Drug Benefits

Medicare ‘Overspent’ by 20% Compared With Costco Prices on Generic Drugs

July 22, 2021

Medicare spent $2.6 billion more on 184 most common generic drugs compared with Costco member prices for the same prescriptions in 2018, according to a recent research letter published in JAMA Internal Medicine. By analyzing more than 1.4 billion Part D claims, researchers estimated that Medicare spent 13.2% more in 2017 and 20.6% more in 2018 than Costco members paid for 30-day and 90-day prescription fills. In 2018, Medicare spending exceeded the Costco member price on 43.2% of all 30-day and 90-day fills of the generic drugs studied.

Medicare spent $2.6 billion more on 184 most common generic drugs compared with Costco member prices for the same prescriptions in 2018, according to a recent research letter published in JAMA Internal Medicine. By analyzing more than 1.4 billion Part D claims, researchers estimated that Medicare spent 13.2% more in 2017 and 20.6% more in 2018 than Costco members paid for 30-day and 90-day prescription fills. In 2018, Medicare spending exceeded the Costco member price on 43.2% of all 30-day and 90-day fills of the generic drugs studied.

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Navitus Debuts Predictive Tool To Prevent Opioid Misuse

July 22, 2021

COVID-19 presented the health care system with many challenges in 2020, but one of the most sobering was the impact on opioid misuse.

The Centers for Disease Control and Prevention (CDC) said earlier this month that more than 93,000 Americans died from a drug overdose in 2020. This represents a 29% increase compared to 2019. Only two states, New Hampshire and South Dakota, reported a decrease in drug overdose deaths.

According to CDC data, opioids represent the largest percentage of drug overdose deaths in 2020, at nearly 70,000. Meanwhile, a recent National Institute on Drug Abuse analysis estimated that more than 20% of these deaths involved prescription opioids. Beyond the increase in overdose deaths, a recent American Medical Association report concluded that every state faced concerns about access to care for substance use disorder and harm-reduction services in 2020.

COVID-19 presented the health care system with many challenges in 2020, but one of the most sobering was the impact on opioid misuse.

The Centers for Disease Control and Prevention (CDC) said earlier this month that more than 93,000 Americans died from a drug overdose in 2020. This represents a 29% increase compared to 2019. Only two states, New Hampshire and South Dakota, reported a decrease in drug overdose deaths.

According to CDC data, opioids represent the largest percentage of drug overdose deaths in 2020, at nearly 70,000. Meanwhile, a recent National Institute on Drug Abuse analysis estimated that more than 20% of these deaths involved prescription opioids. Beyond the increase in overdose deaths, a recent American Medical Association report concluded that every state faced concerns about access to care for substance use disorder and harm-reduction services in 2020.

Against this sobering backdrop, the PBM Navitus Health Solutions has added a predictive analytics product to its Opioid Safety Solutions offering. The product, Predictive Analytics for the Misuse of Opioids (PAMO), generates member-specific risk scores to help prescribers identify who may be at risk of opioid misuse and recommend non-opioid treatment options.

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Rezurock Is Approved With More Transplant Agents in Pipeline

July 22, 2021

When patients receive an organ or tissue transplant, a critical part of their treatment involves therapies that are used to ensure neither their bodies nor the transplanted material rejects the new arrangement. While many first-line treatments given to this patient population are low-cost generics, experts say there is a robust pipeline of treatments in development, including a just-approved treatment for chronic graft vs. host disease (GVHD).

Generally speaking, “maintenance treatment for prevention of organ transplant rejection revolves around immunosuppressive therapy,” explains Arash Sadeghi, a clinical pharmacist at UnitedHealth Group’s OptumRx.

When patients receive an organ or tissue transplant, a critical part of their treatment involves therapies that are used to ensure neither their bodies nor the transplanted material rejects the new arrangement. While many first-line treatments given to this patient population are low-cost generics, experts say there is a robust pipeline of treatments in development, including a just-approved treatment for chronic graft vs. host disease (GVHD).

Generally speaking, “maintenance treatment for prevention of organ transplant rejection revolves around immunosuppressive therapy,” explains Arash Sadeghi, a clinical pharmacist at UnitedHealth Group’s OptumRx.

This includes drugs like calcineurin inhibitors (such as tacrolimus and cyclosporine), mTOR inhibitors (including sirolimus and everolimus), antimetabolic agents (e.g., mycophenolate and azathioprine), and glucocorticoids like prednisone, he tells AIS Health, a division of MMIT.

