Radar on Drug Benefits

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.

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.