Contact

Payer

Pharma

Provider

Formulary guidance and transparency from P&T to point of care

Judy Packer Tursman

Senior Reporter, Health Plan Weekly and Radar on Drug Benefits

Recent Posts

Perspectives on Blockchain Technology

Posted by Judy Packer Tursman on Aug 22, 2019

Industry consultants from Milliman Inc. assert in a July 11 report that blockchain — which is described as a real-time digital ledger for building secure networks — "could potentially transform the relationship between payers, pharmaceutical manufacturers, wholesalers, and pharmacies by offering an alternative, transparent mechanism for processing, pricing, and validating prescription transactions."

Using blockchain technology, payers and pharmacies would reduce the time they spend validating insurance coverage, making phone calls and managing data, Milliman explains. The firm is urging PBMs to work to "evaluate a blockchain alternative now with an eye toward a more efficient drug financing system" capable of handling additional technology improvements, AIS Health reported.
 
Read More

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

Radar On Market Access: Will Blockchain Transform Relationships Industry Wide?

Posted by Judy Packer Tursman on Jul 30, 2019

Industry consultants from Milliman Inc. assert in a July 11 report that blockchain — which is described as a real-time digital ledger for building secure networks — "could potentially transform the relationship between payers, pharmaceutical manufacturers, wholesalers, and pharmacies by offering an alternative, transparent mechanism for processing, pricing, and validating prescription transactions."

Using blockchain technology, payers and pharmacies would reduce the time they spend validating insurance coverage, making phone calls and managing data, Milliman explains. The firm is urging PBMs to work to "evaluate a blockchain alternative now with an eye toward a more efficient drug financing system" capable of handling additional technology improvements, AIS Health reported.
 
Read More

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

Trends That Matter for Oncology Biosimilars Management

Posted by Judy Packer Tursman on Jul 18, 2019

Magellan Rx Management, the PBM division of Magellan Health, Inc., on June 4 announced its launch of an oncology biosimilars program, preparing its health plan customers for the expected market entry of biosimilars for three cancer-fighting drugs — Herceptin, Rituxan and Avastin — later this year, AIS Health reported.

"Oncology is by far the largest therapeutic area for drug spend on the medical benefit, and it is even higher in Medicare," Steve Cutts, senior vice president and general manager for Magellan Rx's specialty drug unit, tells AIS Health. Thus, he says, the PBM will be focusing the oncology biosimilars program "on all lines of business for our clients."
 
Read More

Topics: Industry Trends, Product Release, Data & Analytics

Perspectives on the First NASH Drugs

Posted by Judy Packer Tursman on Jul 11, 2019

Doctors trying to treat patients with nonalcoholic steatohepatitis (NASH) — a serious type of nonalcoholic fatty liver disease (NAFLD) that, if left untreated, may progress to cardiovascular disease, cirrhosis, cancer and possibly the need for a liver transplant — soon may have new options in their arsenal beyond promoting exercise and diet. The first-ever NASH drugs are expected to hit the U.S. market as early as 2020 to help address this increasingly prevalent, complex disease spawned largely by the obesity epidemic and surge of type 2 diabetes in the U.S., AIS Health reported.

Douglas Dieterich, M.D., director of the Institute for Liver Medicine at Mount Sinai Health System, says the entry of first-ever NASH medications will "definitely" offer significant benefit to patients. "There's no question [the drugs will help] — in combination with diet and exercise," he says. "It will have to be the whole package."
 
Read More

Topics: Specialty, Industry Trends, Product Release, Provider, Payer

Radar On Market Access: States Plow Ahead on 'Subscription' Models for Hep C Therapy

Posted by Judy Packer Tursman on Jul 4, 2019

Last month, CMS approved Medicaid state plan amendments for Louisiana and Washington state, thus allowing the states to launch innovative value-based purchasing arrangements. Both states' programs are aimed at working with partnering drug manufacturers to better handle the high costs for curative hepatitis C treatments, and may be the harbinger of similar initiatives by additional states.

Louisiana "put the bow" on its plan to get hepatitis C treatment to Medicaid enrollees and incarcerated individuals over the next five years via a "Netflix"-like subscription model, a state official tells AIS Health.
 
