Radar on Drug Benefits

A recently approved brand drug for bipolar disorder will have little impact on how health plans cover these medications, experts say. Health plans will continue to encourage the use of less expensive generic bipolar drugs.

The brand drug, Allergan plc’s Vraylar (cariprazine), was approved by the FDA in May to treat depressive episodes associated with bipolar 1 disorder in adults. The drug also was previously approved to treat manic or mixed episodes associated with bipolar 1 disorder and schizophrenia in adults. It is an oral, once-daily atypical antipsychotic.

With the federal government consumed by responding to the COVID-19 outbreak, the possibility of Congress passing drug-pricing legislation — once a top priority for the Trump administration — might seem dim. But analysts say it’s very possible that something like an overhaul of the Medicare Part D benefit, upon which there is bipartisan agreement, could still make its way into legislation that federal lawmakers pass in the coming weeks or months to address the ongoing public health crisis.

After days of increasingly tense negotiations, the Trump administration and Senate leaders reached a deal in the early hours of March 25 on a stimulus package worth more than $2 trillion that aims to provide relief for Americans and businesses struggling from the widening economic damage wrought by COVID-19. The COVID-19 pandemic, which as of March 25 caused more than 700 deaths in the U.S., has pummeled the stock market and triggered scores of job losses as many of the country’s most populous cities and states shut down non-essential businesses to slow the virus’ spread.

According to a list compiled by America’s Health Insurance Plans (AHIP), payers have made a variety of changes to their prescription drug benefits as part of their response to the COVID-19 pandemic.

✦ Payers that have waived early refill limits include: Anthem Inc., AvMed Inc., 36 regional affiliates of the Blue Cross and Blue Shield Association, Bright Health Inc., CareFirst Inc., Cigna Corp. (through home delivery), Fallon Community Health Plan Inc. (at in-network pharmacies), Geisinger Health Plan Inc., Harvard Pilgrim Health Care Inc., Humana Inc., Inter Valley Health Plan Inc. (for Part D members), Piedmont Community Health Plan and Valley Health Plan.

The COVID-19 pandemic, which has quickly changed many aspects of everyday life around the globe, could also spark changes in American consumers’ behavior that provide long-term savings for payers and PBMs, experts tell AIS Health.

Across the health insurance industry, payers have moved to increase refill durations (RDB 3/12/20, p. 1) and encourage plan members to have their prescriptions delivered instead of going to a retail pharmacy in order to help members reduce their likelihood of getting — or spreading — the novel coronavirus that has led to more than 700 deaths in the U.S. as of March 25.

✦ CMS on March 11 rolled out a voluntary model that would set out-of-pocket costs for insulin at a maximum $35 copayment per 30-day supply throughout the benefit year for beneficiaries in participating enhanced Part D plans. The goal is to ensure that beneficiaries in participating plans “will have predictable copays for a broad set of formulary insulins, including rapid-acting, short-acting, intermediate-acting, and long-acting insulins, marketed by participating manufacturers from the beginning of the plan year and through the coverage gap phase,” according to a press release. Visit https://go.cms.gov/39Kn1zx.

✦ CVS Health Corp. subsidiary CVS Pharmacy, Inc., plans to acquire Schnuck Markets Inc.’s retail and specialty pharmacy businesses, the companies said on March 10. CVS Pharmacy will take over and rebrand 99 of the Midwest grocery chain’s pharmacies, as well as transfer prescription files from 11 Schnucks pharmacies to CVS locations. Meanwhile, the PBM CVS Caremark said it’s adding five new digital health tools to its Point Solutions Management platform, which helps clients simplify wellness-vendor contracting: Hello Heart, Hinge Health, Livongo, Torchlight and Whil. Those vendors tackle issues such as mental well-being, weight management, heart health, caregiving, joint pain and more. The first service included in Caremark’s Point Solutions Management platform was Sleepio, a personalized digital sleep program. Read more at https://bit.ly/2vZimLt and https://bit.ly/3aLLPr3.