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Trends That Matter for Specialty Drug Management

Posted by Matt Breese on Oct 11, 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, Branding & Marketing, Data & Analytics

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: Payers Wait for Gilead’s HCV Generics to Hit Market Soon

Posted by Judy Packer Tursman on Oct 2, 2018

Many payers likely are keeping a close eye on how the pharma industry reacts to Gilead Sciences, Inc.'s Sept. 24 announcement that it intends to soon launch steeply discounted generic versions of two of its chronic hepatitis C virus (HCV) drugs. The biopharma company says these generics will become available in January 2019 in the U.S. — a move that PBM Express Scripts Holding Co. describes as a win for payers and patients alike, AIS Health reported. 
 
According to Gilead, its newly created subsidiary, Asegua Therapeutics, will sell authorized generics of Harvoni and Epclusa "at a list price of $24,000 for the most common course of therapy."
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Topics: Industry Trends, Payer, Specialty, Provider, Data & Analytics

Trends That Matter for 2019 PBMs' Exclusions

Posted by Judy Packer Tursman on Sep 27, 2018

Leading pharmacy benefit managers (PBMs) recently released updates to their 2019 national formularies. As of Jan. 1, Express Scripts Holding Co. will introduce 48 new formulary exclusions in its 2019 National Preferred Formulary (NPF), which the PBM says will help drive out waste, AIS Health reported.

Adam Fein, Ph.D., president of Pembroke Consulting, Inc. and CEO of Drug Channels Institute, notes that Express Scripts, for the first time, excluded products in two specialty categories: HIV antiretrovirals and Factor VIII recombinant products for hemophilia treatment.

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Topics: Specialty, Industry Trends, Branding & Marketing, 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.
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Topics: Industry Trends, Payer, Specialty, Provider, Data & Analytics

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: Industry Trends, Payer, Specialty, Data & Analytics

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, Branding & Marketing, Data & Analytics

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: Data & Analytics, Industry Trends, Payer, Specialty

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: Market Access, Data & Analytics, Payer, Specialty

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: Data & Analytics, Industry Trends, Payer