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Judy Packer Tursman

Senior Reporter, Health Plan Weekly and Radar on Drug Benefits

Recent Posts

Perspectives on New Postpartum Depression Drug

Posted by Judy Packer Tursman on May 2, 2019

The FDA's recent approval of the first medication specifically aimed at treating postpartum depression is drawing a favorable response from clinicians, while payers could face challenges.

PBM executives tell AIS Health that the postpartum depression drug, Zulresso (brexanolone) injection, is likely to be covered under the medical, not the pharmacy, side of the benefit.
 
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Topics: Specialty, Industry Trends, Product Release, Provider, Payer

Radar On Market Access: Calif. Insurers Fear lll Effects if Medicaid Pharmacy Is Carved Out

Posted by Judy Packer Tursman on May 2, 2019

California is quietly plowing ahead on plans by Gov. Gavin Newsom, a Democrat, to create a statewide bulk purchasing system for prescription drugs — and to transition pharmacy services for Medi-Cal, the state's Medicaid program, from managed care to fee-for-service (FFS) by January 2021, AIS Health reported.

In the latest development related to the initiatives, Los Angeles County tentatively has agreed "to sit at the same bargaining table" with Newsom’s administration to negotiate prices with drug manufacturers, the Los Angeles Times reported April 17.
 
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Topics: Specialty, Industry Trends, Provider, Payer

Radar On Market Access: Diabetic Drug’s Kidney Benefit May Not Be Game-Changer

Posted by Judy Packer Tursman on Apr 30, 2019

The potential use of Invokana (canagliflozin) for chronic kidney disease as well as type 2 diabetes, its current indicated use, recently attracted national headlines. If Janssen Pharmaceuticals, Inc.'s supplemental indication for its medication is approved by the FDA, "it would be the first new treatment for diabetic kidney disease in decades," the National Kidney Foundation said.

The kidney foundation points out that diabetes is a key risk factor for chronic kidney disease. The group says it anticipates strong uptake of Invokana by clinicians and payers facing "high costs and management challenges" in treating advanced kidney disease in people with type 2 diabetes, AIS Health reported.
 
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Topics: Product Release, Provider, Payer

Radar On Market Access: CMS Finalizes Medicare Rates, Unveils '20 Opioid Policies

Posted by Judy Packer Tursman on Apr 18, 2019

CMS recently released its annual payment information and policy updates for Medicare Advantage, MA Prescription Drug (MA-PD) and stand-alone Prescription Drug Plans, underscoring the need for a better approach to opioid monitoring and management, AIS Health reported.

Yet overall, industry experts say perhaps the most eye-catching features of CMS's 2020 MA and Part D Rate Announcement and final Call Letter are the better-than-anticipated pay rate and the lack of worrisome new mandates, policy changes or major technical issues.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: New Postpartum Depression Drug Presents Payer Challenges

Posted by Judy Packer Tursman on Apr 2, 2019

The FDA's recent approval of the first medication specifically aimed at treating postpartum depression is drawing a favorable response from clinicians, while payers could face challenges.

PBM executives tell AIS Health that the postpartum depression drug, Zulresso (brexanolone) injection, is likely to be covered under the medical, not the pharmacy, side of the benefit.
 
Read More

Topics: Specialty, Market Access, Product Release, Provider, Payer

Radar On Market Access: Colorado Soon Will Tighten Rules for Short-Term Plans

Posted by Judy Packer Tursman on Mar 28, 2019

Starting April 1, payers who decide to sell short-term limited duration (STLD) health benefit plans in Colorado must offer products covering essential health benefits mandated by state law — such as preventive services, prescription drugs, hospitalization and maternity and newborn care. Short-term plans also won't be able to deny applicants based on their health status: They must be guaranteed issue, AIS Health reported.

But one basic element will remain unchanged: STLD plans being sold in Colorado, as elsewhere, won't cover pre-existing conditions.
 
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Topics: Provider, Payer

Radar On Market Access: Civica Rx Aims to Provide 14 Drugs in Short Supply in '19

Posted by Judy Packer Tursman on Mar 19, 2019

Since its launch in 2018, Civica Rx, the new not-for-profit generic drug and pharmaceutical company run by health systems and hospitals, tells AIS Health it has made solid progress in its ongoing effort to address persistent shortages of certain drugs administered within hospitals' four walls.

According to Civica spokesperson Debbi Ford, Civica first aims to provide 14 vital drugs, "mostly sterile injectables such as anesthesia medications, antibiotics, and pain medications and expects to deliver these products this year," she says.
 
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Topics: Industry Trends, Product Release, Data & Analytics, Provider, Payer

Trends That Matter for Drug Spending

Posted by Judy Packer Tursman on Mar 14, 2019

For its first annual drug trend report as a part of Cigna Corp., Express Scripts Holding Co. said it had achieved a record low drug trend of 0.4% across its clients' employer-sponsored commercial plans in 2018. Overall, the PBM reported savings of $45 billion for its clients last year, AIS Health reported.

The PBM cited "an unprecedented 0.3% decline" in per-beneficiary drug spending across Medicare plans. Overall, there was a 1.4% decrease in unit cost trend, which allowed clients to absorb a 1.1% increase in utilization, the PBM said. Oncology replaced diabetes as Medicare’s top therapy class by per member per year spend
.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: What Is Behind CVS Health’s LTC Woes?

Posted by Judy Packer Tursman on Mar 7, 2019

Almost four years after CVS Health Corp. spent nearly $13 billion to acquire Omnicare, the long-term-care (LTC) pharmacy business attracted negative attention as a major contributor to "headwinds" in the company's report on fourth quarter and full-year 2018 financial results, AIS Health reported.

For the quarter ended Dec. 31, CVS Health reported a net loss of $421 million on revenues that increased 12.5% to $54.4 billion year over year. Losses reflect $2.2 billion in quarterly and $6.1 billion in full-year 2018 "goodwill impairment charges" related to its LTC business, the company said.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: Express Scripts Reports Record Low Drug Trend Across Commercial Plans in 2018

Posted by Judy Packer Tursman on Feb 19, 2019

For its first annual drug trend report as a part of Cigna Corp., Express Scripts Holding Co. said it had achieved a record low drug trend of 0.4% across its clients' employer-sponsored commercial plans in 2018. Overall, the PBM reported savings of $45 billion for its clients last year, AIS Health reported.

The PBM cited "an unprecedented 0.3% decline" in per-beneficiary drug spending across Medicare plans. Overall, there was a 1.4% decrease in unit cost trend, which allowed clients to absorb a 1.1% increase in utilization, the PBM said. Oncology replaced diabetes as Medicare’s top therapy class by per member per year spend.
 
Read More

Topics: Industry Trends, Market Access, Data & Analytics, Provider, Payer