Radar on Drug Benefits

Access to Novo Nordisk’s Rybelsus (semaglutide) — the first oral glucagon-like peptide-1 receptor agonist (GLP-1) to treat adults with type 2 diabetes — got a major boost Jan. 17 when Novo said Express Scripts, part of Cigna Corp., will cover the agent. Rybelsus was approved in September 2019 and is available as a once-daily tablet version of the drugmaker’s Ozempic (semaglutide), a weekly injection launched in 2018.

“We’ve been keeping a keen eye on the new 2020 formulary postings, watching weekly and monitoring all the big payers’ formularies, and it’s been interesting to note that it looks as though Novo is still in negotiations” for Rybelsus, Jeffrey Casberg, M.S., R.Ph., director of clinical pharmacy at IPD Analytics, tells AIS Health. “You would think by now more often than not you’d see more formularies updated, and we haven’t seen that yet.” IPD provides drug intelligence and consulting to stakeholders across the pharmaceutical landscape.

If Congress or the Trump administration are able to enact any type of drug-pricing reform during 2020 — a year sure to be dominated by the upcoming elections — it’s likely to be a redesign of Medicare Part D, industry experts tell AIS Health. That would put some additional financial responsibility on health insurers’ shoulders, but for PBMs, the regulatory overhang appears to have largely abated, experts say.

In the Senate, tweaking the Part D benefit is part of a larger piece of bipartisan legislation (S. 2543), championed by Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), which was approved by the Finance Committee in July and was modified in December. From the House, there’s the sweeping legislation (H.R. 3) proffered by Speaker Nancy Pelosi (D-Calif.), which passed in December only to meet a dead end in the Senate. Like the Wyden/Grassley bill, it would implement hard out-of-pocket spending caps for Part D beneficiaries and considerably change how costs are divided up in the catastrophic phase of coverage. In both bills, Medicare would pay less, enrollees would pay nothing, and manufacturers and plan sponsors would pay more in that coverage phase.

✦ Novo Nordisk Inc. on Jan 2 launched three new strategies to make insulin more affordable for patients. The My$99Insulin Program allows eligible patients — with or without insurance — to get up to three vials or two packs of any combination of Novo Nordisk insulin products for $99 by enrolling on NovoCare.com and downloading an online card that can be redeemed at a pharmacy. In addition, authorized generic versions of NovoLog and NovoLog Mix will now be stocked at the wholesaler level, and patients can order them at the pharmacy and pick them up in one to three business days. Finally, Novo Nordisk said that in order to prevent insulin rationing, in some cases it will provide a free, one-time, immediate supply of up to three vials or two packs of pens of Novo Nordisk insulin for individuals with a prescription. Read more at https://prn.to/2QSw0GW.

✦ A machine learning system can do a better job of preventing medication errors than clinical decision support (CDS) tools such as alerts and reminders, according to a new study. The study, published in the January edition of The Joint Commission Journal on Quality and Patient Safety, analyzed outpatient data from Brigham and Women’s Hospital and Massachusetts General Hospital in Boston to determine whether a machine learning system generated clinically valid alerts, then compared the alerts to those generated by an existing CDS system. It found that 68.2% of the alerts produced by the machine learning system would not have been generated by the existing CDS system, 92% of a random sample of the chart-reviewed alerts were accurate, and 80% were clinically valid. The study also estimated that the machine learning system could have saved more than $60 per drug alert by potentially preventing adverse events in an outpatient setting, and $1.3 million when extrapolating the findings to the full patient population. Visit https://bit.ly/2ZXqlU0.

Blue Cross Blue Shield of Massachusetts’ partnership with PillPack by Amazon Pharmacy may seem like just another way to offer home delivery of medications to members. But one industry analyst points to PillPack’s potential in improving adherence as the real differentiator, potentially leading to higher retention and acquisition of members.

The Massachusetts Blues plan on Dec. 10 said it will be the nation’s first health plan to provide its members with access to online ordering and delivery of prescriptions by Manchester, N.H.-based PillPack.

Late last month, the Trump administration moved ahead with a proposed rule and draft guidance that could open the door to drug importation. The moves, it contended, would lower U.S. prescription drug prices. But skepticism exists as to whether the policies will ever be implemented, as well as if all involved entities would even participate in the efforts.

An HHS notice of proposed rulemaking (84 Fed. Reg. 70796, Dec. 23, 2019) would allow states and certain nonfederal government entities to submit for review to HHS proposals for programs to import drugs from Canada that have been approved by Health Canada’s Health Products and Food Branch. Those programs also may have co-sponsors, which could be a pharmacist, a wholesaler, another state or another nongovernment entity. Drugs not eligible for importation include controlled substances, biologics, infusibles, intravenous injectables, drugs inhaled during surgery, certain parenteral drugs and drugs with Risk Evaluation and Mitigation Strategies (REMS).