Radar on Drug Benefits

In its newest Drug Pipeline Insights Report, OptumRx highlighted recently approved or soon-to-be-approved drugs that might significantly impact payers and patients. In its latest quarterly report, though, the UnitedHealth Group-owned PBM also put special emphasis on one emerging and potentially costly category of therapies: antibody drug conjugates (ADCs).

ADCs work by combining engineered antibodies — called monoclonal antibodies — with a “potent small-molecule chemotherapy payload” to fight certain cancers, the report explains. Since monoclonal antibodies can discriminate between healthy and cancerous tissues, they are able to deliver chemotherapy drugs that would otherwise be way too powerful to use on their own. For example, in Trodelvy (sacituzumab govitecanis-hziy), which the FDA approved on April 22 to treat an aggressive type of breast cancer, the “chemical payload” is 100 to 1,000 times more toxic than traditional anticancer agents, the OptumRx report pointed out.

With precision medicine an increasingly hot topic in health care, MedImpact is betting that a newly launched program — which reviews every drug prescribed to patients against their genetic profile — will simultaneously give the PBM a competitive edge and improve care. Experts tell AIS Health that such a program could usher in changes to the PBM industry if it proves successful and sparks a larger trend.

In a Feb. 26 press release, MedImpact describes its new program as the industry’s first “any drug, any time, any prescriber” approach to pharmacogenomics (PGx). “This highly personalized approach protects patients against hundreds of ineffective and harmful drugs based on their genetic profile. It will reduce ‘trial and error’ prescribing, reduce waste, lower the risk of adverse events, and improve member health,” the San Diego-based PBM said.

In a move that one attorney says may have a domino effect, Blue Cross Blue Shield plans recently filed suit against CVS Health Corp., claiming that the firm fraudulently overcharged them for generic drugs by “submitting claims for payment at artificially inflated prices.” CVS strongly denies the allegations.

The lawsuit, filed May 27 by Blues plans in Alabama, Florida, Minnesota, North Carolina, North Dakota and Kansas City, Mo., joins several others lodged against CVS and separately, against Walgreen Co., that allege the pharmacy chains failed to count prices in their generic cash discount programs when calculating “usual and customary” (U&C) prices for plan reimbursement.

✦ A poll by the Kaiser Family Foundation found that the deepening economic crisis has made some patients struggle to afford their prescription medication, among other essentials. According to the poll, 8% of Americans have had difficulty paying for medicine since the start of the coronavirus outbreak, while 13% reported problems paying for food, 11% struggled to pay medical bills, and 9% had trouble affording health coverage. Read the poll results at https://bit.ly/2AdXWjI.

✦ There will be heavy demand for influenza vaccines this fall, according to a Reuters poll, and the news service reports that retail pharmacies are stocking up on flu vaccine doses to meet it. The poll, which was taken over the course of May 13 to 19, indicates that 60% of Americans intend to get the flu vaccine in the fall. According to Reuters, Rite Aid Corp. has increased its annual order of flu vaccine by 40%. “We’re in for a double-barreled assault this fall and winter with flu and COVID. Flu is the one you can do something about,” Vanderbilt University Medical Center infectious disease expert William Schaffner, M.D., told Reuters. Read more at https://reut.rs/2ZHadrC.