Read More

Topics: Industry Trends, Market Access, Provider, Payer

Perspectives on Express Script's "Digital Health Formulary"

Posted by Judy Packer Tursman on Jun 27, 2019

Cigna Corp.'s Express Script PBM expects to introduce the industry's first stand-alone "digital health formulary" in 2020, the company said May 16. It intends to use a uniform review process to ensure the safety and quality of apps and devices on the market for diabetes, cardiovascular and pulmonary conditions and behavioral health, AIS Health reported.

By creating a digital formulary, Express Scripts "is using old hat methods to manage these new digital health solutions much like they do on brand and generic drugs or other therapies via utilization management," says Nathan Ray, senior principal in business consulting firm West Monroe Partners’ health care and life sciences practice.
 
Read More

Topics: Industry Trends, Provider, Payer

Radar On Market Access: Troy Medicare Aims to Launch Pharmacist-Centered Model in NC

Posted by Judy Packer Tursman on Jun 25, 2019

Troy Medicare, a small Medicare Advantage plan start-up, aims to shake up the North Carolina MA marketplace during the coming fall open enrollment by offering a pharmacist-centered delivery model that will pay local, independent pharmacists directly for enhanced care management services to seniors.

"We will go live on Jan. 1, 2020," in a five-county, "semi-rural" service area around Charlotte, N.C., Troy CEO Flaviu Simihaian tells AIS Health.
 
Read More

Topics: Industry Trends, Market Access, Provider, Payer

Radar On Market Access: Magellan Rx Initiates Oncology Biosimilars Program

Posted by Judy Packer Tursman on Jun 20, 2019

Magellan Rx Management, the PBM division of Magellan Health, Inc., on June 4 announced its launch of an oncology biosimilars program, preparing its health plan customers for the expected market entry of biosimilars for three cancer-fighting drugs — Herceptin, Rituxan and Avastin — later this year, AIS Health reported.

"Oncology is by far the largest therapeutic area for drug spend on the medical benefit, and it is even higher in Medicare," Steve Cutts, senior vice president and general manager for Magellan Rx's specialty drug unit, tells AIS Health. Thus, he says, the PBM will be focusing the oncology biosimilars program "on all lines of business for our clients."
 
Read More

Topics: Specialty, Industry Trends, Market Access

Radar On Market Access: Payers Are Wary as First NASH Drugs May Hit U.S. Market Soon

Posted by Judy Packer Tursman on Jun 18, 2019

Doctors trying to treat patients with nonalcoholic steatohepatitis (NASH) — a serious type of nonalcoholic fatty liver disease (NAFLD) that, if left untreated, may progress to cardiovascular disease, cirrhosis, cancer and possibly the need for a liver transplant — soon may have new options in their arsenal beyond promoting exercise and diet. The first-ever NASH drugs are expected to hit the U.S. market as early as 2020 to help address this increasingly prevalent, complex disease spawned largely by the obesity epidemic and surge of type 2 diabetes in the U.S., AIS Health reported.

Douglas Dieterich, M.D., director of the Institute for Liver Medicine at Mount Sinai Health System, says the entry of first-ever NASH medications will "definitely" offer significant benefit to patients. "There's no question [the drugs will help] — in combination with diet and exercise," he says. "It will have to be the whole package."
 
Read More

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

Perspectives on CMS's Drug Pricing Proposals

Posted by Judy Packer Tursman on Jun 13, 2019

When CMS issued the final rule on Medicare Advantage and Part D drug pricing on May 16, the agency touted its policy changes as ensuring consumers get greater transparency into the cost of Part D prescription drugs and enabling MA plans to negotiate better prices for physician-administered medicines in Part C. Yet, after receiving 4,000-plus comments related to pharmacy price concessions on negotiated price, CMS held back, saying it won't implement this policy for 2020 — or follow through on proposed exceptions to Part D protected drug classes, AIS Health reported.

Among numerous provisions, CMS's final rule implements the statutory prohibition against gag clauses in pharmacy contracts, barring Part D plans from penalizing pharmacies that disclose a lower cash price to enrollees. But the agency decided against implementing a policy redefining negotiated price as the lowest possible, baseline payment to pharmacies.
 
Read More

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