Radar on Drug Benefits

✦ 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.

During a Sept. 17 virtual session of the America’s Health Insurance Plans (AHIP) National Conference on Medicare, Medicaid & Dual Eligibles, health insurance industry leaders were cautiously optimistic about the impact of CMS’s recent proposed rule seeking to promote value-based purchasing (VBP) for prescription drugs, despite mixed reviews from some industry stakeholders (RDB 7/9/20, p. 1).

In the regulation, which was proposed this summer, CMS outlined an updated interpretation of Medicaid “best price” rules — which dictate how rebates are calculated in the Medicaid Drug Rebate Program — by clarifying best price reporting requirements and enabling new structures including year-to-year scheduled prices that could change in relation to patient outcomes (RDB 6/5/20 p. 1).

This summer, a drug called Tecartus (brexucabtagene autoleucel) became the third chimeric antigen receptor T-cell (CAR-T) therapy approved by the FDA. CAR-T therapies, which use a patient’s genetically modified immune cells to target and fight cancer cells, are a cutting-edge type of treatment that comes with eye-popping price tags, ranging from $373,000 to $475,000. However, a new report from OptumRx highlights an “industry trend to watch” that could eventually provide some relief to payers worried about how to finance CAR-T treatments.

Currently, CAR-T therapies’ high cost is at least in part attributable to the “labor-intensive and time-consuming” manufacturing process for such drugs, stated the UnitedHealth Group-owned PBM’s Drug Pipeline Insights Report for the third quarter of 2020. Essentially, T-cells are taken from a patient, treated and multiplied in a lab, and reinfused into the same patient — a completely personalized process known as autologous therapy.

As the pharmaceutical industry hurtles toward completing a COVID-19 vaccine, payers and PBMs have begun to draft vaccine distribution plans based on emerging guidance from federal public health leaders. Insurance industry leaders say that they anticipate the government and its chosen distributor, McKesson Corp., will handle most of the early work in distributing vaccines, but that payers should anticipate taking a role in educating members and directing inoculations to appropriate populations in later stages.

Official federal vaccine guidance will originate with the Advisory Committee on Immunization Practices (ACIP), the Centers for Disease Control and Prevention’s (CDC) vaccine policy body. ACIP generates ongoing public health and distribution guidelines for vaccinations, including the annual rules for influenza vaccines. According to a Sept. 22 report in the Wall Street Journal, ACIP has opted to defer issuing formal guidance for initial COVID-19 vaccine distribution until clinical trials have advanced further. On a related point, ACIP generally waits to issue guidance until vaccines have been approved by the FDA. ACIP’s next meeting is scheduled for Oct. 28-30, and the panel may release guidance at that point.