RADAR on Drug Benefits

  • News Briefs

     A poll by the Kaiser Family Foundation found that the deepening economic crisis has made some patients struggle to afford their prescription medication, among other essentials. According to the poll, 8% of Americans have had difficulty paying for medicine since the start of the coronavirus outbreak, while 13% reported problems paying for food, 11% struggled to pay medical bills, and 9% had trouble affording health coverage. Read the poll results at https://bit.ly/2AdXWjI.

     There will be heavy demand for influenza vaccines this fall, according to a Reuters poll, and the news service reports that retail pharmacies are stocking up on flu vaccine doses to meet it. The poll, which was taken over the course of May 13 to 19, indicates that 60% of Americans intend to get the flu vaccine in the fall. According to Reuters, Rite Aid Corp. has increased its annual order of flu vaccine by 40%. “We’re in for a double-barreled assault this fall and winter with flu and COVID. Flu is the one you can do something about,” Vanderbilt University Medical Center infectious disease expert William Schaffner, M.D., told Reuters. Read more at https://reut.rs/2ZHadrC.

  • CVS Reports Lowest Drug Trend in Years

    CVS Health Corp.’s 2019 drug trend report shows a 1.4% overall trend, the lowest in five years, and said 41% of its commercial clients saw negative trend. Specialty drugs accounted for almost half of all spending and remained the fastest growing spending category in the pharmacy benefit. Autoimmune treatments, including some of the highest volume medications — Humira, Enbrel, Rituxan and Remicade — comprised a third of specialty pharmacy spending. CVS’s Advanced Control Specialty Formulary (ACSF) helped its clients reach -9.4% price growth in the category. As 20 biosimilars are expected to come to the specialty marketplace by 2023, payers may see significant savings, according to CVS.
  • Navitus Achieves Double-Digit Savings for New Clients in 2019

    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.

  • About 1,750 Medicare Rx Plans Join Fixed-Insulin-Copay Demo

    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.

  • Scarcity, Geography Will Shape COVID-19 Vaccine Rollout

    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.

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