Radar on Drug Benefits

Despite a slew of new branded therapies for acute migraine treatment and migraine prevention, many of which target calcitonin gene-related peptide (CGRP) receptors, health plans and PBMs continue to rely mainly on generic triptans for acute migraine treatment and generic beta-blockers, antiepileptics and tricyclic antidepressants for migraine prevention, drug benefits experts say.

Still, the new drugs available, particularly the CGRP receptor antagonists, provide options for patients whose migraines aren’t adequately controlled by traditional therapies, says Mesfin Tegenu, CEO and chairman of RxParadigm, a pharmacy benefit cost management start-up focused on providing tools and transparency. The CGRPs may also prompt more value-based contracting in the migraine class, he says.

Ohio recently cleared a key hurdle in its plan to revamp how Medicaid enrollees’ pharmacy benefits are managed, choosing Gainwell Technologies as the single PBM that will replace big-name firms including Cigna Corp.’s Express Scripts, CVS Heath Corp.’s Caremark, UnitedHealth Group’s OptumRx and Centene Corp.’s Envolve Pharmacy Solutions.

Although PBMs and insurers generally oppose state moves to carve out pharmacy benefits from their Medicaid managed care contracts, Ohio says it expects the new single-PBM approach will “drive transparency, reduce pharmacy costs and simplify provider administration.” And one health policy expert tells AIS Health that Ohio appears to be on the right track to achieving its goals with its selection of Gainwell.

✦ AlohaCare chose Anthem, Inc. PBM IngenioRx for a three-year contract to serve Medicaid and dual-eligible Medicare/Medicaid beneficiaries in Hawaii, Anthem said on Feb. 24. IngenioRx will serve AlohaCare’s QUEST Integration members, who will be able to opt for services including pill packets for multiple-medication regimens and home delivery. The goal is to “improve the pharmacy experience and drive better health outcomes, while further lowering costs,” per a news release from the company. For more information, contact Lori McLaughlin at lori.mclaughlin2@anthem.com.

✦ In January, prescription volumes continued their downward trend but showed some slight improvement over recent months, according to a recent research note from Citi analyst Ralph Giacobbe, citing IQVIA Health data. Adjusted total prescriptions, which includes both new scripts and refills, were down 4.5% year over year, compared with -6.1% year over year in December and -5.3% in November. Adjusted new prescriptions, which represents the first time a patient has been prescribed a particular drug, was down 6.7% in January, “which indicates slight improvement from trends in December and November that were both down 7.2%,” Giacobbe wrote. Visit www.iqvia.com to learn more.

Editor’s Note: A quotation from Philip Ball has been updated to clarify that he was describing drug manufacturers’ criticisms of ICER, not his own.

As states continue their quest to lower prescription drug prices for the benefit of their budgets and residents, a small but growing number are considering legislation that would levy an 80% tax on drug price increases that the Institute for Clinical Effectiveness Research (ICER) deems “unsupported” by clinical evidence.

Treatment for heart failure still relies significantly on tried-and-true generic drugs, but new brand-name entrants — including Novartis’ Entresto (sacubitril/valsartan) and Amgen’s Corlanor (ivabradine) — are important additions to prescribers’ clinical arsenals against the high-mortality condition, industry insiders say.

In fact, a newly approved expanded indication for Entresto, plus more products recently approved and in the pipeline, could shift the balance more toward brand-name drugs in heart failure treatment, the insiders say.