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Trends That Matter for New Multiple Sclerosis Value-Based Contract

Posted by Sharon Bender on Jan 16, 2020

Under a value-based contracting agreement believed to be the first of its kind, UPMC Health Plan will receive discounts for two Biogen Inc. multiple sclerosis (MS) drugs — Tecfidera (dimethyl fumarate) and Avonex (interferon beta-1a) — based on patient-reported measures of disability progression. The agreement is also based on research with a panel of key MS stakeholders who identified the most meaningful outcomes in relapsing forms of MS, AIS Health reported.

UPMC's Center for Value-Based Pharmacy Initiatives led the research and developed the value-based contract.
 
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Topics: Industry Trends, Market Access, Data & Analytics

Radar on Market Access: State Lawmakers Tee Up Bills on PBMs, Drug Pricing This Year

Posted by Jane Anderson on Jan 16, 2020

State lawmakers will continue to focus on the cost of prescription drugs as the 2020 legislative season gets underway, potentially advancing measures to require the disclosure of manufacturer drug pricing information and bills to limit or eliminate the role PBMs play in state Medicaid programs, AIS Health reported.

However, the abbreviated length of the election-year legislative sessions, plus some unexpected hiccups in states that already have passed bills on those issues, could limit how much actually gets done at the state level in 2020, legislative observers say.

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Topics: Data & Analytics, Provider, Payer

Radar On Market Access: 2020 Could Be 'Wild Year' for Consolidated PBMs

Posted by Leslie Small on Jan 14, 2020

Though the two major transactions that upended the PBM landscape — Cigna Corp. buying Express Scripts Holding Co. and CVS Health Corp. acquiring Aetna Inc. — have already taken place, that doesn't mean the sector won't see more changes this year, industry experts tell AIS Health.

"The market is evolving," says Brian Anderson, a principal with Milliman, Inc. The year 2020 will be marked by a presidential election and significant price pressure on manufacturers, along with pharmacies trying to retain their margin, he adds, "so it's going to be a really wild year."

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

Radar On Market Access: Navajo Nation, Molina Partner on Medicaid Managed Care in New Mexico

Posted by Jane Anderson on Jan 7, 2020

The business arm of the Navajo Nation plans to contract with Molina Healthcare, Inc., to offer Medicaid managed care as part of a partnership between New Mexico, tribal officials and the insurer, AIS Health reported.

The program would be the first-ever Medicaid managed care program dedicated solely to the health care, cultural needs and geographic needs of native populations living in the Navajo Nation, according to Molina.

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Topics: Data & Analytics, Provider, Payer

Trends That Matter for New Acute Migraine Medications

Posted by Jane Anderson on Jan 2, 2020

New oral medications for acute migraine — one pending launch and two more that could be approved in the coming months — likely won't shake up formulary coverage for a condition that's largely treated by generic triptan medications, pharmacy benefit experts tell AIS Health.

Eli Lilly and Co. on Oct. 11 received FDA approval for its drug Reyvow (lasmiditan), an oral medication that's the first serotonin (5-HT)1F receptor agonist to be approved for migraine. Meanwhile, Allergan on Nov. 19 said it's on track for December FDA consideration of ubrogepant, an oral CGRP receptor antagonist for acute migraine. Biohaven Pharmaceuticals also has applied for FDA approval on its oral CGRP antagonist rimegepant.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: New Sickle Cell Medications Offer Both Opportunities and Challenges

Posted by Judy Packer Tursman on Jan 2, 2020

The first targeted therapy to treat pain crises in people with sickle cell disease presents a "welcome" new option that payers likely will embrace, a PBM head tells AIS Health. While the drug's manufacturer cites "positive" early discussions with payers on it, some experts note the lifetime treatment — via a monthly intravenous infusion — is costly: around $100,000 annually.

On Nov. 15, the FDA approved Novartis' Adakveo (crizanlizumab-tmca), a treatment to fight the underlying cause and reduce the frequency of vaso-occlusive crisis, described as a common and painful complication of sickle cell disease. It is approved for patients ages 16 and older with the genetic blood disorder.

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

Radar On Market Access: Health Insurers Receive Multiple Gifts In Year-End Spending Package

Posted by Leslie Small on Dec 26, 2019

For health insurers, there's a lot to like in a spending package passed by Congress to avoid a government shutdown.

One of the two measures that make up the $1.4 trillion spending package will completely repeal the long-reviled health insurer fee (HIF) starting in 2021, which will especially help insurers in the Medicare Advantage business. The legislation also includes two provisions to that could stabilize the Affordable Care Act exchanges by thwarting any attempts to ban silver loading or auto-reenrollment, AIS Health reported.

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Topics: Data & Analytics, Provider, Payer

Radar On Market Access: Uptake of New MA Supplemental Benefits Remains Modest in 2020, Report Says

Posted by Lauren Flynn Kelly on Dec 24, 2019

Despite Medicare Advantage insurers' enthusiasm for increased flexibility in allowable supplemental benefits and a slew of recent plan press releases touting goodies such as pest control and "Papa Pals" for the 2020 plan year, uptake of more "resource intensive" benefits geared toward seriously ill seniors remains relatively modest, according to a new report from the Duke Margolis Center for Health Policy.

The December report, "Improving Serious Illness Care in Medicare Advantage: New Regulatory Flexibility for Supplemental Benefits," showed that a total of 507 standard MA plans in 2019 offered one of five types of benefits addressing serious illness, accounting for roughly 11% of the approximately 4,500 standard MA plans in 2019, AIS Health reported. By contrast, 377 in 2020 offered at least one of the five benefits highlighted in the report, while no plans in 2019 offered more than one of these benefits. But that drop was mainly driven by one major carrier abandoning its caregiver support benefit for 2020. Meanwhile, about 175 plans offered at least two of these types of these benefits, according to Robert Saunders, research director and one of the report's authors.

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Topics: Data & Analytics, Provider, Payer

Trends That Matter for Anti-VEGF Market

Posted by Angela Maas on Dec 19, 2019

In October 2019, the FDA approved Beovu (brolucizumab-dbll) from Novartis Pharmaceuticals Corp. for the treatment of neovascular (wet) age-related macular degeneration (AMD). The intravitreal injection will compete in a fairly crowded anti-vascular endothelial growth factor (anti-VEGF) market that is led by Eylea (aflibercept) from Regeneron Pharmaceuticals, Inc., AIS Health reported.

Novartis priced Beovu at $1,850 per vial — the same per-dose price as Eylea. Following three initial monthly doses, Beovu can be administered every eight to 12 weeks. Eylea also has three initial monthly doses and then may be administered every four, eight or 12 weeks..
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: Patient-Reported Outcomes Play Key Role in New Multiple Sclerosis Value-Based Contract

Posted by Sharon Bender on Dec 19, 2019

Under a value-based contracting agreement believed to be the first of its kind, UPMC Health Plan will receive discounts for two Biogen Inc. multiple sclerosis (MS) drugs — Tecfidera (dimethyl fumarate) and Avonex (interferon beta-1a) — based on patient-reported measures of disability progression. The agreement is also based on research with a panel of key MS stakeholders who identified the most meaningful outcomes in relapsing forms of MS, AIS Health reported.

UPMC's Center for Value-Based Pharmacy Initiatives led the research and developed the value-based contract.

Read More

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