RADAR on Drug Benefits

  • COVID-19 Crisis Spurs Increased Interest in Home Care

    As visits to hospitals and outpatient clinics have become sources of anxiety for patients worried about exposure to the novel coronavirus, plans and providers alike have begun to make major investments in home care. Experts say that the shift away from clinical settings and back into the home could make a major dent in the cost of care.

    According to a July white paper prepared by KMPG, the home health space has optimal conditions for growth: “more patients, including recovering COVID-19 patients, are choosing home care to avoid crowded hospitals,” while “technological improvements allow for better home-care services, which are also more frequently reimbursed.”

  • News Briefs

     The U.S. Court of Appeals for the Eighth Circuit on Aug. 7 sided with a PBM trade group in a legal challenge to a 2017 North Dakota law that regulates such firms. In Pharmaceutical Care Management Association v. Tufte et al, the appeals court determined that the North Dakota law is preempted by the Employee Retirement Income Security Act of 1974, as it can affect both ERISA-regulated and non-ERISA health plans. In its judgment, the court cited past arguments in Rutledge v. Pharmaceutical Care Management Association, a case challenging a PBM-regulating law in Arkansas that is set to be argued before the Supreme Court on Oct. 6. Read the judgment at https://bit.ly/3gWK5yY.

     GoodRx Inc., a company that helps consumers track prescription drug prices and offers free drug coupons, is applying for a potential initial public offering (IPO) with the Securities and Exchange Commission, Reuters reported on Aug. 2. Citing sources familiar with the matter, the news outlet said GoodRx is in the process of hiring advisers for the IPO, and the listing could come later this year or early next year. Read more at https://reut.rs/3fRXdUD.

  • Shingrix Uptake May Be Slowed By Part D Cost Sharing

    Since GlaxoSmithKline plc’s Shingrix (zoster vaccine recombinant, adjuvanted) launched in early 2018, a steady number of adults ages 50 and older have been getting the shingles vaccine. But a confusing patchwork of adult vaccine coverage — one that leads to significant out-of-pocket expenses for many in the vaccine’s target population — may be leaving some patients behind, analysts say.

    Richard Hughes IV, managing director at Avalere Health, tells AIS Health that commercial plan members can receive Shingrix with no cost sharing, but Medicare Part D members generally face cost sharing of around $50 or more. Some Medicaid plans don’t cover the vaccine at all, he adds. The two-shot Shingrix series costs around $280 without insurance.

  • Implementation Could Be Tough For Rebate Executive Order

    On July 24, the Trump administration released three executive orders, which call for regulations allowing drugs to be imported from other countries, requiring Federally Qualified Health Centers to make insulin and epinephrine available to low-income people at the discounted prices set by the 340B Drug Pricing Program, and removing safe harbor protections under the Anti-Kickback statue for prescription drug rebates in Medicare Part D. A fourth executive order would tie drug prices to their list prices in countries with Most Favored Nation status, but it has not yet been released.

    Industry experts and trade groups have been particularly critical of the executive order that directs HHS to resurrect the so-called rebate rule, which the administration withdrew in 2019.

  • Anthem, Cigna, CVS Say PBMs Are Weathering COVID-19

    For PBMs, 2020 has been far from business as usual, given the myriad ways the COVID-19 pandemic has changed how people interact with the health care system. However, during their second-quarter earnings conference calls, companies that own some of the largest PBMs emphasized that they are largely satisfied with how the PBM segments of their businesses are performing.

    Anthem, Inc. Chief Financial Officer John Gallina, for example, said during the insurer’s July 29 earnings call that “IngenioRx is actually doing quite well, and has really done a nice job of meeting our expectations.”

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