Radar on Drug Benefits

Express Scripts said it saved enrolled plans some $4.3 billion in 2019 through its SafeGuardRx programs, which combine multiple cost- containment strategies such as value- based contracting and payments from financial guarantees.

The PBM first launched its “cure value” program in 2015 for hepatitis, shortly after the FDA approved Gilead Sciences’ Harvoni (ledipasvir/sofosbuvir), the first among a slate of pricey second-generation hepatitis C therapies.

✦ President Donald Trump’s statements touting chloroquine and hydroxychloroquine as promising treatments for the new coronavirus has triggered hoarding of the drug and subsequent shortages, the New York Times reported. Those drugs, which have not been approved by the FDA to treat COVID-19, the disease caused by the coronavirus, are typically used to treat malaria, lupus, rheumatoid arthritis and other conditions. In response to the stockpiling of the drugs, states including Idaho, Kentucky, Nevada, North Carolina, Ohio, Oklahoma and Texas have all issued emergency restrictions or guidelines on how the drugs can be dispensed at pharmacies. Read more at https://nyti.ms/33MdDJu.

✦ A bill has cleared the Kentucky legislature that would require the state’s Medicaid program to pay pharmacies directly for prescription drugs, essentially cutting out the role of PBMs, the Associated Press reported on March 18. CVS Health Corp. is among the major opponents of the measure, with the firm arguing that it’s based on “flawed analysis” and would be a “costly step backwards” for Kentucky. Read more at https://bit.ly/2y6Pkui.

Recently, CMS unveiled a new program to reduce Medicare beneficiaries’ out-of-pocket costs for insulin (RDB 3/12/20, p. 8). The voluntary model aims to lower the cost of a 30-day supply to “no more than $35” and reduce annual insulin costs by an average of $446 per person. Industry experts say the program, called the Part D Senior Savings Model, should save patients money but will have a limited impact on overall drug spending.

“The goal of the program is a way of putting the rebates and additional pricing incentives up front to the member level,” Brian Anderson, an actuary at Milliman Inc., tells AIS Health via email. “This is not a direct point-of-sale rebate approach, but it is a similar strategy for this therapeutic category.”

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.