Radar on Drug Benefits

wo new PBMs entered the game in recent weeks: EmsanaRx, a not-for-profit venture owned by the Purchaser Business Group on Health (PBGH), and CostPlus PBM, a startup funded by venture capitalist and Dallas Mavericks owner Mark Cuban as part of his larger foray into the pharmaceutical business. Like other recent PBM startups, both ventures claim they will be more transparent and client-focused than the Big Three PBMs (Cigna Corp.’s Express Scripts, CVS Health Corp.’s Caremark and UnitedHealth Group’s OptumRx) — but health care insiders say those promises are hard to keep.

Both PBMs will begin serving clients in 2023. EmsanaRx will start by serving a small number of PBGH members that year. It will eventually be open to any purchasing entity but will not pursue business on a large scale. On the other hand, CostPlus PBM has aggressive growth targets: Its CEO, Alex Oshmyansky, M.D., Ph.D., tells AIS Health, a division of MMIT, that the company will “absolutely” seek to grow to Big Three size.

The month of October brought two important developments for interchangeable biosimilars, which industry observers have long hoped will help increase uptake of lower-cost versions of complex biologic drugs.

On Oct. 15, the FDA approved Cyltezo, the first interchangeable biosimilar version of blockbuster autoimmune condition treatment Humira. And on Oct. 20, Cigna Corp.-owned Express Scripts revealed that it will now prefer Semglee — the first FDA-approved interchangeable biosimilar on the U.S. market — over the branded long-acting insulin Lantus on the PBM’s largest formulary.

Eli Lilly & Co. has announced plans to run a head-to-head clinical trial of its Alzheimer’s drug, donanemab, against Aduhelm (aducanumab), the controversial Biogen Inc. Alzheimer’s drug. Meanwhile, Aduhelm has continued to have what one expert calls “the worst drug launch ever,” after state Medicaid leaders told CMS they want no part of paying for the drug.

In its third-quarter results, Biogen reported in a Securities and Exchange Commission filing that Aduhelm revenues totaled $300,000, citing the fact that many clinicians don’t want to prescribe the drug. Meanwhile, Eli Lilly & Co.’s donanemab is under an accelerated approval process. That process will include a Phase III study comparing donanemab directly to Aduhelm, according to Daniel Skovronsky, M.D., Ph.D., a Lilly senior vice president and its chief scientific and medical officer.