Speciality

MMIT Reality Check on Ovarian Cancer (Dec 2019)

December 27, 2019

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

According to our recent payer coverage analysis for ovarian cancer 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 ovarian cancer treatments shows that under the medical benefit, almost 46% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: Most products are limited by their policies for treatment at specific stages of ovarian cancer. This may not remain true as we see clinical trials proving that targeted therapies can provide improvement earlier in the disease cycle and during the maintenance phase.

MMIT Reality Check on Migraine (Dec 2019)

December 20, 2019

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 under the pharmacy benefit, almost 47% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: New oral medications for acute migraine — Eli Lilly and Co.’s Reyvow (lasmiditan), Allergan’s ubrogepant and Biohaven Pharmaceuticals’ CGRP antagonist rimegepant — likely won’t shake up formulary coverage for a condition that’s largely treated by generic triptan medications, pharmacy benefit experts say.

Radar On Market Access: Patient-Reported Outcomes Play Key Role in New Multiple Sclerosis Value-Based Contract

December 19, 2019

Under a value-based contracting agreement believed to be the first of its kind, UPMC Health Plan will receive discounts for two Biogen Inc. multiple sclerosis (MS) drugs — Tecfidera (dimethyl fumarate) and Avonex (interferon beta-1a) — based on patient-reported measures of disability progression. The agreement is also based on research with a panel of key MS stakeholders who identified the most meaningful outcomes in relapsing forms of MS, AIS Health reported.

Under a value-based contracting agreement believed to be the first of its kind, UPMC Health Plan will receive discounts for two Biogen Inc. multiple sclerosis (MS) drugs — Tecfidera (dimethyl fumarate) and Avonex (interferon beta-1a) — based on patient-reported measures of disability progression. The agreement is also based on research with a panel of key MS stakeholders who identified the most meaningful outcomes in relapsing forms of MS, AIS Health reported.

UPMC’s Center for Value-Based Pharmacy Initiatives led the research and developed the value-based contract.

Previous value-based contracts for MS drugs have connected payment to outcome indicators derived from claims and electronic health record data, says Rochelle Henderson, Ph.D., Express Scripts’ vice president of research and a co-author of the study report.

“This research [gives] a greater level of transparency into the outcome indicators that rank the highest in terms of value for stakeholders,” she says. “The key advantage of patient-reported outcomes is that it gets at information that can be used to evaluate the success of a medication where that information is not available by traditional means.”

Similarly, Henderson says, many outcomes that are important to payers are not available in the electronic medical record. “What we learned is that stakeholders rated ‘worsening physical disability’ and ‘functional impairment’ as the most valuable indicators for providing information about the status of MS.”

Payer interest and participation in outcomes-based contracting with manufacturers continues to grow. “Based on our research and our discussions with stakeholders in health care, there are a number of organizations on the payer side who would like to go in this direction,” says Avalere Health’s John E. Linnehan, practice director of health economics and advanced analytics.

“Payers typically are looking for outcomes-based contracting in conditions with high prevalence, high costs, or both,” Linnehan says, adding that because the MS category includes new entrants and generics, it is a focus of interest for outcomes-based contracts.

MMIT Reality Check on Multiple Myeloma (Dec 2019)

December 13, 2019

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 under the pharmacy benefit, almost 52% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: In July 2019, the FDA gave accelerated approval to Karyopharm Therapeutics Inc.’s Xpovio (selinexor) in combination with dexamethasone for the treatment of adults with relapsed or refractory multiple myeloma who have received at least four prior therapies and whose disease is refractory to at least two proteasome inhibitors, two immunomodulatory agents and an anti-CD38 monoclonal antibody.

Radar On Market Access: Highmark’s New Hemophilia Initiative Aims to Improve Care, Reduce Costs

December 11, 2019

With an eye on reducing spending and improving care among members with hemophilia, Highmark Inc. will launch a comprehensive program focused on the condition on Jan. 1. The health plan will partner exclusively with three companies — Option Care Health, Inc., Soleo Health and the Hemophilia Center of Western Pennsylvania — on the initiative, which has the potential to improve member care, reduce costs and cut down on fraud, waste and abuse, AIS Health reported.

With an eye on reducing spending and improving care among members with hemophilia, Highmark Inc. will launch a comprehensive program focused on the condition on Jan. 1. The health plan will partner exclusively with three companies — Option Care Health, Inc., Soleo Health and the Hemophilia Center of Western Pennsylvania — on the initiative, which has the potential to improve member care, reduce costs and cut down on fraud, waste and abuse, AIS Health reported.

Highmark chose hemophilia to focus on for a few reasons, says Sean Burke, manager of specialty pharmacy services at the plan. “We have a pretty comparatively high population” of people with hemophilia, and “clients were coming to us” for effective management strategies. New therapies — as well as a crowded pipeline — mean there is “a big opportunity to potentially save money.”

Of Highmark’s 4.5 million members, approximately 190 have a hemophilia diagnosis, and the health plan says it spends about $80 million annually on their care, with pharmacy costs making up about 90% of that.

The partners will be able to obtain the therapies at competitive rates, in large part because they “have more volume,” says Ned Finn, director of specialty pharmacy services at the insurer.

Highmark and the providers have performance guarantees and oversight protocols in place. Plan members not only will receive better care, but members and health plan clients will see potential cost savings of “15% or so,” says Burke.

“There are a number of guarantees,” Drew Walk, Soleo’s CEO, says, that are “focused on reducing waste and overall cost of care,” as well as “improving patient outcomes.…There are clinical and financial outcomes measurements.” Hemophilia is a “unique” condition which requires “monitoring individual patient response,” he notes. The key, he maintains, is to “not be too obtrusive” in management but to “intervene when necessary and provide a good patient experience. It’s more than just dispensing the product.”

If a product experiences a shortage or goes off the market temporarily, “we have direct lines of communication with the providers” to handle the situation, says Burke. “These pharmacies are very experienced with knowing how to handle this.”

MMIT Reality Check on Chronic Lymphocyctic Leukemia (Dec 2019)

December 6, 2019

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.

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 under the pharmacy benefit, almost 48% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: The FDA has approved two biosimilars for Biogen and Genentech’s Rituxan (rituximab), and both are indicated for CLL. Teva Pharmaceuticals USA, Inc. and Celltrion, Inc.’s Truxima (rituximab-abbs) launched in November 2019, and Pfizer Inc.’s Ruxience (rituximab-pvvr), approved in July 2019, will launch in January 2020.