Radar on Drug Benefits

Pharmacists and other non-physician care managers can improve the quality of diabetes care in the primary care setting, but structural issues make it difficult to fully leverage their potential, according to research published in the July issue of the journal Health Affairs.  

“We need to have a different way of taking care of people with a chronic illness,” said Thomas Bodenheimer, a professor emeritus of family and community medicine at the University of California, San Francisco, who spoke at a Health Affairs briefing on July 19. The briefing convened several researchers who published diabetes-focused articles in the journal’s July issue. 

Spending in the U.S. on medicines increased by 12% in 2021, primarily because of COVID-19 vaccines and therapies, according to the IQVIA Institute’s annual report on drug trends. The report also found that “Despite an increase in overall spending, costs per prescription on average are flat or slightly declining. Prescription drug use reached a record 194Bn daily doses in 2021 as new prescription starts for both chronic and acute care recovered from the slowdown recorded in 2020…[but] spending on medicines is expected to return to pre-pandemic growth trend lines by 2023.” 

A federal appeals court on July 25 held that a Pfizer Inc. coupon program violated the federal Anti-Kickback Statute. The Second Circuit Court of Appeals ruled that Pfizer offering copay assistance to Medicare beneficiaries was illegal under the statue. AHIP applauded the ruling, arguing that “By upholding these protections, the courts have taken an important step to protect Americans from what would otherwise be an unchecked multi-billion-dollar price tag that would make coverage and care less affordable for everyone.” 

The state of California announced last week that it would become the first state to manufacture its own insulin, while a payer-owned coalition said it would distribute its initial generic medication later this summer. Taken together, the moves show that some payers, be they the government or health insurers, are serious about reining in the costs of generics and dealing with inefficiencies in the pharmaceutical supply chain, according to health policy and drug pricing experts who spoke with AIS Health, a division of MMIT. 

California Gov. Gavin Newsom (D) revealed the insulin plans on July 7 via a video on Twitter, keeping to a promise he had first made in 2019 when he was elected to office. The announcement followed the news in June that EmsanaRx became the first PBM to join CivicaScript, a company founded two years ago by a consortium of payers that is aiming to manufacture and lower the cost of generic medications in outpatient settings. In addition, Navitus Health Solutions, a startup PBM that touts a 100% pass through model, joined the CivicaScript partnership on July 13.

After more than a year of deliberation and false starts, Congress might finally reform pricing and federal purchasing of prescription drugs in the fall, D.C. insiders tell AIS Health, a division of MMIT. The substance of the drug pricing bill is similar to previous proposals, but the political ground inside the Democrats’ Senate caucus may have shifted enough to allow prescription drug pricing to eke through as part of a diminished catch-all spending bill that would still be the signature achievement of the beleaguered Biden administration.

Progress on the drug pricing bill resumed when Senate Majority Leader Chuck Schumer (D-N.Y.) on July 7 submitted the text of a bill to the Senate parliamentarian. The parliamentarian will deem whether the bill conforms with the Senate rules that govern the budget reconciliation process. Budget reconciliation is an arcane procedure that allows the Senate to pass legislation with a simple majority, so long as the bill in question relates largely, in the parliamentarian’s judgment, to the budget.