Radar on Drug Benefits

The Part D Enhanced Medication Therapy Management Model launched in 2017 with the intention of incentivizing prescription drug plans (PDPs) to investigate new strategies to optimize medication therapy management (MTM) programs and ultimately reduce Medicare costs. This five-year program, launched across five different Part D regions, is about to come to an end, raising questions such as: What are some of the lessons learned? How could expanding the scope of traditional MTM programs improve outcomes?

Health care solutions company Tabula Rasa HealthCare partnered with Blue Cross and Blue Shield Northern Plains Alliance, a model participant, to improve its MTM program. Now, the company has published a series of papers in the American Journal of Managed Care (AJMC) demonstrating how identifying at-risk patients and optimizing medication regimens at the pharmacist level can impact health care costs and outcomes for Medicare beneficiaries.

Although House Democratic leaders recently suffered a setback when a trio of moderates in a key committee voted against a sweeping set of drug pricing reforms, health care policy experts tell AIS Health that the pharmaceutical industry has every reason to be worried about the prospect of government price controls becoming law.

As one Capitol Hill insider put it: “The drug lobby has never been as worked up and worried before as they are right now, and the reason is because there is an extreme likelihood that something is going to pass.”

As biologics research and development becomes more granular, biosimilars may wind up both less useful and profitable than boosters of the drug category once thought. According to experts, the first wave of biologic patent expiry is almost over — and a new set of expirations starting in 2024 will determine whether biosimilars will have as big an impact in the U.S. as they have in the European Union.

There has been a large number of biosimilar approvals in recent years, according to business intelligence firm GlobalData. The EU “experienced this biosimilar wave ahead of regions such as the US and Asia-Pacific because the EU created the first biosimilar-specific approval pathway,” according to Quentin Horgan, GlobalData’s senior drugs database analyst. Approvals of biosimilars have slowed down in recent years.

✦ Walgreens Boots Alliance Inc. will spend $970 million to acquire a 71% stake in Shields Health Solutions, a specialty pharmacy company. Shields contracts with health systems and hospitals to build and operate on-site specialty pharmacies. The transaction builds on a minority investment that Walgreens made in July 2019. According to a Sept. 21 press release, Shields “represent[s] more than 1 million specialty patients across more than 30 disease states, with more than 70 health system partners nationwide.”

✦ Inovalon Holdings Inc. struck a deal with CorEvitas LLC to gain access to CorEvitas’ analytics on rheumatoid arthritis and psoriasis. Inovalon will combine the data from the CorEvitas platform with its larger chronic condition database. According to a Sept. 21 press release on the deal, “insights made possible through these analytics can advance clinical development, inform trial design and recruitment, substantiate value narratives, and inform patient-specific intervention plans.”

Earlier this month, the FDA approved a drug that the manufacturer touts as “the first-and-only twice-yearly injectable for the treatment of schizophrenia in adults.” Drug benefits experts say it could be a good option for patients who have previously been on extended-release drugs for the schizophrenia — with careful monitoring — and will likely be covered similar to existing long-acting treatments.

The drug is called Invega Hafyera (six-month paliperidone palmitate), a product produced by Janssen Pharmaceuticals, Inc., a Johnson & Johnson unit. It received FDA clearance on Sept. 1 after a randomized, double-blind, non-inferiority Phase III global study that enrolled 702 adults living with schizophrenia from 20 countries, which found that 92.5% of patients treated with Invega Hafyera were relapse-free at 12 months.