Radar on Drug Benefits

Major PBMs reported strong results for the first quarter of 2020 as members rushed to fill prescriptions in March ahead of the COVID-19 pandemic. However, financial analysts warn the pandemic could have unpredictable effects on PBMs for the rest of 2020 and moving into 2021.

The 2021 PBM selling season could be disrupted in still-unknown ways, analysts said, and members are cutting back on routine physician visits and elective procedures, resulting in lower script volume overall.

✦ Recent developments related to Gilead Sciences Inc.’s antiviral drug remdesivir indicate that it could be a promising treatment for COVID-19. In a New England Journal of Medicine paper published on April 10, researchers reported that clinical improvement was observed in 36 out of 53 (or 68%) of COVID-19 patients who were given remdesivir on a compassionate-use basis. Then on April 16, Stat published an article offering an early look at results from Gilead’s two Phase III clinical trials on remdesivir, which it conducted on 125 COVID-19 patients being treated at the University of Chicago Medical Center. The news outlet reported that the hospital saw rapid recoveries in fever and respiratory symptoms among patients treated with the drug, with nearly all patients discharged in less than a week. View the NEJM paper at https://bit.ly/2KplOmd and the Stat article at https://bit.ly/3br9rSP.

✦ Novartis AG said on April 20 that the FDA will allow it to proceed with a Phase III clinical trial in which it will test the anti- malarial drug hydroxychloroquine on hospitalized patients with COVID-19. Sandoz, the generics and biosimilars division of Novartis, will supply hydroxychloroquine for the clinical trial, which the Swiss drugmaker said will be “conducted at more than a dozen sites in the United States” and begin enrolling patients within the next few weeks. Demand for hydroxychloroquine and its more potent cousin, chloroquine, surged after President Donald Trump touted early evidence that it could be a promising treatment for COVID-19, causing major PBMs to restrict dispensing such drugs to prevent stockpiling for off-label uses (RDB 4/9/20, p. 1). Meanwhile, a recent study conducted on 368 COVID-19 patients at U.S. veterans hospitals “found no evidence that use of hydroxychloroquine, either with or without azithromycin [an antibiotic], reduced the risk of mechanical ventilation” for those patients. Read more at https://bit.ly/3eFkPMN and https://bit.ly/3bx5eg6

Spending on prescription drugs that are covered under the medical benefit increased by 65% between 2014 and 2018 for commercial insurers and 40% for Medicare, according to Magellan Rx Management’s annual Medical Pharmacy Trend Report. A Magellan executive says the release of expensive new therapies — especially cancer drugs — is a main driver of price growth.

“The increase in medical pharmacy spend seems to largely be driven by inflation,” Kristen Reimers, Magellan’s senior vice president of specialty clinical solutions, tells AIS Health. “This can be a combination of two things, increasing costs of existing drugs and providers utilizing newer more expensive drugs. The pipeline was extremely robust and new therapies to market are contributing to inflation, driving the trend.”

A recently released study from Prime Therapeutics LLC highlights an eyebrow-raising trend: Over the last two and a half years, the number of the PBM’s commercially insured members with asthma who used biologic medicines nearly doubled, and so did spending on those drugs.

Prime, which is owned by 18 Blue Cross and Blue Shield plans, examined integrated pharmacy and medical claims from 14 million commercially insured members from January 2017 to June 2019. It found that the number of members with an asthma diagnosis using one of five asthma biologics — Cinqair (reslizumab), Dupixent (dupilumab), Fasenra (benralizumab), Nucala (mepolizumab) and Xolair (omalizumab) — increased by 78%, from 3.3 users per 10,000 members to 5.8 out of 10,000.

As a result of the COVID-19 pandemic, patients with autoimmune disorders who depend on caregiver-administered drugs face serious challenges to their safety, according to a recent analysis published by Avalere Health. Many patients who need to visit a clinical site to receive treatment for autoimmune disorders are confronted with a difficult choice: go out in public to face the danger of a virulent, fast-spreading pandemic for which they are at acute risk, or stay home and go without their medication.

“[Immunocompromised] patients are experiencing this maybe more acutely than any of us,” Lance Grady, a managing director at Avalere and one of the authors of the white paper, tells AIS Health. “For a patient to have to sit in their home and have a telehealth engagement with their provider, that’s a new experience. Then for a patient to go through a workup with their provider and understand what other therapeutic alternatives might be available, or what the next steps are in care — typically these are interventions that require a patient to ambulate. A patient would then have to say, ‘Is it safe for me to go out there?’”