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

Radar On Market Access: USPS Delivery Slowdown Is Unlikely to Cause Major Rx Fill Disruption

Posted by Peter Johnson on Sep 1, 2020

The recent, sudden disruption of U.S. Postal Service (USPS) deliveries has caused concern about people receiving their medications later than they normally would. While news reports and statements by lawmakers indicate that many Americans have lost prescriptions in the mail or received them late, drug benefit and supply chain experts tell AIS Health the disruption to the most vulnerable patients served by specialty and mail order pharmacies should be minimal.

An Aug. 24 Axios-Ipsos poll shows that one in five Americans received medication through the mail during the preceding week. One in four of that group, or 5% of Americans overall, didn't receive their medication or got it late.

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

Radar On Market Access: Large Employers Expect Cost Uncertainty, More Virtual Care in 2021

Posted by Leslie Small on Aug 25, 2020

While the COVID-19 pandemic has not caused employers to significantly alter their health care cost estimates for the coming year, it has unquestionably intensified their interest in embracing virtual care. Those are just a couple of the major findings from the Business Group on Health's 2021 Large Employers' Health Care Strategy and Plan Design Survey, AIS Health reported.

Notably, 80% of respondents said they believe virtual health will play a significant role in how care is delivered in the future, up considerably from 64% last year. Further, when asked about actions they were taking to ease the burdens of COVID-19 for employees, the largest share of respondents — 76% — said they "made changes to allow for better access to virtual care solutions."

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

Perspectives on UnitedHealth, Humana's Chronic Conditions Programs

Posted by Jane Anderson on Aug 20, 2020

Both UnitedHealthcare and Humana Inc. are rolling out new disease-specific care management programs aimed at providing patients with the tools they need to help control their chronic conditions, AIS Health reported.

The new initiatives highlight new digital and time-tested interpersonal ways of managing chronic conditions, observers say.
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: COVID-19 Pandemic Amps Up Interest in Home Care

Posted by Peter Johnson on Aug 20, 2020

As visits to hospitals and outpatient clinics have become sources of anxiety for patients worried about exposure to the novel coronavirus, plans and providers alike have begun to make major investments in home care, AIS Health reported.

Humana Inc., for example, recently announced a $100 million investment in home primary care startup Heal Inc. Heal CEO Nick Desai says his company will aid Humana's long-term strategy to reduce the cost of care and improve quality.

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

Radar On Market Access: Trump Administration Issues Telehealth Executive Order, More Acts Are Needed

Posted by Peter Johnson on Aug 13, 2020

Recent events indicate the telehealth boom caused by the COVID-19 pandemic will result in a permanent expansion of virtual care. On Aug. 3, the Trump administration issued an executive order directing HHS to make permanent some of the telehealth regulations it relaxed for Medicare beneficiaries during the public health emergency, AIS Health reported.

The executive order directs officials to issue proposed regulations that will lock in some of the changes in telehealth policy that the Trump administration included as part of pandemic relief. In response to the order, CMS on Aug. 3 proposed a rule that would permanently allow Medicare to reimburse for certain services that are furnished virtually, "including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient's home), and certain types of visits for patients with cognitive impairments."

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

Radar On Market Access: FDA Approved Two PARP Inhibitors for Prostate Cancer

Posted by Angela Maas on Aug 11, 2020

Although poly ADP-ribose polymerase (PARP) inhibitors are not new to the market, two of them recently gained approval for use in prostate cancer for the first time. The therapies will bring a new option for the treatment of certain subpopulations of patients, AIS Health reported.

On May 19, the FDA expanded the label of AstraZeneca and Merck & Co., Inc.'s Lynparza (olaparib) to include the treatment of people with deleterious or suspected deleterious germline or somatic homologous recombination repair gene-mutated metastatic castration-resistant prostate cancer who have progressed following treatment with Xtandi (enzalutamide) or Zytiga/Yonsa (abiraterone acetate).

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

Perspectives on Remdesivir's $3,120 Price Tag

Posted by Leslie Small on Aug 6, 2020

Gilead Sciences, Inc. revealed that for promising COVID-19 treatment remdesivir, it will charge $2,340 for a typical five-day, six-vial treatment course for people covered by U.S. government health programs and $3,120 for those covered by private insurance, AIS Health reported.

In an open letter, Gilead CEO Daniel O'Day argued that Gilead priced remdesivir "well below" its estimated value, considering it can save the U.S. health care system approximately $12,000 per patient by reducing the length of COVID-19 patients’ hospital stays.
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Topics: Market Access, Product Release, Provider, Payer

Radar On Market Access: Experts Are Skeptical of Trump Administration's Drug Pricing Executive Orders

Posted by Peter Johnson on Aug 4, 2020

In executive orders released July 24, the Trump administration renewed its push toward a signature campaign issue: lowering drug prices. The three executive orders call for regulations allowing drugs to be imported from other countries, requiring Federally Qualified Health Centers to make insulin and epinephrine available to low-income members of the public at the discounted prices set by the 340B Drug Pricing Program, and removing safe harbor protections under the Anti-Kickback Statue for prescription drug rebates in Medicare Part D, AIS Health reported.

"I think that what you have here is a collection of policies that are intended to make noise, but will have little to no practical effect on drug prices before the election," Avalere founder Dan Mendelson says.

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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Manufacturers, Payers Wait on Federal COVID-19 Vaccine Distribution Plan

Posted by Peter Johnson on Jul 28, 2020

As the many COVID-19 vaccines under development barrel toward clinical trials for safety and efficacy, questions remain about how they will be distributed when they become available, AIS Health reported.

In a hearing held by a subcommittee of the House Energy & Commerce committee, pharmaceutical executives said they would rely on guidance from the Trump administration and the Centers for Disease Control and Prevention (CDC) to distribute vaccine doses.

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

Perspectives on Trump Admin's COVID-19 Testing Payment Guidance

Posted by Jane Anderson on Jul 23, 2020

As more employers turn to COVID-19 testing to see if employees are safe to return to the workplace, the Trump administration has clarified that insurers must cover only physician-ordered "medically necessary" diagnostic and antibody tests, AIS Health reported.

The guidance, released jointly on June 23 by HHS, the Dept. of Labor and the Dept. of the Treasury, also says self-funded employer plans must pay for COVID-19 testing that’s medically appropriate.
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Topics: Industry Trends, Provider, Payer