Trends That Matter

Trends That Matter for HIV Treatments

December 6, 2018

At the annual Medicaid Health Plans of America conference, Express Scripts Holding Co. Senior Vice President and Chief Medical Officer Steve Miller, M.D., had a simple message for health plan leaders: “You have to think long term if you’re going to have better outcomes,” AIS Health reported.

At the annual Medicaid Health Plans of America conference, Express Scripts Holding Co. Senior Vice President and Chief Medical Officer Steve Miller, M.D., had a simple message for health plan leaders: “You have to think long term if you’re going to have better outcomes,” AIS Health reported.

One area in which Medicaid is not heeding that call, Miller said, is how it approaches treating and preventing HIV.

While the number of HIV patients is decreasing, the amount spent on treating HIV has risen in recent years — and the culprit is rising drug costs, Miller said. Thus, Medicaid programs and plans are often choosing to cover the least expensive medications, which tend to be multi-tablet regimens, rather than pricier single-tablet therapies, he said.

While that approach may cost less in the near term, patients treated this way are less likely to be adherent to their treatment plans than those who get a single-tablet therapy.

Commercial health plans, which have less of an issue with finances than Medicaid, almost always choose single-tablet regimens for patients, according to Miller. Medicaid beneficiaries with HIV, on the other hand, are getting single-tablet regimens less than 60% of the time.

“So the reality is we’re sub-optimizing that care, and therefore we’re actually going to cost ourselves a lot more in the long run,” he added.

Trends That Matter for Drug Prices

November 22, 2018

Pharmaceuticals are expected to undergo a 4.92% price increase from 2018 to 2019, according to the July-August 2018 Drug Price Forecast from Vizient. That’s actually a slowing from the 7.61% increase for 2018, AIS Health reported.

Pharmaceuticals are expected to undergo a 4.92% price increase from 2018 to 2019, according to the July-August 2018 Drug Price Forecast from Vizient. That’s actually a slowing from the 7.61% increase for 2018, AIS Health reported.

The company conducted its analysis using price and volume data from hospital and non-acute facilities participating in its Vizient Pharmacy Program. Among Vizient members, therapeutic classes with the highest spend include many with specialty drugs.

Disease-modifying antirheumatic agents lead the way with an estimated 8.57% increase, followed by the immunomodulatory agents for multiple sclerosis, at 7.33%. According to the report, “Based on the total amount of spend across care environments, the types of molecular entities approved by the FDA, and the investigational products in the development pipeline, it is certain that specialty pharmaceuticals will continue to play an increasingly important role in pharmacy budgeting.”

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.”

Trends That Matter for Specialty Drug Management

October 11, 2018

Specialty drugs continue to be a concern for large employers, according to The Large Employers’ 2019 Health Care Strategy and Plan Design Survey by the National Business Group on Health (NBGH), AIS Health reported.

NBGH surveyed its corporate members in May and June on what they are doing for 2019. When NBGH asked employers about specialty pharmacy benefit management techniques, respondents selected more aggressive utilization management protocols as the top strategy,

Specialty drugs continue to be a concern for large employers, according to The Large Employers’ 2019 Health Care Strategy and Plan Design Survey by the National Business Group on Health (NBGH), AIS Health reported.

NBGH surveyed its corporate members in May and June on what they are doing for 2019. When NBGH asked employers about specialty pharmacy benefit management techniques, respondents selected more aggressive utilization management protocols as the top strategy, with 64% citing this, followed by having employees get specialty drugs through a specialty pharmacy or the specialty department of the health plan or PBM, cited by 58%. At 44%, site-of-care management notched the third top technique.

Trends That Matter for 2019 PBMs’ Exclusions

September 27, 2018

Leading pharmacy benefit managers (PBMs) recently released updates to their 2019 national formularies. As of Jan. 1, Express Scripts Holding Co. will introduce 48 new formulary exclusions in its 2019 National Preferred Formulary (NPF), which the PBM says will help drive out waste, AIS Health reported.

Adam Fein, Ph.D., president of Pembroke Consulting, Inc. and CEO of Drug Channels Institute, notes that Express Scripts, for the first time, excluded products in two specialty categories: HIV antiretrovirals and Factor VIII recombinant products for hemophilia treatment.

Leading pharmacy benefit managers (PBMs) recently released updates to their 2019 national formularies. As of Jan. 1, Express Scripts Holding Co. will introduce 48 new formulary exclusions in its 2019 National Preferred Formulary (NPF), which the PBM says will help drive out waste, AIS Health reported.

Adam Fein, Ph.D., president of Pembroke Consulting, Inc. and CEO of Drug Channels Institute, notes that Express Scripts, for the first time, excluded products in two specialty categories: HIV antiretrovirals and Factor VIII recombinant products for hemophilia treatment.

Separately, CVS Health’s spokesperson Christine Cramer said, “We are removing 23 drugs from our Standard Control Formulary in 2019 and we will add back four drugs to the formulary. The vast majority of members we serve — 98.76 percent — will be able to stay on their current therapy.”

According to a recent Solid Benefit Guidance white paper, the changes are likely to negatively impact 0.2% to 1.24% of members, as estimated the two largest national PBMs.

Trends That Matter for Epinephrine Medications

September 13, 2018

In August, the FDA approved Teva Pharmaceuticals’ generic version of Mylan N.V.’s EpiPen — a move the FDA says will provide a lower-cost option, though Teva hasn’t released pricing details, AIS Health reported.

In May, after consumers around the country reported difficulties in finding EpiPens to treat severe allergic reactions, the FDA announced shortages of two brands of epinephrine auto-injectors: Mylan Inc.’s EpiPen and Impax Laboratories, LLC’s Adrenaclick.

 

In August, the FDA approved Teva Pharmaceuticals’ generic version of Mylan N.V.’s EpiPen — a move the FDA says will provide a lower-cost option, though Teva hasn’t released pricing details, AIS Health reported.

In May, after consumers around the country reported difficulties in finding EpiPens to treat severe allergic reactions, the FDA announced shortages of two brands of epinephrine auto-injectors: Mylan Inc.’s EpiPen and Impax Laboratories, LLC’s Adrenaclick.

 

 

“The approved ANDA [abbreviated new drug application] generic for EpiPen is a welcomed addition to the market,” says Mesfin Tegenu, R.Ph., president of PerformRx, LLC. “While it is not out yet and we are not certain of the pricing, we are assuming it will be priced at the minimum similar or cheaper than the authorized generic manufactured by Mylan.”