Radar on Drug Benefits

A new proposed rule (85 Fed. Reg. 37286, June 19, 2020), which CMS touted as a way to tweak Medicaid’s best-price provision to encourage more value-based purchasing (VBP) for expensive drugs, has drawn considerable criticism from stakeholders across the health care system. Experts say the rule is much more complex than it was initially made to seem, and the 30-day comment period is unusually short for such a substantial change.

“Generally, stakeholders across the board have voiced concerns with the short comment period,” Lindsay Bealor Greenleaf tells AIS Health. Greenleaf is vice president for policy at ADVI Health LLC, a health care consultancy. “There are a lot of complex proposals included in this rule that take time to unpack, to really analyze.”

In what one expert calls a “logical” move for a PBM vying for business from cost-conscious payers, Anthem, Inc.’s IngenioRx said on July 6 that it acquired ZipDrug, a company that focuses on improving patients’ medication adherence and affordability.

“As plan sponsors and members opt in for the service, ZipDrug ensures members are matched with the best high-quality pharmacy to fulfill their needs,” Justin Petronzi, IngenioRx’s vice president of strategic growth, explains to AIS Health via email. Services offered by ZipDrug include “guaranteed prescription delivery, multi-dose compliance packaging that provides specific instructions to empower patients to manage their medications at home safely on a daily basis, along with other targeted clinical programs,” he says. ZipDrug can also help members find lower-cost alternatives to their medications to help ensure they’re affordable.

Two lawsuits — one against federal health regulators by a drugmaker and the other against a drugmaker by the Dept. of Justice — represent the latest salvos in the dispute over whether and how drug company-supported charities can help patients pay for expensive medications.

The two suits may ultimately offer a chance to clarify what manufacturers can and cannot do to fund copay assistance charities, particularly for patients with rare diseases, says Lance Grady, who leads the market access practice at Avalere Health.

Since the first studies emerged suggesting Gilead Sciences, Inc.’s remdesivir was a promising treatment for COVID-19, speculation has abounded regarding what price the manufacturer would set for the antiviral drug. On June 29, Gilead ended that speculation by revealing that it will charge $2,340 for a typical five-day, six-vial treatment course for people covered by U.S. government health programs and $3,120 for those covered by private insurance.

Remdesivir has not been approved by the FDA, but the agency did grant the infused drug an Emergency Use Authorization for the treatment of hospitalized patients with severe COVID-19. It is being studied in multiple international trials; one U.S.-government led study found remdesivir shortened COVID-19 patients’ recovery time by 31%.

✦ Kaiser Permanente is joining Civica Rx – the not-for-profit generic drug company run by health systems and hospitals — as a governing member with a seat on the board of directors. Civica, which was founded in 2018 in a bid to address shortages of critical drugs, is already manufacturing 20 essential generic medications — “10 of which are currently being used to treat COVID-19 patients,” the organizations noted in a June 18 press release. “The COVID-19 pandemic has put a spotlight on the critical need for ensuring consistent supplies of affordable, generic medications for patients and we are proud to join with Civica Rx to help lead these efforts,” Kaiser Permanente Chairman and CEO Greg Adams said. Visit https://prn.to/37JMNDQ.

✦ Humana Inc. said it’s teaming up with a company called Pharmacy Quality Solutions (PQS) on a pilot program that aims to improve outcomes for diabetes patients. Using PQS’s EQuIPP platform, select pharmacies in Arizona, Iowa, Kentucky, North Carolina, Ohio and Texas that serve Humana Medicare Advantage members with a prescription drug benefit will be able to track the performance of their patients on two quality measures, Diabetes Control — A1c Testing and Diabetes Control — A1c Under Control, through the 2020 program year. “For pharmacies, higher performance scores will correspond to greater incentives,” a press release stated. Read more at https://bwnews.pr/2CibImo.