Radar on Drug Benefits

A federal panel of medical experts on Aug. 22 recommended that pre-exposure prophylaxis be prescribed to people at increased risk of HIV infection, and included long-lasting, physician-administered injectable forms of PrEP in its guidance. However, a leading vaccine expert says the decision by the U.S. Preventive Services Task Force (USPSTF) is unlikely to increase access to PrEP, especially given an ongoing conservative-led legal battle that threatens to overturn the preventive services mandate included in the Affordable Care Act.

USPSTF granted PrEP an “A” grade, its highest rating. In the rating, USPSTF experts “recommend[ed] that healthcare professionals prescribe PrEP to people at increased risk for HIV to help prevent HIV.” Notably, the new rating mentions injectable PrEP, Apretude (cabotegravir extended-release injectable suspension), which had not been included in USPSTF PrEP recommendations before. In a 2019 PrEP endorsement, the task force only mentioned oral PrEP.

With many new, expensive treatments entering the U.S. market, plan sponsors are facing more challenges when designing their drug benefits packages, according to Pharmaceutical Strategies Group’s 2023 “Trends in Drug Benefit Design Report,” sponsored by Rx Savings Solutions. The report is based on surveys of 180 individuals representing employers, health plans and union/Taft Hartley plans.

In 2023, almost all employers and health plans offered a preferred provider organization (PPO) plan and most offered a high-deductible health plan (HDHP) with a health savings account (HSA). Yet only 43% of respondents agreed or strongly agreed that HDHPs effectively manage overall drug trend. The percentage showed a modest increase compared to 35% in 2022.

CVS Health Corp. on Aug. 23 launched a subsidiary called Cordavis, which will work with drug manufacturers to “commercialize and/or co-produce biosimilar products.” CVS said it has contracted with Sandoz to bring Hyrimoz, a Humira biosimiliar, to market in the first quarter of 2024 under a private Cordavis label. The list price of Cordavis Hyrimoz, the company said, will be “more than 80% lower than the current list price of Humira.” Sandoz launched a branded, high-concentration formulation of Hyrimoz on July 1, joining several other Humira biosimilars that launched in the same month.

On Aug. 21, Pfizer Inc.’s Abrysvo became the first vaccine approved by the FDA for use in pregnant people to prevent respiratory syncytial virus (RSV) in infants. The vaccine, which is administered in one dose, is approved for use at 32 through 36 weeks gestational age of pregnancy, and it can prevent lower respiratory tract disease caused by RSV in infants from birth through six months old. In May, the FDA approved Abrysvo for the prevention of lower respiratory tract disease cause by RSV in people age 60 and older. The FDA in July approved AstraZeneca and Sanofi’s Beyfortus (nirsevimab-alip) for preventing RSV in infants, and the Centers for Disease Control and Prevention in early August recommended the vaccine be given to all infants under 8 months and some older babies at increased risk of severe illness starting this fall.

Demand for Novo Nordisk A/S’s Wegovy (semaglutide) may spike even higher following the Danish pharma giant’s Aug. 8 announcement that the diabetes drug, recently approved by the FDA for use as a weight loss treatment, “reduces the risk of major adverse cardiovascular events by 20%” in patients with obesity. Clinicians and pharmacists say the drug’s broad appeal became even greater with the news but suggest that insurers and plan sponsors are likely to continue to erect access barriers to Wegovy given its high cost and clinical limitations.

Novo said a double-blinded trial “compared subcutaneous once-weekly semaglutide 2.4 mg with placebo as an adjunct to standard of care for prevention of major adverse cardiovascular events (MACEs) over a period of up to five years,” and “achieved its primary objective by demonstrating a statistically significant and superior reduction in MACE of 20% for people treated with semaglutide 2.4 mg compared to placebo.”

Amid ongoing concerns about heightened health care utilization, Medicaid redeterminations and even risk adjustment, major managed care companies in their second-quarter 2023 earnings reports made sure to emphasize the strong performance of their health care services segments — which happen to house the country’s three largest PBMs.

The Cigna Group, which owns the PBM Express Scripts under its Evernorth division, kicked off its quarterly earnings call on Aug. 3 with CEO David Cordani singing Evernorth’s praises.

“In Evernorth Health Services, we saw another strong quarter of our market-leading pharmacy, care and benefits portfolio,” Cordani said. “Express Scripts, our pharmacy benefits business, harnesses our deep relationships, extensive clinical expertise, and is delivering innovations and innovative solutions for those we serve.”