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Leslie Small

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Radar On Market Access: CVS, Cigna Preview What’s in Store After Their Deals Close

Posted by Leslie Small on Nov 13, 2018

CVS Health Corp. — which is on the brink of closing its $69 billion purchase of Aetna Inc. — is offering up more details about the "revolutionary" new health care model it plans to create after the companies officially combine, AIS Health reported.

The Dept. of Justice approved the CVS-Aetna deal in mid-October, contingent upon Aetna selling its Medicare Part D Prescription Drug Plan (PDP) business to WellCare Health Plans, Inc. In addition, 23 out of the 28 states that must approve the transaction have now done so, and CVS is "well down the line" with the remaining five states, CEO Larry Merlo said on the company's third-quarter earnings call. He said CVS now expects to close the deal before Thanksgiving.

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Topics: Industry Trends, Payer, Provider

Perspectives on CVS Bid to Lower Drug Launch Prices

Posted by Leslie Small on Nov 1, 2018

In an effort to pressure drug manufacturers to temper their launch prices for new drugs, CVS Health Corp. is rolling out a program in which drugs that have a price exceeding a certain cost-effectiveness threshold will be excluded from coverage, AIS Health reported.

CVS will let clients refuse to cover drugs that have a price tag of more than $100,000 per quality-adjusted life year (QALY), provided they are not designated as "breakthrough" therapies by the FDA.

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

Radar On Market Access: Express Scripts Exec Urges Smarter Treatment of HIV

Posted by Leslie Small on Nov 1, 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.

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

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Topics: Industry Trends, Payer, Specialty, Provider

Radar On Market Access: Proposed Part D Change Might Not Be “Catastrophic”

Posted by Leslie Small on Oct 30, 2018

If the Trump administration gets its way, Medicare Part D plan sponsors may at some point be on the hook for a greater share of costs once beneficiaries reach the catastrophic phase of coverage for prescription drugs. While America's Health Insurance Plans (AHIP) is opposed to the idea, experts tell AIS Health that the time may be ripe for such a change.

Beneficiaries enter the catastrophic coverage phase when, as of 2018, their "true out-of-pocket costs" exceed $5,000. Once in that phase, beneficiaries pay no more than 5% of the total cost for their drugs, while the federal government pays 80% and the Part D plan pays 15%.

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Topics: Industry Trends, Payer, Specialty, Provider

Trends That Matter for Epilepsy Medications

Posted by Leslie Small on Oct 25, 2018

This June, the FDA approved Epidiolex (cannabidiol), the first-ever agency-approved treatment that contains a purified drug substance derived from marijuana, AIS Health reported. The oral solution, produced by GW Pharmaceuticals plc, is indicated for the treatment of seizures associated with two rare forms of childhood-onset epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome, for patients ages two and older.

The average gross price for Epidiolex will be $32,500 per year, Julian Gangolli, North America president of GW Pharmaceuticals, said during the company's Aug. 7 earnings call.

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Topics: Specialty, Market Access, Payer

Radar On Market Access: UnitedHealth Bolsters OptumRx With Genoa Buy

Posted by Leslie Small on Oct 23, 2018

UnitedHealth Group’s acquisition of Genoa Healthcare — the fifth largest pharmacy chain in the country — gives OptumRx an edge in a competitive PBM space where companies are racing to innovate, one expert tells AIS Health.

Ashraf Shehata, a principal in KPMG’s health care and life sciences advisory practice, says not only does the purchase add to UnitedHealth’s ever-growing size — “and bigger is always better” — but it also helps give the company a boost in a highly competitive environment where the CVS Health Corp./Aetna Inc. and Cigna Corp./Express Scripts Holding Co. deals are changing the game.

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Topics: Industry Trends, Payer, Market Access

Radar On Market Access: Once Deal Closes, What’s Next for Cigna/Express Scripts?

Posted by Leslie Small on Oct 9, 2018

On Sept. 17, the U.S. Department of Justice (DOJ) formally approved Cigna Corp.'s acquisition of Express Scripts Holding Co., a move that sets the companies on a path to close their transaction by the end of the year. Once their tie-up is completed, though, Cigna and Express Scripts will be tasked with a new set of challenges, experts tell AIS Health
 
"I think the greatest challenge will be kind of the integration of different cultures," says Brian Anderson, a principal at Milliman, Inc., noting that Express Scripts is used to functioning as a stand-alone PBM and Cigna as a health insurer.
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Topics: Industry Trends, Specialty, Market Access

Radar On Market Access: Plans Might Tap Utilization Management for Marijuana-Derived Epilepsy Drug

Posted by Leslie Small on Oct 4, 2018

When a pricey, unique medication for two rare forms of childhood-onset epilepsy comes onto the market — which could happen later this year — payers are likely to cover it but will probably subject the drug to prior authorization, experts tell AIS Health.
 
The drug in question is Epidiolex (cannabidiol), which in June became the first FDA-approved treatment that contains a purified drug substance derived from marijuana. The oral solution, produced by GW Pharmaceuticals plc, is indicated for the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) or Dravet syndrome for patients ages two and older.
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Topics: Industry Trends, Payer, Specialty, Provider, Data & Analytics

Radar On Market Access: CVS Bid to Lower Drug Launch Prices Sees Pushback

Posted by Leslie Small on Sep 27, 2018

In an effort to pressure drug manufacturers to temper their launch prices for new drugs, CVS Health Corp. is rolling out a program in which drugs that have a price exceeding a certain cost-effectiveness threshold will be excluded from coverage, AIS Health reported.
 
CVS will let clients refuse to cover drugs that have a price tag of more than $100,000 per quality-adjusted life year (QALY), provided they are not designated as "breakthrough" therapies by the FDA.
Read More

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