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Leslie Small

Recent Posts

Trends That Matter for Insulin

Posted by Leslie Small on Apr 25, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.
 
Leading PBMs, such as CVS Health Corp., Express Scripts and Prime Therapeutics, also applied formulary strategies to keep insulin affordable. CVS Health reported a -1.7% trend for antidiabetic drugs in 2018, despite increasing utilization and 5.6% average wholesale price inflation for brand drugs, according to its 2018 drug trend report
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: CMS Guidance on Rebate Shift Offers Transition for Part D Plans

Posted by Leslie Small on Apr 25, 2019

As insurers and PBMs prepared to submit their comments about a proposed overhaul of the prescription drug rebate system, CMS on April 5 issued a guidance document aimed at mitigating at least some of their concerns, AIS Health reported.

The proposed rule would remove safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs, Part D plans and Medicaid managed care organizations, and it would create a new safe-harbor protection for point-of-sale drug discounts.
 
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Topics: Specialty, Industry Trends, Provider, Payer

Perspectives on Insulin Management

Posted by Leslie Small on Apr 18, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D "doughnut hole." 
 
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Topics: Industry Trends, Market Access, Data & Analytics, Provider, Payer

Radar On Market Access: PBM Trade Group Offers Alternative to Proposed Drug Rebate Changes

Posted by Leslie Small on Apr 16, 2019

One day before executives from the country's largest PBMs testified on Capitol Hill about rising drug prices, the Pharmaceutical Care Management Association (PCMA), which lobbies on behalf of PBMs, submitted a comment letter telling the Trump administration in no uncertain terms that a proposed rule aiming to upend the prescription drug rebate system will do more harm than good, AIS Health reported.

The proposed rule, released Jan. 31, would remove safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs, Part D plans and Medicaid managed care organizations, and it would create a new safe-harbor protection for point-of-sale drug discounts.
 
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Topics: Industry Trends

Radar On Market Access: Insurer Tools Aim to Help Members Save on Prescription Drugs

Posted by Leslie Small on Apr 4, 2019

As many Americans continue to struggle to afford their medications, health insurers and their PBMs are responding with tools that help consumers not only understand the cost of drugs before prescriptions are filled, but also find ways to spend less money on them, AIS Health reported.

However payers choose to design such tools, two keys to their success include making improvements over time and making sure members know about them before they might need them, according to Nathan Foco, senior director of market and sales intelligence for Michigan-based Priority Health.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Magellan’s PBM Could Be Attractive Acquisition Target

Posted by Leslie Small on Mar 26, 2019

After weathering a rocky 2018 and facing public pressure from a hedge fund, Magellan Health Inc. appears more and more likely to end up on the selling block. Some say that if the company does opt for a sale, its PBM could be one of the most attractive assets to potential buyers, AIS Health reported.

On Feb. 22, the hedge fund Starboard Value — which owns approximately 9.8% of Magellan shares — sent an open letter to the company's shareholders suggesting new candidates for its board of directors and urging Magellan management to explore selling all or part of the company.
 
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Topics: Specialty, Provider, Payer

Radar On Market Access: As Insulin Prices Balloon, Insurers Try to Offer Some Relief

Posted by Leslie Small on Mar 21, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D "doughnut hole." 
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Diplomat Pharmacy Postpones Earnings Release Amid PBM Struggles

Posted by Leslie Small on Mar 5, 2019

Diplomat Pharmacy Inc.'s stock value plummeted recently after the company said it would delay the release of its fourth-quarter and full-year earnings results — primarily because of difficulties with its PBM business, AIS Health reported.

Diplomat entered the PBM space in 2017 when it acquired National Pharmaceutical Services and LDI Integrated Pharmacy Services. The company disclosed in a Feb. 22 press release that it anticipates writing down a "significant portion" of its PBM business' approximately $630 million in assets. It also said it is withdrawing its preliminary 2019 full-year earnings outlook, in part because it's seen "additional customer losses in its PBM business since early January," which combined with a "softer outlook for client wins and other factors" has led to a lower-than-expected outlook for its PBM business in 2019.
 
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Topics: Industry Trends, Data & Analytics, Provider

Radar On Market Access: Highmark Expands Proving Ground for Innovative Therapies

Posted by Leslie Small on Feb 28, 2019

After Highmark Health expanded from an insurer to an integrated delivery system, the organization decided it was uniquely positioned to launch a platform to test early-stage, FDA-approved medical innovations that were struggling to attain the evidence needed for widespread adoption — and, critically, insurance reimbursement, AIS Health reported.

Nearly four years later, Highmark Health Plan and its affiliate Allegheny Health Network have changed their policies and purchasing contracts to provide therapeutic innovations to members after gathering evidence on their effectiveness. Examples include HeartFlow, which can create a 3D model of coronary arteries and blockages, and FreeSpira, a digital therapeutic that reduces debilitating panic attacks.
 
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Topics: Data & Analytics, Provider, Payer

Perspectives on California's Plan to Move Medicaid Pharmacy Purchasing to FFS

Posted by Leslie Small on Feb 21, 2019

Under the direction of its new governor, Democrat Gavin Newsom, California is planning to take control of the pharmacy benefit for all of the state's Medi-Cal beneficiaries — the vast majority of which currently have that part of their care administered by private insurers and their PBMs, AIS Health reported. What's more, the order directs state agencies to create bulk-purchasing arrangements for high-priority drugs and establish a framework for letting private businesses and insurers join the state’s buying pool.

The idea of the state's Medicaid program shifting to an entirely fee-for-service drug benefits system is already sparking worries about what it will do to PBMs' bottom lines.
 
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Topics: Industry Trends, Provider, Payer