Radar on Drug Benefits

  • Prime Signed Value-Based Deal With EMD Serono for Mavenclad

    Prime Therapeutics LLC recently unveiled that it had signed a value-based agreement for a relatively new multiple sclerosis (MS) drug with a complicated treatment regimen and high price tag.

    In early June, the PBM said it had signed a deal with EMD Serono, Inc. for Mavenclad (cladribine) by which Prime would be financially compensated based on the rate at which members discontinue the therapy or switch to another MS drug over the typical course of treatment.

  • Care Deferral Dings OptumRx 2Q Earnings, Big RFP Wins

    Although the steep decline in health care utilization tied to COVID-19 lockdowns proved to be an overall boon for UnitedHealth Group during the second quarter of 2020, that was not the case for the company’s PBM subsidiary.

    OptumRx’s earnings declined 6% year over year in the second quarter as prescription volume dropped due to “lower care activity,” UnitedHealth Chief Financial Officer John Rex said during a July 15 earnings call. “Unsurprisingly, given the sharp drop in primary care and specialist visits, first fills of prescriptions declined by about one-third early in the second quarter,” he said, but added that first fills “began to recover as the quarter progressed and have continued to do so as care activity increases.”

  • Payers, Manufacturers Await Federal Vaccine Rollout Plan

    As the many COVID-19 vaccines under development barrel toward clinical trials for safety and efficacy (see infographic,below), questions remain about how they will be distributed when they become available. Payers and PBMs will likely play a critical role in vaccine rollout, but what that will entail is not yet clear. In large part, that’s because both the health insurance industry and pharmaceutical manufacturers are waiting on a vaccine distribution plan from the federal government.

    According to Anthony Fauci, M.D., head of the National Institute of Allergy and Infectious Diseases, drug manufacturing firms will coordinate closely with the government to distribute vaccine doses.

  • Pandemic Complicates, Doesn’t Stop Push to Lower Drug Costs

    With a presidential election looming and the COVID-19 pandemic still raging, it might stand to reason that drug pricing reform efforts would be on the backburner. However, there are indications that policymakers remain focused on initiatives that could have tangible business impacts for insurers, PBMs and drug manufacturers. Furthermore, legal battles over those initiatives are continuing to play out — including one case slated for Supreme Court review in the fall.

    That case, Rutledge v. Pharmaceutical Care Management Association, concerns PCMA’s challenge to a 2015 Arkansas law that requires PBMs to reimburse pharmacies at or above their wholesale cost for generic drugs (RDB 8/21/15, p. 7). The trade group argues that PBMs should be exempt from such regulation by states, as they act as agents under the Employee Retirement Income Security Act of 1974. After split decisions in the lower courts, the Supreme Court agreed to hear the case, which experts have told AIS Health has far-reaching consequences for state efforts to regulate PBMs. Hearings are now scheduled for October after being delayed due to the COVID-19 pandemic.

  • News Briefs

     A new report from UnitedHealth Group-owned OptumRx puts a spotlight on prescription prenatal vitamins — which the PBM counts among an “influx of clinically superfluous brand drugs that carry hefty price tags but offer little to no added clinical value.” According to OptumRx, some of the “worst offenders” include Solubiomix’s Azesco, Foxland Pharmaceuticals’ Trinaz, 7T Pharma’s Genicin Vita-S and TMIG Inc.’s Lorid, which have an average cost of $5,600 for a 90-day supply vs. $44 for a generic alternative covered by the PBM. Read more at https://bit.ly/31TWn6p.

     The Pharmaceutical Research and Manufacturers of America (PhRMA) on June 30 filed litigation challenging a Minnesota law that would allow diabetic patients to access an “urgent” 30-day supply of insulin for a copay of no more than $35. The law — HF 3100, also known as the Alec Smith Insulin Affordability Act — would also allow qualifying individuals to access a $50-or-less 90-day supply of insulin for up to a year. PhRMA argued that the law violates the fifth and 14th amendments of the U.S. Constitution, which “prohibits Minnesota from taking manufacturers’ private property for public use without just compensation.” Read PhRMA’s statement at https://onphr.ma/3gIQzAD.

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