Radar on Drug Benefits

In 2021, about half of enhanced stand-alone Prescription Drug Plans (PDPs) and a little more than a third of Medicare Advantage-Prescription Drug (MA-PD) plans will participate in a new demonstration that aims to lower diabetic seniors’ out-of-pocket costs by capping copays at $35 for a broad set of insulin products. That’s one finding from a new analysis by consulting firm Avalere Health, which also uncovered some illuminating trends regarding how plan sponsors chose to price PDPs and MA-PD plans featuring the new benefit.

Among the 310 enhanced PDPs that opted to participate in CMS’s Part D Senior Savings Model for 2021, the average enrollment-weighted premium is $57.53 — $23.46 higher than the average premium for non-participating plans, the analysis found. But an opposite scenario is playing out in the MA-PD space, where the average enrollment-weighted premium for the 1,287 participating plans is $10.36 less than the cost of non-participating plans ($22.74 versus $33.10).

Based on current enrollment figures, virtually every Medicare beneficiary who signs up for a stand-alone Prescription Drug Plan (PDP) in 2021 will be enrolled in a plan rated 3.5 stars or higher, CMS estimated recently. However, only 17% of beneficiaries are in plans with 4 or more stars for 2021.

That dynamic is unlikely to shift unless CMS opts to pay PDPs bonuses for higher star ratings, an idea that hasn’t been discussed seriously by policymakers in recent years, industry insiders say.

Prime Therapeutics, the PBM jointly owned by 18 Blue Cross Blue Shield plans, recently entered an agreement with Cigna Corp.-owned PBM Express Scripts to offer Blues plans the option of using Express Scripts’ mail order and specialty pharmacy services. Though experts say a merger of the two PBMs is unlikely, the deal deepens the trend of integration and consolidation across the PBM space and between the two firms, which have shared some joint operations since the end of 2019.

Kyle Skiermont, Pharm.D., Prime’s senior vice president for specialty pharmacy and home delivery, tells AIS Health that the deal’s purpose is to offer Blues plans a choice between Prime’s specialty and mail order pharmacy operations and Express Scripts’ specialty branch, Accredo. Prime has an existing mail order and specialty joint venture with Walgreens Boots Alliance Inc., called AllianceRx Walgreens Prime.

✦ Manufacturer prices for insulin in the United States were “considerably” — often five or 10 times — higher than those in other Organisation for Economic Co-operation and Development countries, according to a new report from researchers at RAND Corp. The average price per unit across all types of insulin in the United States was $98.70, the report said, while other countries would have paid a fraction of that for the same insulins. In addition, “the analysis suggests that U.S. insulin prices would still have been considerably higher — about four times higher — than those in other countries even when accounting for potential rebates,” researchers wrote. View the report at https://bit.ly/3izlH6k.

✦ CVS Health Corp. is offering Whil — a “digital training platform” focused on workplace mindfulness, stress resilience, sleep, and mental and emotional wellbeing — to its PBM clients as part of its Points Solutions Management offerings for employers. “Employers and other plan sponsors are increasingly looking for innovative tools to help people manage their mental health, especially in light of the COVID-19 pandemic,” Sree Chaguturu, M.D., CVS Caremark’s chief medical officer, said in an Oct. 1 news release. “Whil’s commitment to clinical evaluation and research aligns with our focus on helping our clients include clinically effective digital point solutions as part of their benefits packages.” Visit https://bwnews.pr/3d8T8vB.

More than two years after Amazon Inc. unveiled its plan to acquire PillPack, which specializes in pre-sorted dose packaging and home delivery of prescription drugs (RDB 7/13/18, p. 1), UnitedHealth Group has reportedly purchased a very similar startup.

CNBC reported on Sept. 29 that UnitedHealth bought the firm, divvyDOSE, for just over $300 million, citing a person familiar with the deal. UnitedHealth declined to comment about the transaction to either CNBC or AIS Health when asked to confirm the news.