Radar on Drug Benefits

The Medicare Part D and Medicaid programs could save a significant amount of money if more patients took immediate-release (IR) medications that require two doses per day instead of extended-release (ER) versions that are taken just once a day, according to a recent study. The cross-sectional study analyzed 20 extended-release drugs with 37 Medicare formulations and 36 Medicaid formulations. Between 2012 and 2017, Medicare Part D and Medicaid could have saved a combined $13.7 billion through a switch from ER to IR formulations. “It’s not a huge difference in terms of patient convenience, but the cost difference is remarkable,” study coauthor Ambarish Pandey, M.D., of the University of Texas Southwestern Medical Center, told Reuters.

Targeted therapies have made tremendous progress in oncology, with some products essentially rendering certain cancers chronic conditions. According to the National Cancer Institute, the FDA has approved hundreds of targeted therapies across 30 types of cancers. Genomic testing can help determine whether a patient is a candidate for a particular therapy, and CVS Health has launched a program focused on boosting patient access to this.

The PBM is offering its Transform Oncology Care program via a collaborative with precision medicine-focused technology company Tempus. The program uses the testing results at the point of prescribing so patients are started on the treatment appropriate for them in a timely fashion. It also matches patients to clinical trials for which they are eligible. AIS Health recently spoke with Prem Shah, Pharm.D., executive vice president of specialty and product innovation for CVS Health, to learn more about the program.

Health insurers are praising a provision in a recently proposed regulation that gives commercial plans greater leeway to run so-called copay accumulator programs, which prevent drug manufacturer coupons from counting toward patients’ annual deductibles or out-of-pocket cost limits. But the pharmaceutical industry slammed the proposal as “misguided” and liable to prevent patients from getting vital medications.

Regardless of whether CMS finalizes the copay accumulator provision in the proposed 2021 Notice of Benefit and Payment Parameters (NBPP) — an omnibus rule that primarily lays out regulations for Affordable Care Act-compliant plans — one health policy expert says such programs are a trend that will stick around as insurers look to lower the amount they spend on prescription drugs.

On March 3, St. Louis, Mo.-based integrated health system SSM Health revealed that Costco Wholesale Corp. purchased a minority stake in Navitus Health Solutions, the health system’s PBM that includes specialty pharmacy subsidiary Lumicera Health Services.

Ashraf Shehata, KPMG’s national sector leader for health care and life sciences, says this move is driven by a political push for greater drug price transparency, in particular with specialty pharmacy and branded pharmacy, and the need for a better cost model at PBMs.

The U.S. Preventive Services Task Force (USPSTF) has expanded its screening recommendation for hepatitis C virus (HCV), calling for all asymptomatic adults ages 18 through 79, including pregnant women, to be tested for the virus. That means all health plans must cover the expanded screening for free.

The B-level recommendation from USPSTF, released March 2, indicates there is high certainty that the net benefit of expanded HCV testing will be moderate, or there is moderate certainty that the net benefit will be moderate to substantial. The USPSTF also states that clinicians might consider testing adolescents with past or current injection drug use, although it stopped short of recommending testing. Over the past three years, the HCV drug regimens commonly used in adults have been approved for use in adolescents 12 years old and older.