Radar on Drug Benefits

✦ When the size, shape, color and markings on their prescription pills change without explanation, it can hamper patients’ medication adherence, according to a study published on Aug. 12 in the American Journal of Managed Care. The study outlined results of two 2016 surveys: one conducted on patients 50 years and older taking generic drugs for depression, diabetes, epilepsy, HIV, hyperlipidemia or hypertension, and one conducted on licensed pharmacists. The pharmacists acknowledged that pill appearance changes frequently in their pharmacies, and more than three-fourths of respondents reported notifying patients about those changes often, either verbally or through a sticker on pill bottles. Yet less than half of patient respondents reported being notified of pill-appearance changes — something 82% said they would prefer pharmacists do. “Among patients who reported experiencing a change, 12% reported stopping their medication or using it less frequently,” the study said. Read more at https://bit.ly/3aVUbxD.

✦ Humana Inc. is suing a Florida-based company called QuivvyTech and multiple doctors, alleging that they ran an “organized, elaborate telemedicine scheme” targeting Humana members. According to the suit, which was filed on Aug. 20, telemarketers cold-called Humana members and “tricked them into talking about common ailments,” then sent that information to doctors who electronically prescribed high-cost topical creams to the members without ever actually speaking to them. The fraudulent prescriptions were then wired to the co-conspirator pharmacies, which dispensed the medications to the targeted members and “billed Humana millions of dollars for these fraudulent prescription claims,” the complaint alleged. Humana members, meanwhile, “often were left confused, irate and in the possession of unwanted expensive creams.” View the lawsuit at https://bit.ly/34vL0Tx.

Uber Technologies Inc. is expanding its health care business to include last-mile prescription delivery through a partnership with NimbleRx, a California health care startup. The new joint service will start with pilot programs in the Dallas and Seattle areas, “with plans to grow in the coming months,” according to a blog post by Dan Trigub, the head of Uber Health.

An Uber Health spokesperson tells AIS Health that the COVID-19 pandemic is a driving motivator for the partnership. The pandemic has wrought havoc on Uber’s core ride-hailing business: according to the firm’s second quarter earnings report, overall revenue during that period fell 29% year over year. The move into prescription delivery seems to indicate a company-wide pivot to delivery and last-mile logistics. During the second quarter, Uber Eats, the company’s food delivery service, brought in more revenue than ride-hailing for the first time in company history.

As the debate continues over the merits of overhauling the prescription drug rebate system, large employers — which traditionally have retained drug discounts that PBMs negotiate with manufacturers — appear to be searching for a different way forward.

“Employers struggle to reconcile the role of manufacturer rebates in pharmacy benefit management. With no meaningful alternatives to the rebate-driven contracting model, large employers have continued to implement point-of-sale (POS) rebate programs,” stated the Business Group on Health’s 2021 Large Employers’ Health Care Strategy and Plan Design Survey.

UnitedHealthcare is dropping coverage in its commercial plan formularies for Gilead Sciences, Inc.’s HIV pre-exposure prophylaxis (PrEP) medication Descovy (emtricitabine and tenofovir alafenamide), steering patients instead to Gilead’s Truvada (emtricitabine/tenofovir disoproxil fumarate) as a generic version of Truvada is set to launch.

Other plans are likely to follow suit in their PrEP formularies when Teva Pharmaceutical Industries Ltd. releases its generic version of Truvada on Sept. 30, one industry insider says. But formularies could be shaken up again in 2021 as an “A” rating from the U.S. Preventive Services Task Force (USPSTF) for PrEP takes effect, requiring plans to provide health plan members at high risk of HIV with access to PrEP without copayments or deductibles.