Radar on Drug Benefits

EmployersRX, a coalition of organizations representing health care purchasers that aims to bring down drug costs, has joined the growing number of groups expressing concern about the cost of a recently approved novel Alzheimer’s disease drug. “The approval of Aducanumab despite its questionable effectiveness, and its unjustifiable price, demonstrate the profound need for substantial reforms to how the United States approves and prices prescription drugs,” wrote the group in a letter to congressional leaders dated June 21. The FDA approved Biogen, Inc.’s Aducanumab (aducanumab-avwa) earlier this month even though an independent advisory council advised against it, sparking outcry over concerns about its efficacy as well as its annual wholesale acquisition cost of $56,000.

✦ In other Aducanumab-related news, The Wall Street Journal reported on June 22 that the FDA’s approval of the drug came despite objections from the agency’s drug statistics office, which argued that clinical trial data fell short of the proof typically required to put a new product on the market. The article, which cites “newly released internal memos,” reveals that the FDA ultimately decided to approve the drug in part because Alzheimer’s patients have “a serious, progressive, ultimately fatal disease and are desperate for treatments,” in the words of Peter Stein, director of the FDA’s office of new drugs.

New starts of antidepressants declined by 7.5%, anxiolytics by 5.6%, and antipsychotics by 2.6% compared with forecast levels during the first five months of the COVID-19 pandemic, according to a new study published in Health Affairs. For all medications, declines in new starts were particularly dramatic during the initial stay-at-home order period from March to May 2020. Though there was a significant rebound in new prescription starts after mid-May, the numbers remained below 2019 levels. There were substantial drops in new starts for patients younger than 18, across all medication classes, with a 34.6% decline in antidepressants, 27.3% in anxiolytics and 22.2% in antipsychotics compared with the expected levels.

The pharmaceutical industry should continue to enjoy strong financial results in the next 12 to 18 months, according to a new report from Moody’s Investors Service. The credit ratings firm projects 4% to 6% growth in annual earnings before interest, taxes, depreciation and amortization over that period.

The authors predict that growth will be driven by increased uptake of oncology, immunology and diabetes drugs; COVID-19 vaccines and boosters; and a low number of patents set to expire. However, the report does project some headwinds for pharmaceutical firms, namely potential drug pricing legislation and increased biosimilar development. The report also predicted that “pharmaceutical spending will continue to rise globally, across almost all regions.”

Mail-order pharmacies garnered a larger-than-ever share of the prescription drug business due to the pandemic. Though data varies, some insiders say the shift away from retail to mail order is durable, and experts say prescription delivery could become a dominant channel, especially for maintenance medications.

The move toward delivered prescriptions also builds on a trend that emerged from payer-PBM rollups in recent years, which has led the merged firms to try to tempt members into mail-order fills. The combined firms, such as Cigna Corp./Express Scripts, have a strong incentive to bypass retail pharmacies. Doing so allows the firms to retain more rebate revenue and avoid coupons at the point of sale. Meanwhile, prescription delivery originating at a retail pharmacy has drawn some of the same gig economy players that have competed for restaurant takeout and grocery delivery, such as Uber Inc.

In a move that signals Blue Cross Blue Shield plans are getting increasingly serious about driving down the cost of prescription drugs, five major Blues affiliates on June 22 launched a startup company that aims to “offer innovative medication solutions to patients, providers and customers.”

Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Inc. and Independence Blue Cross are all providing “significant funding” to support the launch of Evio, which they characterize as an “independent pharmacy solutions startup.”