Radar on Drug Benefits

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.”

The FDA on Aug. 4 approved Zurzuvae (zuranolone) for the treatment of postpartum depression (PPD), making it the first oral pill available to treat a condition that affects an estimated 500,000 people annually. While that ostensibly would be good news for the drug’s manufacturers — Biogen Inc. and Sage Therapeutics, Inc. — Sage’s shares plummeted amid the FDA’s decision not to approve Zurzuvae for major depressive disorder, which affects a much larger patient population.

That setback, plus the FDA’s addition of a boxed warning that cautions patients not to drive or operate heavy machinery for at least 12 hours after taking Zurzuvae, led analysts to express significant concerns about the sales potential of the drug. Meanwhile, from a coverage standpoint, experts tell AIS Health, a division of MMIT, that rebates will play a significant role in whether payers choose to put the new drug on their formularies.

After the introduction of newly FDA-approved, competing products in their therapeutic classes, the net price growth rate of select medications declined, according to an analysis published in the August issue of Health Affairs. The findings suggest that both “me too” therapies and PBM rebate negotiation might have an important role to play in reducing costs, researchers say.

The study found there was an estimated $10.4 billion reduction in net commercial spending for the existing therapies in the first three years after the introduction of the new medications. The authors noted that represented an 18.5% decline in projected spending on the existing therapies compared with if the new medications had never hit the market.

Brand-name medications introduced from 2013 to 2017 across 12 therapeutic classes reduced net commercial spending by over $10 billion on existing medications, according to a new Health Affairs study.

Entry of new therapeutic competition led to a lower net price growth for 10 of the 12 drugs studied. Four of the medications showed a statistically significant decrease in the growth rate of net prices, including the long-acting insulin Levemir (insulin detemir) and the asthma inhaler Advair (fluticasone/salmeterol). Overall, the introduction of new drugs was associated with a 4.2% decrease in annual net price growth and a 6.8% immediate decrease in the mean net price of the existing drugs.