Radar on Drug Benefits

For PBMs, 2020 has been far from business as usual, given the myriad ways the COVID-19 pandemic has changed how people interact with the health care system. However, during their second-quarter earnings conference calls, companies that own some of the largest PBMs emphasized that they are largely satisfied with how the PBM segments of their businesses are performing.

Anthem, Inc. Chief Financial Officer John Gallina, for example, said during the insurer’s July 29 earnings call that “IngenioRx is actually doing quite well, and has really done a nice job of meeting our expectations.”

CVS Health Corp. has launched a group purchasing organization called Zinc Health Services as part of its Caremark business, joining a small but growing group of PBMs that are turning to GPOs as an alternative way to source medications.

The group, which also includes Cigna Corp.’s Express Scripts, may be seeking to shift rebates and discounts into a less transparent fee structure, suggested a June 24 blog post by Drug Channels Institute CEO Adam Fein, Ph.D., that highlighted a similar perspective outlined in a report from Nephron Research analysts. Express Scripts rolled out its own GPO called Ascent last year, and Ascent also negotiates prices for Blue Cross Blue Shield-owned PBM Prime Therapeutics LLC.

✦ Blue Cross and Blue Shield of North Carolina is offering certain customers up to a 33% discount on their copays for 90-day orders of maintenance medications. The policy, which became effective July 15, applies to the Blues plan’s fully insured commercial customers. “By reducing how much members pay for their 90-day prescription supply, we hope we can make things a little easier for members in addition to helping them stay home to reduce the spread of COVID-19,” said Rahul Rajkumar, M.D., chief medical officer for the insurer. Read more at https://bit.ly/2CTUSe4.

✦ The average time needed to complete clinical development of new prescription drugs in the United States is lengthening more than the regulatory approval time for new drugs is shortening. That’s according to new research by the Tufts Center for the Study of Drug Development (CSDD), which said the net effect was that the average time to conduct clinical studies and then complete the approval process decreased by 4.8 months from the 2008-2013 time period to 2014-2018. Part of the reason that clinical development time is getting longer is that the number of clinical study participants is growing, according to lead study author Joseph DiMasi, director of economic analysis and research associate professor at Tufts CSDD. Contact Luna Rodriguez at luna.rodriguez@tufts.edu to learn more.

Prime Therapeutics LLC recently unveiled that it had signed a value-based agreement for a relatively new multiple sclerosis (MS) drug with a complicated treatment regimen and high price tag.

In early June, the PBM said it had signed a deal with EMD Serono, Inc. for Mavenclad (cladribine) by which Prime would be financially compensated based on the rate at which members discontinue the therapy or switch to another MS drug over the typical course of treatment.

Although the steep decline in health care utilization tied to COVID-19 lockdowns proved to be an overall boon for UnitedHealth Group during the second quarter of 2020, that was not the case for the company’s PBM subsidiary.

OptumRx’s earnings declined 6% year over year in the second quarter as prescription volume dropped due to “lower care activity,” UnitedHealth Chief Financial Officer John Rex said during a July 15 earnings call. “Unsurprisingly, given the sharp drop in primary care and specialist visits, first fills of prescriptions declined by about one-third early in the second quarter,” he said, but added that first fills “began to recover as the quarter progressed and have continued to do so as care activity increases.”