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News Briefs

July 22, 2021

✦ AARP launched a seven-figure, digital ad campaign on July 19 aimed at pressing Congress to support actions to lower drug prices, The Hill reported. The campaign will appear in The New York Times, The Washington Post, CNN, Politico and Axios through July 30 and will focus on the Washington, D.C. area — a move that comes on the heels of the interest group running digital ads on publications’ websites for two weeks ending on June 9. AARP’s ads cite a survey that the group published in June, which found that 87% of people age 50 and older support allowing Medicare to negotiate with drug companies for lower prices and 78% favor putting a cap on out-of-pocket costs for Medicare Part D drugs.

✦ AARP launched a seven-figure, digital ad campaign on July 19 aimed at pressing Congress to support actions to lower drug prices, The Hill reported. The campaign will appear in The New York Times, The Washington Post, CNN, Politico and Axios through July 30 and will focus on the Washington, D.C. area — a move that comes on the heels of the interest group running digital ads on publications’ websites for two weeks ending on June 9. AARP’s ads cite a survey that the group published in June, which found that 87% of people age 50 and older support allowing Medicare to negotiate with drug companies for lower prices and 78% favor putting a cap on out-of-pocket costs for Medicare Part D drugs.

✦ A committee comprising employers, health plans, PBMs, drug manufacturers, health systems, consultants, retailers, wholesalers and other key stakeholders is recommending that the U.S. pharmaceutical supply chain be overhauled to “address long-standing conflicts” and achieve a better delivery model. The committee, convened by the Business Group on Health, met over the past two years to study challenges within the pharmaceutical supply chain, and ultimately issued 70 reform recommendations. One of the key tenets used to guide specific recommendations, for example, is that “benchmarks for drug prices should be established by a transparent and independent third party, informed by a cost-effectiveness analysis and validated by real-world data evaluations.

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Datapoint: Kadmon Holdings Scores First FDA Approval

July 20, 2021

The FDA last week approved Kadmon Holdings’ Rezurock for the treatment of chronic graft-versus-host disease, making the drug both Kadmon’s first-ever FDA approved drug, and the first ROCK2 inhibitor in the graft-versus-host market basket. Among the most advantaged therapies for graft-versus-host disease are Johnson & Johnson and AbbVie’s Imbruvica, which holds covered or better status for 73% of all insured lives under the pharmacy benefit, Incyte Corp.’s Jakafi (72%) and Amgen’s Enbrel (70%).

The FDA last week approved Kadmon Holdings’ Rezurock for the treatment of chronic graft-versus-host disease, making the drug both Kadmon’s first-ever FDA approved drug, and the first ROCK2 inhibitor in the graft-versus-host market basket. Among the most advantaged therapies for graft-versus-host disease are Johnson & Johnson and AbbVie’s Imbruvica, which holds covered or better status for 73% of all insured lives under the pharmacy benefit, Incyte Corp.’s Jakafi (72%) and Amgen’s Enbrel (70%).

SOURCE: MMIT Analytics, as of 7/19/21

Datapoint: Padcev Snags Expanded Approvals in Bladder Cancer

July 15, 2021

The FDA last week granted Seagen Inc. and Astellas Pharma’s Padcev two expanded bladder cancer indications, following a priority review. The antibody-drug conjugate now has regular approval as a third-line treatment for metastatic or locally advanced urothelial cancer, plus a new nod as a second-line therapy for bladder cancer patients who are ineligible for certain types of chemotherapy. For the treatment of bladder cancer, Padcev currently holds covered or better status for 54% of all insured lives under the pharmacy benefit. Under the medical benefit, Padcev is covered or better for 82% of lives.

The FDA last week granted Seagen Inc. and Astellas Pharma’s Padcev two expanded bladder cancer indications, following a priority review. The antibody-drug conjugate now has regular approval as a third-line treatment for metastatic or locally advanced urothelial cancer, plus a new nod as a second-line therapy for bladder cancer patients who are ineligible for certain types of chemotherapy. For the treatment of bladder cancer, Padcev currently holds covered or better status for 54% of all insured lives under the pharmacy benefit. Under the medical benefit, Padcev is covered or better for 82% of lives.

SOURCE: MMIT Analytics, as of 7/14/21