Radar on Drug Benefits

Experts say a last-minute proposal by President Donald Trump to distribute $200 prescription drug credits to Medicare Part D enrollees on preloaded debit cards faces many unanswered questions and will be difficult to implement, especially in the short time before the Nov. 3 election. The proposal, the latest in a series of proposals and executive orders from the administration that are intended to reduce drug prices, would do little to help seniors with high out-of-pocket drug costs, they say.

“I’ll be the point guard for the Knicks before this happens,” says Joe Paduda, principal of Health Strategy Associates. “This is just another of the president’s many off-the-cuff promises, one it appears none of his staff knew about before he made it in a campaign speech.”

Editor’s Note: A previous version of this article misstated how OptumRx is covering Tecfidera, Ruxience, Rituxan and Truxima. This version has been corrected.

CVS Health Corp.’s Caremark will exclude 57 medications from its 2021 formulary and add six back. Meanwhile, UnitedHealth Group’s OptumRx subsidiary will exclude 19 medications and products while adding back five and implementing restrictions on others.

Following an Oct. 6 Supreme Court hearing, legal experts tell AIS Health that PBMs appear to have a good shot at prevailing in their challenge of a 2015 Arkansas law, which has major implications for how both health and drug benefits are regulated.

The case, Rutledge v. Pharmaceutical Care Management Association (PCMA), centers on a law known as Act 900 that aimed to protect independent pharmacies from what Arkansas Attorney General Leslie Rutledge calls the “abusive payment practices” of PBMs. Chiefly at issue is whether Arkansas can force PBMs to reimburse pharmacies for the price of any given drug set by the pharmacy’s wholesaler, even if that amount is higher than the maximum allowable cost (MAC) set by a PBM.

✦ Highmark Inc. said on Sept. 21 that it entered into an outcomes-based payment agreement with AstraZeneca PLC for Fasenra (benralizumab), which is an add-on treatment for patients age 12 and older with severe asthma. The agreement will hold AstraZeneca accountable for the clinical effectiveness of Fasenra when used by Highmark’s commercial and Medicare members. Previously, the insurer and drugmaker collaborated on an outcomes-based agreement for the asthma and chronic obstructive pulmonary disease drug Symbicort (budesonide/formoterol fumarate dihydrate), “one of the first outcomes-based agreements in the U.S. for the treatment of those chronic respiratory conditions.” Read more at https://bit.ly/2ROxyCA.

✦ Cigna Corp. on Sept. 16 said that it is rebranding its health services portfolio — which includes its PBM and specialty pharmacy businesses — as Evernorth. Tim Wentworth, who was the CEO of Express Scripts before Cigna acquired it, will be the CEO of the rebranded division. Cigna also unveiled new products that Evernorth will offer, including a “comprehensive fertility solution” called FamilyPath and Healthy Ways to Work, a suite of solutions that aims to help health plans and employees address challenges tied to COVID-19. Read more at https://bit.ly/3ks2vZD.