology space, AIS Health reported.

As innovations in digital capabilities continue to be used with various health care products, Proteus Digital Health, Inc. is developing a suite of what it terms digital medicines. And while the company has been working on such products for a few years, it recently came out with the first such product within the oncology space, AIS Health reported.

Proteus is partnering with Fairview Health Services and the University of Minnesota Health to offer oral capecitabine combined with an ingestible sensor to treat stage 3 and stage 4 colorectal cancer patients.

David Purdie, vice president of medical affairs at Proteus, explains that through an open capsulation process, a pharmacist will place a capecitabine pill and a sensor within a capsule and then seal it. The capsule dissolves within a person’s stomach within a minute or so after it’s ingested. “Each sensor has a unique identifier,” and after the capsule dissolves, an app on a mobile device transmits data such as the time of the dose, the medication taken, the dosage of the drug and certain patient reactions to the drug to the cloud, where the information matches up with a database. “Every pill is uniquely identified,” so if someone takes 30 different pills at one time, the database will be able to know exactly what each medication is.

Below is the current market access to colorectal cancer medications under the pharmacy benefit:

Radar On Market Access: Magellan Sees Success With Infliximab Biosimilars

May 7, 2019

Magellan Rx Management saw a significant shift in utilization from Janssen Biotech, Inc.’s Remicade (infliximab) to biosimilars after it implemented a comprehensive utilization management (UM) program, resulting in 34% drug cost savings, the PBM reported.

Magellan Rx Management saw a significant shift in utilization from Janssen Biotech, Inc.’s Remicade (infliximab) to biosimilars after it implemented a comprehensive utilization management (UM) program, resulting in 34% drug cost savings, the PBM reported.

The program, which began in late 2017, involves any patient prescribed an infliximab product for any indication, and is available to all payer clients as an opt-in option, Steve Cutts, senior vice president and general manager, tells AIS Health.

When Magellan Rx began the infliximab program in the fourth quarter of 2017, 100% of the PBM’s patients receiving an infliximab product received Remicade and none took biosimilars, the PBM said. In the third quarter of 2018, the last quarter for which Magellan has data, 86% of patients got the biosimilar and 14% took the brand-name drug.

The FDA approved the first infliximab biosimilar, Pfizer, Inc.’s Inflectra (infliximab-dyyb), in April 2016. The agency now lists three approved infliximab biosimilars: Inflectra; Merck & Co., Inc.’s Renflexis (infliximab-abda); and Pfizer’s Ixifi (infliximab-qbtx). Pfizer is not launching Ixifi in the U.S. since it already has Inflectra on the market, so only Inflectra and Renflexis are being sold in the U.S.

Magellan Rx works with both infliximab biosimilar manufacturers, Cutts says, and can “offer multiple options to our clients regarding which biosimilar or combination of biosimilars will work best for their unique situation.”

The Magellan Rx infliximab UM program aims to overcome reluctance on the part of physicians to prescribe biosimilars by emphasizing that they provide the same level of clinical efficacy and safety, with the added benefit of cost savings.

“Likely the most important factor [in the Magellan Rx utilization management program] is obtained provider acceptance that the biosimilar is going to deliver the same results as the innovator product,” says Daniel Malone, R.Ph., Ph.D., professor at the University of Arizona College of Pharmacy.

Trends That Matter for Insulin

April 25, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

Leading PBMs, such as CVS Health Corp., Express Scripts and Prime Therapeutics, also applied formulary strategies to keep insulin affordable. CVS Health reported a -1.7% trend for antidiabetic drugs in 2018, despite increasing utilization and 5.6% average wholesale price inflation for brand drugs, according to its 2018 drug trend report.

By removing Lantus and Toujeo from the formulary and making Basaglar preferred, CVS reported its clients saw a 21.7% reduction in cost per long-acting insulin prescription, which translated to a lower overall cost of $0.34 per member per month.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D “doughnut hole.”

One tactic that the organization’s health plan deploys to ease the burden on members is a policy called “plan pay the difference,” Fried says. If a brand drug becomes cheaper than the generic version after rebates, “we would actually have the member pay the generic copay instead of the brand, and then we would reimburse the pharmacy the brand cost, so that they’re made whole as well,” she says.