Radar on Drug Benefits

Some 70% of pharmacists have taken on new job responsibilities — ranging from childhood immunizations and diagnostic testing to patient counseling on care and payment options for their medications — during the COVID-19 pandemic, a survey from CoverMyMeds shows.

This trend toward an expanded scope of practice for pharmacists, which had been building prior to the pandemic, accelerated with federal and state actions to relax restrictions in order to improve access to care during the public health emergency, experts say. While pharmacists in some states may lose ground on their practice scope when the emergency ends, it’s likely that more pharmacists will retain the ability to vaccinate children and perform diagnostic tests.

While client-filed lawsuits against PBMs and regulatory scrutiny of their business models continue to make headlines, a newly released survey finds that plan sponsors’ overall satisfaction with their PBMs is relatively high. But Pharmaceutical Strategies Group’s 2020 Pharmacy Benefit Manager Customer Satisfaction Report also reveals that customer satisfaction of PBMs varies depending on the firms’ size and the type of client being served. PSG, a pharmacy benefits consulting firm, was acquired by EPIC Insurance Brokers & Consultants in February.

“The size of the PBM does make a difference, often in the services that are provided because of scale. It also makes a difference in the types of customers who choose a PBM — so many customers are looking to middle-market, midsized PBMs for more flexibility, where others look to the larger PBMs for perhaps deeper discounts,” Sharon Phares, Ph.D., senior vice president of research and data innovation at PSG, said during a May 25 webinar to discuss the survey’s findings.

Prescription drug shopping app GoodRx, Inc.’s 2021 is off to a good start, with strong growth in its first publicly traded quarter yielding enough liquidity for the startup to purchase one of its competitors, RxSaver, for $50 million in cash. Experts say the deal and the company’s strong results are proof that it is here to stay, regardless of how retail giants like CVS Health Corp. and Amazon.com Inc. try to shake up the prescription drug market.

GoodRx reported 20% revenue growth year over year for the first quarter of 2021 and 9% growth in prescription volume, although income was only $1.7 million due to the acquisition of RxSaver and expenses related to the firm’s initial public offering. It acquired health and wellness video production company HealthiNation in April.

✦ Officials in as many as seven states plus the District of Columbia are now probing PBM business practices, The Wall Street Journal reported on May 11. One of those states, Ohio, has filed lawsuits against Cigna Corp., UnitedHealth Group and Centene Corp. that accuse the companies and their PBM divisions of overcharging the state, and it is also moving to a single-PBM system (RDB 3/11/21, p. 1). In addition to Ohio’s probe, the Journal found that PBM investigations are ongoing in Arkansas, D.C., Georgia, Kansas, Mississippi, New Mexico and Oklahoma. Several states are working with the same law firm that is filing suits on behalf of Ohio. Read more at https://on.wsj.com/3bkkFdE.

✦ When it comes to patients’ exposure to rising drug list prices, prescription drug benefit design makes a big difference, according to a study recently published in JAMA Network Open. The study examined pricing data from January 2015 to December 2017 for 79 brand-name drugs as well as a national insurance claims database. Among that commercially insured cohort, roughly half had fixed copayments and “were insulated from increases in list prices.” But the other half of patients had prescription drug benefits that included deductibles or coinsurance “and, in that cohort, out-of-pocket costs increased when manufacturers increased list prices,” the study found. What’s more, “changes in net drug prices accounting for manufacturer rebates were not correlated with changes in patient out-of-pocket spending, suggesting that increasing rebates offered by manufacturers to partially offset list price hikes are not being directly passed on to patients, even if they limit increases to total drug spending.” Read more at https://bit.ly/3o6ZwsF.

In its 2020 Drug Trend Report, CVS Health Corp.’s Caremark PBM said its overall drug trend increased by 2.9% in 2020 and that 34% of its clients saw their pharmacy benefit spending decrease.

According to the report, specialty drug costs were the biggest concern. In fact, specialty treatments accounted for 52% of pharmacy spending in 2020, with 90% of spending concentrated on just five therapeutic categories. Despite that, the report asserts that “more than 40% of [Caremark] clients had single- digit specialty trend,” and “18% of [Caremark] clients had negative specialty trend.”