Radar on Drug Benefits

Despite experiencing medical cost trends during the second quarter of 2021 that were much less favorable than they were a year ago, publicly traded health insurers during their recent earnings calls were eager to tout the performance of their pharmacy-related holdings. They placed particular emphasis on how integrated PBMs are poised to mine the cost-saving potential of biosimilar drugs.

“During the quarter, the strength of our Evernorth business was clearly a standout,” Cigna Corp. CEO David Cordani, for example, said during the company’s Aug. 5 conference call with investors to discuss quarterly financial results. Specifically, adjusted revenues for the segment — which includes the PBM Express Scripts — grew 14% year over year to $32.6 billion, and Evernorth’s pretax earnings grew 13% to $1.4 billion.

Humana Inc. and Anthem, Inc. are teaming up with hedge fund administrator SS&C Technologies Holdings, Inc. to create DomaniRx, a new joint venture that aims to offer a “best-in-class” PBM cloud-based claims adjudication platform. Humana will be the first customer for DomaniRx, the companies say, and industry observers predict a potential market among Blues plans and Medicare Advantage plans.

The “second generation” claims adjudication platform will leverage SS&C’s technology capabilities and will reside on SS&C’s private cloud, according to the company.

✦ AARP launched a seven-figure, digital ad campaign on July 19 aimed at pressing Congress to support actions to lower drug prices, The Hill reported. The campaign will appear in The New York Times, The Washington Post, CNN, Politico and Axios through July 30 and will focus on the Washington, D.C. area — a move that comes on the heels of the interest group running digital ads on publications’ websites for two weeks ending on June 9. AARP’s ads cite a survey that the group published in June, which found that 87% of people age 50 and older support allowing Medicare to negotiate with drug companies for lower prices and 78% favor putting a cap on out-of-pocket costs for Medicare Part D drugs.

✦ A committee comprising employers, health plans, PBMs, drug manufacturers, health systems, consultants, retailers, wholesalers and other key stakeholders is recommending that the U.S. pharmaceutical supply chain be overhauled to “address long-standing conflicts” and achieve a better delivery model. The committee, convened by the Business Group on Health, met over the past two years to study challenges within the pharmaceutical supply chain, and ultimately issued 70 reform recommendations. One of the key tenets used to guide specific recommendations, for example, is that “benchmarks for drug prices should be established by a transparent and independent third party, informed by a cost-effectiveness analysis and validated by real-world data evaluations.

When patients receive an organ or tissue transplant, a critical part of their treatment involves therapies that are used to ensure neither their bodies nor the transplanted material rejects the new arrangement. While many first-line treatments given to this patient population are low-cost generics, experts say there is a robust pipeline of treatments in development, including a just-approved treatment for chronic graft vs. host disease (GVHD).

Generally speaking, “maintenance treatment for prevention of organ transplant rejection revolves around immunosuppressive therapy,” explains Arash Sadeghi, a clinical pharmacist at UnitedHealth Group’s OptumRx.

COVID-19 presented the health care system with many challenges in 2020, but one of the most sobering was the impact on opioid misuse.

The Centers for Disease Control and Prevention (CDC) said earlier this month that more than 93,000 Americans died from a drug overdose in 2020. This represents a 29% increase compared to 2019. Only two states, New Hampshire and South Dakota, reported a decrease in drug overdose deaths.