Health Plan Weekly

Two patient advocacy groups are declaring victory after Blue Cross Blue Shield of North Carolina made midyear formulary changes that shifted several HIV treatments from higher to lower tiers, meaning patients can access them at much lower cost-sharing levels.  

In an Aug. 31 press release, the HIV+Hepatitis Policy Institute and the North Carolina AIDS Action Network pointed out that the move came after they filed discrimination complaints with the North Carolina Dept. of Insurance and HHS’s Office for Civil Rights arguing that the Blue Cross NC formulary violated the Affordable Care Act’s prohibitions against discriminatory plan design. The formulary in question is the Blue Cross and Blue Shield of North Carolina Essential Formulary, which applies to ACA marketplace plans sold in the state. 

The proposed acquisition of Blue Cross and Blue Shield of Louisiana (BCBSLA) by Elevance Health, Inc., the parent company of Anthem, faces deepening legal and political opposition from Louisiana elected officials and other stakeholders. The deal is not the first proposed rollup of Blues affiliates to face determined opposition from state officials and regional health care stakeholders — nor is it likely be the last, experts say.

Public officials including Louisiana Attorney General Jeff Landry, a Republican, have spoken out against the deal. Landry, also the leading Republican candidate in this year’s governor’s race, is in the midst of an antitrust investigation of the sale, according to the New Orleans Times-Picayune. If the deal goes through, the paper reports, it will make Elevance the largest health insurer in the state, with 1.4 million members, beating out UnitedHealthcare.

CVS Health Corp. plans to launch its own white-label line of biosimilars, the retail and health care giant said on Aug. 23, in a play to lower specialty pharma costs. Experts say that it could be years before anyone is able to tell whether the venture has brought down costs — especially since the biosimilar market itself is still in its early stages of development.

The new CVS brand, Cordavis, will be “a wholly owned subsidiary that will work directly with manufacturers to commercialize and/or co-produce biosimilar products,” a press release said. The division “will help ensure consistent long-term supply of affordable biosimilars,” and, in doing so, leverage “one of the biggest opportunities for reducing drug costs for employers and consumers.”

Major blood thinners are among the first 10 prescription drugs for which the Biden administration will seek lower Medicare prices as part of the Inflation Reduction Act (IRA). The negotiated prices will be announced on Sept. 1, 2024, and go into effect in 2026.

Medicare beneficiaries who filled prescriptions for the 10 selected drugs paid a total of $3.4 billion in out-of-pocket costs for those therapies in 2022. The Medicare program paid more than $50 billion for the drugs between June 2022 and May 2023, CMS reported. Bristol Myers Squibb’s blood thinner Eliquis (apixaban) alone accounted for more than $16 billion.