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

Radar On Market Access: Specialty Drug Management Continues to Concern Employers

Posted by Matt Breese on Sep 4, 2018

Specialty drugs continue to be a concern for large employers, according to The Large Employers' 2019 Health Care Strategy and Plan Design Survey by the National Business Group on Health (NBGH), AIS Health reported. 
NBGH surveyed its corporate members in May and June on what they are doing for 2019. When NBGH asked employers about specialty pharmacy benefit management techniques, respondents selected more aggressive utilization management protocols as the top strategy, with 64% citing this, followed by having employees get specialty drugs through a specialty pharmacy or the specialty department of the health plan or PBM, cited by 58%. At 44%, site-of-care management notched the third top technique.
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Topics: Specialty, Industry Trends, Data & Analytics, Payer

Trends That Matter for Global Oncology

Posted by Matt Breese on Aug 30, 2018

The field of oncology continues to see increasingly innovative treatments and increasingly higher prices, according to IQVIA Institute for Human Data Science’s report Global Oncology Trends: Innovation, Expansion and Disruption

According to the report, the programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors represent a paradigm shift in the treatment of cancer. Since the therapies first entered the U.S. market in 2014, their use has expanded rapidly, and in 2017, they were used to treat patients with 23 tumor types.

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Topics: Specialty, Industry Trends, Data & Analytics, Branding & Marketing

Radar On Market Access: Generic Firm as "Societal Asset"

Posted by Matt Breese on Aug 2, 2018

Earlier this year, Intermountain Healthcare teamed up with other health systems to start building a not-for-profit generic drug manufacturing business, with a goal to create "what we think…[is] a first-of-its-kind societal asset," said Dan Liljenquist, vice president of Intermountain Healthcare's Enterprise Initiative Office.
"Essentially, we're going to set this up where the governing members of this organization are going to act more like public service commissioners and build a public-utility-type model for the manufacturing and distribution of essential generic medications," he said.
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Topics: Specialty, Industry Trends, Data & Analytics, Payer

Trends That Matter for Specialty Pharmaceuticals' Managed Care Strategies

Posted by Matt Breese on Jul 19, 2018

A survey by EMD Serono, Inc. revealed that managing oncology drugs and services remains the top challenge for health plans, tied with determining the value of specialty drugs and ensuring clinically appropriate use of specialty therapies. 

Site-of-care programs continue to rise in use, with a 135% increase. Intravenous immune globulin (89%), rheumatoid arthritis/Crohn's (86%) and multiple sclerosis (67%) were the top therapeutic categories for site-of-care strategies.

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Topics: Specialty, Market Access, Data & Analytics, Payer

Radar On Market Access: Clover Health Offers Pharmacogenomics Testing

Posted by Matt Breese on Jul 17, 2018

In-home primary care has become a de rigueur offering for Medicare Advantage (MA) organizations looking to avoid costly emergency room visits and hospital admissions. Clover Health aims to innovate the traditional multidisciplinary structure with pharmacogenomic testing that could lead to safer and more effective medication use, AIS Health reported. 
Clover currently serves about 600 frail, chronically ill members in its home care program, who on average have between six and 11 chronic conditions and are on 10 or more medications. The insurer in June began offering genetic testing capabilities provided by YouScript, a proprietary clinical decision support tool designed to assist in medication therapy management.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Amazon/PillPack Deal Has Limited Effect

Posted by Matt Breese on Jul 12, 2018

Amazon recently unveiled its plan to purchase PillPack — a tech-enabled startup that offers pre-sorted dose packaging and home delivery of prescription drugs for those taking multiple medications — yet industry analysts do not appear convinced that the acquisition will have a significant effect on PBMs or health insurers, at least not in the short term, AIS Health reported.
"We do not expect any material impact on our financial expectations for the MCOs we cover and thus we make no change to our estimates or ratings," Credit Suisse's A.J. Rice wrote in a research note.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Centene Highlights New PBM Asset

Posted by Matt Breese on Jul 10, 2018

Amid a flurry of recent deal-making in the PBM sector, Centene Corp. highlighted the capabilities of the tech-savvy PBM it recently invested in, RxAdvance, during its June 15 investor day presentation, AIS Health reported.
Centene's equity investment in RxAdvance, CEO Michael Neidorff said, was made to complement the insurer's internal PBM, US Script. RxAdvance's technology and PBM cloud platform "will enable us to drive change across the care continuum," he added.
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Topics: Industry Trends, Data & Analytics, Payer

Trends That Matter for Drug Cost

Posted by Matt Breese on Jul 5, 2018

IngenioRx, the PBM being developed by Anthem, Inc., released a drug trend report on May 31 that says Anthem's ability to manage both medical and pharmacy benefits kept the average drug cost increase at 2% for the insurer's affiliated employer-based health plans in 14 states in 2017, AIS Health reported. 

The report also found that inflation was the primary contributor to 2017 drug trends, pushing it up by 5.6%. In addition, specialty medical (21.1%) and specialty pharmacy (29.1%) accounted for 50.2% of drug spending in 2017, but by 2021 that share is expected to increase to 59.3%.

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Topics: Market Access, Data & Analytics

Perspectives on Outcomes-Based Drug Pricing

Posted by Matt Breese on Jun 28, 2018

While outcomes-based contracts for prescription drugs are a continual hot topic in the health care industry, experts who spoke on a panel at the World Health Care Congress cited several barriers that are keeping these contracts from proliferating widely: chiefly, not enough reliable data and regulatory issues such as the federal antikickback statute.
"The beautiful thing about value-based contracts is we are basically putting the patient at the center of everything," said Enrique A. Conterno, senior vice president of Eli Lilly and Co.  
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Prime's New Platform Targets Fraud, Waste and Abuse

Posted by Matt Breese on Jun 21, 2018

Prime Therapeutics LLC has rolled out a new analytics platform to help identify and weed out fraud, waste and abuse. The tool takes a comprehensive look across both pharmacy and medical claims, giving a complete picture of a member's situation. Its fraud framework also builds out scenarios in order to help predict where the new area of fraud is going to be, AIS Health reported. 
Last year alone, Prime identified more than $211 million in fraud, waste and abuse within its network. The new tool is estimated to save the company's clients "more than $250 million in the next year," according to Prime.
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Topics: Specialty, Industry Trends, Data & Analytics