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Leslie Small

Recent Posts

Trends That Matter for Medicare Part D Costs

Posted by Leslie Small on Aug 15, 2019

A recently published study in Health Affairs shines a light on a peculiar quirk of the Medicare Part D benefit structure: For some high-priced specialty medications, seniors might pay less out-of-pocket for brand-name drugs than their generic counterparts.

The study found that, assuming a 61% discount between brand-name and generic drugs, Part D beneficiaries with prescriptions costing between $22,000 and $80,000 per year would have lower out-of-pocket spending if they use brand-name drugs over a generic, AIS Health reported.
 
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Topics: Industry Trends, Product Release, Data & Analytics

Radar On Market Access: Congress Eyes Measures That Could Affect PBMs

Posted by Leslie Small on Aug 6, 2019

Now that the Trump administration has abandoned its bid to overhaul the Medicare Part D drug rebate system, all eyes are on what Congress will do to address the ever-vexing problem of high drug prices, AIS Health reported.

While some ideas lawmakers are considering could be very problematic for PBMs, industry analysts are dubious about their prospects. Other less-drastic changes, though, could make it into law.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Can Louisiana’s Hepatitis C Drug Payment Model Be Replicated?

Posted by Leslie Small on Aug 1, 2019

Beginning last month, Louisiana has been able to treat hundreds of patients who were waiting to receive a pricey cure for hepatitis C thanks to after hammering out an innovative payment model with a drug manufacturer, AIS Health reported.

But the road to get there was long and difficult, according to Rebekah Gee, M.D., secretary of the Louisiana Dept. of Health, who, during a July 22 event hosted by the Brookings Institution, detailed the challenges she faced in trying to get a costly curative therapy to more people while facing down a $2 billion budget deficit. "We were told 'No' at least 50 times from a variety of people, whether it was the industry, or policymakers or individuals at the CDC…because it had never been done before," she said.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Plans Offer More $0 Copay Drugs to Boost Adherence

Posted by Leslie Small on Jul 23, 2019

As various players in the health care industry sharpen their focus on disease prevention, some experts tell AIS Health they’re seeing health plans offering more and more "preventive" drugs at no cost to members.

Dean Health Plan recently said it’s "adding even more preventive drugs to our list of drugs available to [members] for $0." Additions to the list, which total more than 200, include Advair inhalers (fluticasone propionate and salmeterol) for asthma, the diabetes drug Januvia (sitagliptin), and Alendronate for osteoporosis, says Kevin Engelien, manager of large group product and market research at the Wisconsin-based insurer.
 
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Topics: Industry Trends, Market Access, Provider, Payer

Radar On Market Access: In Medicare Part D, Generic Drugs May Not Always Be Cheaper

Posted by Leslie Small on Jul 16, 2019

A recently published study in Health Affairs shines a light on a peculiar quirk of the Medicare Part D benefit structure: For some high-priced specialty medications, seniors might pay less out-of-pocket for brand-name drugs than their generic counterparts.

The study found that, assuming a 61% discount between brand-name and generic drugs, Part D beneficiaries with prescriptions costing between $22,000 and $80,000 per year would have lower out-of-pocket spending if they use brand-name drugs over a generic, AIS Health reported.
 
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Topics: Specialty, Industry Trends, Market Access, Data & Analytics, Provider, Payer

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