Radar on Drug Benefits

  • CenterWell Pharmacy Exec: New App Targets Digitally Savvy Seniors

    Like its competitors, Humana Inc.’s evolution from a pure-play health insurer to a highly diversified health care firm came with a rebranding. To that end, Humana Pharmacy — the company’s mail-order and retail pharmacy brand — in 2022 became CenterWell Pharmacy, nestled under the company’s CenterWell health services subsidiary. Now, that division not only has a new name, but also a new app.

    The app — which is available to CenterWell Pharmacy members covered by Humana’s Medicare Advantage and Part D plans — represents a “total redesign,” with increased personalization capabilities and a streamlined approach to prescription management, the firm said in a Feb. 20 press release.

  • New Medicare Out-of-Pocket Drug Cost Cap Will Benefit Millions in 2025

    Millions of Medicare Part D beneficiaries will save money after the introduction of a $2,000 out-of-pocket (OOP) spending cap for prescription drugs, a provision that is included in the Inflation Reduction Act of 2022 and takes effect next year, according to a recent KFF analysis.

    Based on KFF’s review of drug claims data for Part D enrollees who do not qualify for the low-income subsidy (LIS), the analysis projected that, if the $2,000 cap had been in place in 2021, 1.5 million Medicare Part D beneficiaries — who spent $2,000 or more OOP on prescription drugs — would have saved money. Over the 10-year period between 2012 and 2021, a total of 5 million enrollees had OOP drug costs of $2,000 or more in at least one year.

  • News Briefs: FTC, HHS Seek Public Comment on Drug Shortages

    The Federal Trade Commission (FTC) and HHS issued a request for information (RFI) on Feb. 14 regarding the role of health care group purchasing organizations (GPOs) and drug wholesalers in widespread generic drug shortages. The agencies are seeking public input about market concentration and contracting practices in those two industries and their involvement in the generic drug market. The agencies noted in a press release that they want information about “how both entities may influence the pricing and availability of pharmaceutical drugs.” Last year, the FTC announced an investigation into rebate-aggregating GPOs tied to major PBMs.

    A federal judge on Feb. 12 dismissed a lawsuit brought by the trade group Pharmaceutical Research and Manufacturers of America (PhRMA) challenging the Medicare drug price negotiation program. PhRMA sought to overturn the section of the Inflation Reduction Act creating the program, which allows the federal government to negotiate the price of select high-cost medications. Individual drugmakers such as Merck & Co., Bristol Myers Squibb Co., Johnson & Johnson and AstraZeneca PLC all have similar suits underway. CMS on Feb. 1 sent initial price offers to the manufacturers of the first 10 medications that were selected for the Medicare drug price negotiation program, which goes into effect in 2026.

  • ‘D’ Is for Dynamic: CMS Proposals Could Shake Up Medicare Drug Benefits

    In two recent proposals, CMS outlines numerous changes to technical aspects of the Medicare Part D program — many of which are related to provisions in the Inflation Reduction Act (IRA) that restructured the Part D benefit phases. Sources tell AIS Health, a division of MMIT, that the proposals could have both positive and negative effects on Part D plan sponsors and beneficiaries and will likely attract a bevy of industry feedback.

    The documents in question are the 2025 Advance Notice of payment changes for Medicare Advantage and Part D plans and the Draft 2025 Part D Redesign Program Instructions. While the Advance Notice is unveiled around the same time every year, the draft Part D redesign instructions are being issued to help implement provisions of the IRA that make major changes to the structure of the Part D benefit.  

  • Direct-to-Consumer Prescribing Could Have Downsides

    UnitedHealth Group’s Optum division recently launched a new direct-to-consumer telehealth prescribing venture as part of its Optum Perks vertical, joining a crowded field of DTC prescribing and dispensing. Experts say that the Optum Perks debut is proof that DTC prescribing around “lifestyle drugs” will likely continue to grow rapidly, but they say that there are clear downsides around utilization management and care coordination — particularly where glucagon-like peptide-1 (GLP-1) agonists are concerned.

    Optum Perks’ rollout follows closely on the heels of Eli Lilly & Co.’s Lilly Direct launch, which also saw a health care giant steer into DTC prescribing waters. Lilly and industry watchers say that Lilly Direct is mainly intended to dispense its tirzepatide GLP-1 drugs, known by the brand names Mounjaro and Zepbound. Patients may or may not be able to obtain GLP-1s from Optum Perks; UnitedHealth’s press release doesn’t have a comprehensive list of drugs offered under the service, although it says that “low-cost care and prescription treatments for hundreds of conditions ranging from acne to a cough to high blood pressure” are available.

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