Radar on Drug Benefits

Navitus Health Solutions, a PBM that touts a 100% rebate pass-through model and a lowest-net-cost formulary, says it is seeing success in moderating total net cost per-member per-month (PMPM), particularly for new clients.

The company’s 2019 Drug Trend report, released in May, said Navitus achieved an “industry-leading” total net cost PMPM of $78.12 across its commercial business, 16% lower than the forecasted industry average of $93.11 PMPM.

The Trump administration on May 26 shared new details about a program that offers diabetic seniors access to a variety of insulin products for a maximum $35-per-month copay.

More than 88 health insurers offering about 1,750 standalone Medicare Part D Prescription Drug Plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MA-PDs) have now applied to participate in the Part D Senior Savings Model, which CMS unveiled in mid-March (RDB 3/26/20, p. 5). Medicare beneficiaries in all 50 states, the District of Columbia and Puerto Rico will be able to enroll in a participating plan during the Medicare open enrollment period that lasts from Oct. 15 to Dec. 7, 2020, for Part D coverage that begins on Jan. 1, 2021.

The rollout of a vaccine for SARS-CoV-2, the virus that causes COVID-19, is an unprecedented logistical challenge. So will be deciding who gets it: experts say that the initial vaccine supply will not be large enough to dose everyone who wants it — and payers and PBMs will have a large role to play in distributing the medicine to the right people quickly.

David Simchi-Levi, Ph.D., a systems engineer who studies manufacturing and supply chain at MIT, tells AIS Health that it’s inevitable that vaccine supply will not meet demand when it is available.

While the COVID-19 pandemic led to worrying spikes in demand for certain drugs back in March and April — spurring PBMs to swiftly establish dispensing limits — that particular storm appears to have passed. However, a push to reduce reliance on foreign-produced medicines could be the next cause for concern about the drug supply chain.

HHS on May 19 said it awarded a four-year, $354 million contract to “a team of private industry partners,” led by Virginia-based startup company Phlow Corp., which will work toward expanding pharmaceutical manufacturing in the U.S. “for use in producing medicines needed during the COVID-19 response and future public health emergencies.” The COVID-19 pandemic “has reminded us how health threats or other sources of instability can threaten America’s medical supply chains,” HHS Secretary Alex Azar said in a press release.

✦ In its final Notice of Benefit and Payment Parameters for the 2021 benefit year, CMS crystallized a controversial policy of allowing commercial health insurers to prevent drug manufacturer coupons from counting toward members’ annual out-of-pocket limits. So-called copay accumulator programs, in the eyes of health insurers, help prevent drug coupons from steering patients to higher-priced, brand-name drugs by obscuring their true cost (RDB 3/12/20, p. 4). But drugmakers and some patient advocacy organizations contend that copay accumulators stop patients from getting crucial help to pay for their medications. Read the final rule at https://go.aws/2Any1WY.

✦ Maryland Gov. Larry Hogan, a Republican, vetoed funding for a board that would have set maximum prices that the state and local governments would have to pay for certain medicines. In a letter to legislators on the matter, the governor said he made the move to prevent increasing taxes during the emerging pandemic-driven economic catastrophe. The board’s supporters criticized the governor’s decision, arguing price controls would have protected vulnerable consumers, and that the program would be paid for by fees assessed to drugmakers, PBMs and insurance companies, according to an article from Stat. Read Hogan’s letter to legislators at https://bit.ly/2T1VdjQ and the Stat article at https://bit.ly/2YZ0DQt.