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Radar On Market Access: Express Scripts Takes on Industry's Digital Transformation

Posted by Judy Packer Tursman on May 30, 2019

Cigna Corp.'s Express Script PBM expects to introduce the industry's first stand-alone "digital health formulary" in 2020, the company said May 16. It intends to use a uniform review process to ensure the safety and quality of apps and devices on the market for diabetes, cardiovascular and pulmonary conditions and behavioral health, AIS Health reported.

By creating a digital formulary, Express Scripts "is using old hat methods to manage these new digital health solutions much like they do on brand and generic drugs or other therapies via utilization management," says Nathan Ray, senior principal in business consulting firm West Monroe Partners’ health care and life sciences practice.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: CMS 'Meaningfully Walks Back' on Key Drug Pricing Proposals

Posted by Judy Packer Tursman on May 28, 2019

When CMS issued the final rule on Medicare Advantage and Part D drug pricing on May 16, the agency touted its policy changes as ensuring consumers get greater transparency into the cost of Part D prescription drugs and enabling MA plans to negotiate better prices for physician-administered medicines in Part C. Yet, after receiving 4,000-plus comments related to pharmacy price concessions on negotiated price, CMS held back, saying it won't implement this policy for 2020 — or follow through on proposed exceptions to Part D protected drug classes, AIS Health reported.

Among numerous provisions, CMS’s final rule implements the statutory prohibition against gag clauses in pharmacy contracts, barring Part D plans from penalizing pharmacies that disclose a lower cash price to enrollees. But the agency decided against implementing a policy redefining negotiated price as the lowest possible, baseline payment to pharmacies.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Trends That Matter for Infliximab Biosimilars

Posted by Jane Anderson on May 23, 2019

Magellan Rx Management saw a significant shift in utilization from Janssen Biotech, Inc.'s Remicade (infliximab) to biosimilars after it implemented a comprehensive utilization management (UM) program, resulting in 34% drug cost savings, the PBM reported.

The program, which began in late 2017, involves any patient prescribed an infliximab product for any indication, and is available to all payer clients as an opt-in option, Steve Cutts, senior vice president and general manager, tells AIS Health.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: Study Examines Effects of Strategies in SBS Management

Posted by Angela Maas on May 23, 2019

People with short bowel syndrome (SBS) need a high-touch approach to be effectively managed. Option Care Enterprises, Inc. has a nutritional support team providing clinical interventions, and it recently released a study showing that this approach can save millions of dollars in costs per year, AIS Health reported.

People with SBS have a hard time absorbing nutrients and maintaining hydration and electrolyte balance, and diarrhea is common. Dehydration is a common, even fatal, aspect of this condition, and it often results in hospitalization with an average three-day length of stay.
 
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Topics: Data & Analytics

Radar On Market Access: Use of Biologics, Biosimilars Showed Rapid Uptake in 2018

Posted by Angela Maas on May 16, 2019

Almost 5.8 billion prescriptions were dispensed in the United States in 2018, an increase of 2.7% over the previous year, according to the IQVIA Institute for Human Data Science’s report Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023, AIS Health reported.

Retail and mail pharmacies dispensed 127 million specialty prescriptions last year, an increase of 15 million since 2014. In 2018, for the second year in a row, specialty prescription volume grew more than 5% although the medicines accounted for only 2.2% of prescriptions overall. With an increase in the availability of oral and self-injected specialty therapies, these drugs "are increasingly dispensed through retail pharmacies," said Murray Aitken, executive director of the institute, during a May 6 press call.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: CBO Says Proposed Rebate Rule Will Cost Government $177B

Posted by Angela Maas on May 14, 2019

When HHS unveiled a proposed rule in late January aimed at eliminating drug rebates in Medicare Part D and Medicaid managed care, the proposal was met with mixed responses. A recently released score from the Congressional Budget Office (CBO) calls into question whether the administration chooses to move forward with the proposal in its current form, AIS Health reported.

The proposal would do away with the safe harbor protection in the anti-kickback statute for rebates negotiated between manufacturers and PBMs starting Jan. 1, 2020.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Trends That Matter for Colorectal Cancer Medications

Posted by Angela Maas on May 9, 2019

As innovations in digital capabilities continue to be used with various health care products, Proteus Digital Health, Inc. is developing a suite of what it terms digital medicines. And while the company has been working on such products for a few years, it recently came out with the first such product within the oncology space, AIS Health reported.

Proteus is partnering with Fairview Health Services and the University of Minnesota Health to offer oral capecitabine combined with an ingestible sensor to treat stage 3 and stage 4 colorectal cancer patients
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: Magellan Sees Success With Infliximab Biosimilars

Posted by Jane Anderson on May 7, 2019

Magellan Rx Management saw a significant shift in utilization from Janssen Biotech, Inc.'s Remicade (infliximab) to biosimilars after it implemented a comprehensive utilization management (UM) program, resulting in 34% drug cost savings, the PBM reported.

The program, which began in late 2017, involves any patient prescribed an infliximab product for any indication, and is available to all payer clients as an opt-in option, Steve Cutts, senior vice president and general manager, tells AIS Health.
 
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Topics: 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

2019 Specialty Pharmacy Patient Choice Awards Finalists Announced

Posted by Matt Breese on Apr 23, 2019

 

The Specialty Pharmacy Patient Choice Award was created to recognize specialty pharmacies and their commitment to patient satisfaction. The criteria for this award were formulated by a committee comprised of individuals representing pharmaceutical manufacturers, health plans, pharmacy benefit managers (PBMs), trade organizations, consultants and equity research firms.

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Topics: Industry Trends, Market Access, Data & Analytics, Provider, Payer, Branding & Marketing