Radar on Drug Benefits

Editor’s note: A previous version of this article incorrectly stated that Ehave, Inc. is the manufacturer of EndeavorRx. The digital therapeutic device is made by Akili Interactive. This version has been corrected.

In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them.

Two new pieces of federal legislation aim to boost adoption of biosimilars — which has been slower than many hoped — by increasing public awareness of branded-biologic alternatives and making changes to the patent system. The PBM industry’s largest trade group praised the legislation, but experts say that, while the new laws are welcome, they are unlikely to change the complex pricing dynamics that make biologics and even biosimilars so expensive.

One of the laws, the Advancing Education on Biosimilars Act, would increase efforts by federal agencies to promote biosimilars among providers, patients and other health care stakeholders. The bill was sponsored by Sens. Bill Cassidy, M.D., (R-La.) and Maggie Hassan (D-N.H.). The Ensuring Innovation Act, introduced by Cassidy and Sens. Tina Smith (D-Minn.) and Roger Marshall, M.D., (R-Kan.) changes definitions in the Food, Drug, and Cosmetic Act to limit the ways that drug manufacturers can make alterations to drugs in order to extend the exclusivity of patents beyond their original term — a practice called “evergreening.” Both bills passed the House with large majorities and the Senate unanimously, although President Joe Biden has yet to sign them as of press time.

In a sign of pent-up demand as the COVID-19 pandemic winds down, a near-record number of companies likely will consider switching to a new PBM during the 2022 selling season that’s now underway, consultants and observers say.

In addition, generally negative publicity about the PBM industry’s contracts and tactics is leading employers to look at more transparent alternatives to the largest traditional PBMs, says David Dross, national practice leader for managed care pharmacy consulting at Mercer.

✦ CVS Health Corp. said on March 31 that its PBM division Caremark will “continue to serve the government-wide Service Benefit Plan” in a deal effective Jan. 1, 2022. The contract is an arrangement with carriers of the Federal Employees Health Benefits program and adds specialty drug management to Caremark’s existing contract providing retail, mail and clinical pharmacy services. Prime Therapeutics LLC previously held the specialty contract. Read more at https://bit.ly/3t11yfk.

✦ After replacing Novartis’ psoriasis drug Cosentyx (secukinumab) with Eli Lilly and Co.’s Taltz (ixekizumab) on most of its 2021 formularies, Cigna Corp. is offering a financial incentive for recalcitrant patients to switch to the cheaper drug. In March, the insurer sent a letter advising doctors that patients could receive a $500 debit card if they switch from Cosentyx to Taltz or an older biologic before Aug. 31 and then refill the prescription before Dec. 31, according to the American Journal of Managed Care. Visit https://bit.ly/3wBh0kJ.

In recent years, the pharmaceutical industry has not been popular with the public: Problems like the rising cost of prescription drugs and the opioid epidemic combined to make the industry the least popular nationwide in a 2019 Gallup poll. According to a recent poll, the public now thinks better of the industry due to the rapid development of COVID-19 vaccines — but still wants drug prices to be reined in.

In a March 2021 national survey, progressive polling group Data for Progress found that 56% of respondents had a favorable view of pharmaceutical companies (see infographic, p. 6). Vaccine developers scored well on an individual basis: majorities had favorable views of Johnson & Johnson (68%), Moderna, Inc. (60%) and Pfizer Inc. (65%). Also, 75% of respondents said they approve of those specific companies’ vaccine development efforts. However, the poll also found that 73% of respondents disapprove of “how pharmaceutical companies are handling the rising cost of prescription drugs.”