Radar on Drug Benefits
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Digital Endpoints Are Coming — and Payers Need to Be Ready
Digital evidence from apps, wearables and remote sensors is already being used by medical product developers to test and measure their effectiveness. The FDA issued draft guidance earlier this year on the use of digital health technologies to acquire data remotely from clinical trial participants. And the European Medicines Agency approved its first digital endpoint, accepting one to be used to evaluate medications for Duchenne Muscular Dystrophy.
Payers are next, warned Jennifer Goldsack, CEO of the Digital Medicine Society (DiMe), speaking at the AHIP 2022 conference in Las Vegas, N.V.
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New Drug Benefit Design Report Shows Increasing Emphasis on Member Experience
In 2022, the majority of plan sponsors used a drug benefit consultant while designing their drug benefit programs, according to Pharmaceutical Strategies Group’s 2022 “Trends in Drug Benefit Design Report,” sponsored by Rx Savings Solutions. The report, which is based on surveys of 153 individuals representing employers, union/Taft-Hartley plans and health plans that covered an estimated 35.1 million lives, also revealed an increasing focus on member satisfaction.
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News Briefs: Supreme Court Declines PBM Fiduciary Responsibility Case
The U.S. Supreme Court declined on June 27 to hear a case that could have saddled PBMs with a fiduciary responsibility to a clients under ERISA. The case, a class action lawsuit titled John Doe v. Express Scripts, considered whether PBMs have a fiduciary duty to lower drug prices for clients, which is not the standard required by existing law or industry practice. However, some proposals currently under consideration by Congress would impose such a requirement, which could end practices such as spread pricing.
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Some Employers Embrace Alternate Funding Programs Despite Legal Issues
Pharmacy benefit consultants have mixed views on how many plan sponsors are turning to alternate funding programs, which aim to save on specialty drug costs by eliminating coverage for certain drugs and diverting costs to pharmaceutical companies’ patient assistance programs. But scrutiny of the programs is growing, with one major pharma company challenging the legality of these programs in court.
“A large percentage” of WTW’s employer clients now are using this strategy, Chantell Sell Reagan, Pharm.D., the national pharmacy practice clinical lead for WTW, tells AIS Health, a division of MMIT.
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Medically Integrated Dispensing Chops Waste, Signals Expansion
Newly released results of a Prime Therapeutics LLC oncology program suggest that if the PBM were to expand its highly coordinated oral oncology dispensing model beyond the pilot population, cost savings could exceed $1 million. And these promising results signal that the model may be on the brink of expanding into more disease states.
Prime’s medically integrated dispensing (MID) model, which takes a high-touch, care coordination-intensive approach, cut waste by limiting overfills, according to a Prime study released June 2. Compared with the traditional central specialty pharmacy dispensing of oral oncology drugs, the MID pilot involving 627 patients across three commercial insurance plans showed the potential to cut $1,800 in costs “per medication dose change,” according to the results.
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