Market Access

MMIT Reality Check on Migraine (Nov 2018)

November 16, 2018

According to our recent payer coverage analysis for migraine treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for migraine treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for migraine treatments shows that about 42% of the covered lives under commercial formularies are restricted.

Trends: The launch of the CGRP inhibitors disrupts the current market dynamics, and it’s currently unclear if they will create a treatment step after generic products but before botulinum toxins or be treated roughly equal to botulinum toxins. Via AIS Health.

Radar On Market Access: FDA’s OK of Opioid Makes ‘Diversion of Even One Tablet’ Risky

November 15, 2018

When a highly potent new opioid formulation was approved by his agency on Nov. 2, FDA Commissioner Scott Gottlieb, M.D., downplayed safety concerns about AcelRx’s Dsuvia. He stressed the importance of the painkiller for military use and the “very tight restrictions being placed on the distribution and use of this product,” AIS Health reported.

When a highly potent new opioid formulation was approved by his agency on Nov. 2, FDA Commissioner Scott Gottlieb, M.D., downplayed safety concerns about AcelRx’s Dsuvia. He stressed the importance of the painkiller for military use and the “very tight restrictions being placed on the distribution and use of this product,” AIS Health reported.
In general, PBM and health plan experts say such restrictions likely will hold and keep the drug within its proper niche, and the regulatory green light for Dsuvia shouldn’t interfere with broad ongoing efforts to better manage opioid use in the U.S.
Dsuvia is a sublingual formulation of an established drug, sufentanil, that is delivered through a disposable, pre-filled, single-dose applicator. It’s seen as ideally suited for certain special circumstances where patients may not be able to swallow oral medication, and where access to intravenous pain relief is not possible, including its potential use on the battlefield. Gottlieb notes that this opioid formulation, along with Dsuvia’s delivery device, was “a priority medical product” for the Pentagon because it fills a specific, though limited, unmet medical need.
“A single-dose applicator could potentially prevent abuse due to the complexity of removing it [i.e., the medication] from the applicator,” says Mesfin Tegenu, R.Ph., president of PerformRx, LLC. “However, because it is 10 times more potent than fentanyl and 1,000 times more potent than morphine, the diversion of even one tablet can be risky.”
Tegenu adds that restricting the sites where Dsuvia can be administered “is a good step in preventing misuse. However, there is no guarantee that such a diversion will not occur and contribute to the opioid crisis.”
Yet Sharon Jhawar, Pharm.D., chief pharmacy officer for SCAN Health Plan, doesn’t anticipate a significant problem with diversion of the strong medication.
“Our perspective on Dsuvia is it’s been approved only in specific health care settings by someone who is medically trained, and is really for severe, acute pain in which other opioids would not be enough,” she says. “And because of the requirement of the setting and who needs to give it, this isn’t a medication you’re going to see insurers have on their formulary.”

MMIT Reality Check on Multiple Myeloma (Nov 2018)

November 9, 2018

According to our recent payer coverage analysis for multiple myeloma treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for multiple myeloma treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for multiple myeloma treatments shows that more than 76% of the covered lives under Medicare formularies are restricted.

Trends: In May, 2018, the FDA granted an additional indication to Darzalex (daratumumab) in combination with Velcade (bortezomib), melphalan and prednisone for people with newly diagnosed multiple myeloma who are not eligible for an autologous stem cell transport. Via AIS Health.

Trends That Matter for Sensor-Equipped Pills

November 8, 2018

In a move that one expert says Medicaid plans will be watching closely, Magellan Health and the drug manufacturer Otsuka America Pharmaceutical, Inc. said in August that they will work together to allow “select regional provider networks” contracted through Magellan to opt into a program involving the Abilify MyCite system, AIS Health reported.

In a move that one expert says Medicaid plans will be watching closely, Magellan Health and the drug manufacturer Otsuka America Pharmaceutical, Inc. said in August that they will work together to allow “select regional provider networks” contracted through Magellan to opt into a program involving the Abilify MyCite system, AIS Health reported.

Abilify (aripiprazole) treats schizophrenia and other mental illnesses. The MyCite system comprises Abilify tablets embedded with sensors; patches that detect and record the date and time of the pill’s ingestion as well as physiological data like activity level; an app that lets patients review their data and enter additional information; and a web-based dashboard that lets providers and caregivers display and track a patient’s drug ingestion patterns over time.

One in five Medicaid enrollees has been diagnosed with a serious mental illness or other behavioral health issue, and there’s likely another one in five who are undiagnosed, says Jeff Myers, president and CEO of Medicaid Health Plans of America. “So anything the plans can get [in their] tool belt to ensure adherence to their drug regimen, to do what we can to keep them well, is something the plans are going to look at very carefully.”

Radar On Market Access: Sensor-Equipped Pills Draw Plans’ Interest

November 8, 2018

In a move that one expert says Medicaid plans will be watching closely, Magellan Health and the drug manufacturer Otsuka America Pharmaceutical, Inc. said Aug. 30 that they will work together to allow “select regional provider networks” contracted through Magellan to opt into a program involving the Abilify MyCite system, AIS Health reported.

In a move that one expert says Medicaid plans will be watching closely, Magellan Health and the drug manufacturer Otsuka America Pharmaceutical, Inc. said Aug. 30 that they will work together to allow “select regional provider networks” contracted through Magellan to opt into a program involving the Abilify MyCite system, AIS Health reported.
Abilify (aripiprazole) treats schizophrenia and other mental illnesses. The MyCite system comprises Abilify tablets embedded with sensors; patches that detect and record the date and time of the pill’s ingestion as well as physiological data like activity level; an app that lets patients review their data and enter additional information; and a web-based dashboard that lets providers and caregivers display and track a patient’s drug ingestion patterns over time.
A 30-day supply of all the components in Abilify MyCite costs $1,650, says John A. Bardi, vice president of public affairs and digital medicine business development for Otsuka.
One in five Medicaid enrollees has been diagnosed with a serious mental illness or other behavioral health issue, and there’s likely another one in five who are undiagnosed, says Jeff Myers, president and CEO of Medicaid Health Plans of America. “So anything the plans can get [in their] tool belt to ensure adherence to their drug regimen, to do what we can to keep them well, is something the plans are going to look at very carefully.”
Down the road, if states consider adding Abilify MyCite to their carved-out formularies, or if managed care plans begin to roll it into their formularies, “the states are going to have some questions about how are you going to manage the benefit, and are we going to get the value out of spending this extra money,” Myers says.
To that end, insurers are particularly interested in learning whether the Abilify MyCite system can reduce hospital stays among the population that Magellan and Otsuka study, he adds.

MMIT Reality Check on CLL (Nov 2018)

November 2, 2018

According to our recent payer coverage analysis for chronic lymphocyctic leukemia (CLL) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

According to our recent payer coverage analysis for chronic lymphocyctic leukemia (CLL) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for CLL treatments shows that more than half of the covered lives under Medicare formularies are restricted.

Trends: The FDA approved Verastem, Inc.’s Copiktra (duvelisib) for the treatment of adults with relapsed or refractory CLL after at least two treatments.