Radar on Drug Benefits

  • How Can U.S. Prevent Drug Supply Chain Disruptions?

    After disruptions during the height of the COVID-19 pandemic, the National Academies of Science, Engineering and Medicine (NASEM) convened a committee to ensure that supplies of medical technology and pharmaceuticals wouldn’t be interrupted during future crises. Experts tell AIS Health, a division of MMIT, that while the report’s recommendations will help prevent disaster pricing if implemented, it won’t have a significant effect on the pricing behaviors or day-to-day operations of PBMs.

    The panel, a multidisciplinary group of business leaders, medical practitioners and academics — which included recently approved FDA head Robert Califf, M.D. — had seven notable recommendations, according to an official summary:

  • News Briefs: Rite Aid’s PBM Joins Trade Group

    Elixir, Rite Aid Corp.’s PBM business, has joined the Pharmaceutical Care Management Association (PCMA) trade group. According to a March 1 press release, Elixir Chief Operating Officer Chris DuPaul will also serve on the PCMA board of directors. Rite Aid changed the name of its subsidiary EnvisionRxOptions to Elixir in March 2020, saying at the time that the company plans to significantly invest in the rebranded division’s technology platform.
  • Pharma Industry Spent Big to Block Drug Price Reform in 2021

    With drug price reforms on the agenda, pharmaceutical companies last year rallied their significant lobbying resources to block or water down transformational policies. Partly as a result of those lobbying efforts, drug price reform is on the ropes, though sources say there is a meaningful chance that a standalone drug price reform bill could pass Congress this year before the midterm elections.

    Drug price reform efforts have most recently been part of the proposed Build Back Better Act (BBBA), a bill that contains much of President Joe Biden’s proposed policy agenda. That bill stalled out in December, when centrist Sen. Joe Manchin (D-W.Va.) said he could not back the measure as proposed. When Congress disbanded for the holiday recess, the BBBA had several notable drug-pricing provisions. The federal government would have been able to negotiate the prices of certain high-cost medications with pharmaceutical manufacturers. Also, drug prices would be barred from rising at a higher rate than inflation, the Medicare Part D benefit design would be revamped to lower beneficiaries’ out-of-pocket costs and the price of insulin would be capped. Moreover, the never-implemented Trump-era rule that would have overhauled the prescription drug rebate structure in Medicare Part D would have been repealed.

  • Payers Can Play a Role in Encouraging Naloxone Coprescribing

    To prevent deaths and injuries related to prescription opioid misuse, research has shown that coprescribing the overdose-treatment drug naloxone when patients on chronic pain-management therapy receive high doses of opioids can make a big difference. Yet federal data show that less than 1% of patients who should be prescribed naloxone with their opioid medications obtain a prescription for it — a rate that managed care entities can play a role in changing, according to a new paper from the Academy of Managed Care Pharmacy (AMCP) Addiction Advisory Group.

    The AMCP Addiction Advisory Group in 2019 polled AMCP payer members, addiction treatment providers and managed behavioral health organizations, with the goal of understanding and evaluating “trends in treatment, coverage, policies, and needs associated with providing health services to patients with substance use disorders.” One particularly notable finding was that 80% of the managed behavioral health organizations and 47% of AMCP payer members who responded to the survey encouraged naloxone coprescribing in patients at high risk of overdose, but “no organizations required coprescribing.”

  • Optum Aims to Cut Specialty Spend With Management Tool

    UnitedHealth Group’s Optum division recently unveiled an analytics-fueled medication management system aimed at tackling rising costs in the specialty drug market. The company says the new product, known as Specialty Fusion, has the capability to generate significant savings while reducing administrative burden for prescribers.

    Positioned as a solution for commercial health plans, Specialty Fusion is designed to integrate medical and pharmacy benefit data into a single point-of-service management system. According to Optum, the Specialty Fusion system differs from other solutions on the market because it provides “a full integration” of medical and pharmacy benefits. The system incorporates various cost determinants at the point of care, such as available rebates, lower cost sites of care and manufacturer assistance programs, in addition to a carousel of more affordable drug therapies.

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