Drug Benefits

Datapoint: Octapharma’s Wilate Scores Hemophilia A Indication

October 16, 2019

The FDA last week approved Octapharma’s Wilate for the treatment of Hemophilia A, both for routine management of the disease and as needed to control a single bleeding episode. Wilate was previously only approved for the treatment of Von Willebrand disease. In the pharmacy benefit, Wilate holds preferred formulary status for 12% of covered lives. In the medical benefit, Wilate is covered without restrictions for 33% of lives.

The FDA last week approved Octapharma’s Wilate for the treatment of Hemophilia A, both for routine management of the disease and as needed to control a single bleeding episode. Wilate was previously only approved for the treatment of Von Willebrand disease. In the pharmacy benefit, Wilate holds preferred formulary status for 12% of covered lives. In the medical benefit, Wilate is covered without restrictions for 33% of lives.

SOURCE: MMIT Analytics, as of 10/14/19

Low-Cost Enhanced PDP Offerings See Growth in 2020

October 16, 2019

When it comes to Medicare Part D stand-alone Prescription Drug Plans (PDPs) in 2020, experts say the most notable trend is the rising prevalence of lower-cost enhanced plan offerings.

According to CMS’s recently released landscape files, there will be a total of 1,433 PDP plans in 2020, up from 1,369 in 2019.

That increase is “mainly due to additional enhanced, low-premium plans being offered this year, both through existing carriers offering new plans, and then there’s also a new entrant to the national PDP market,” says Shelly Brandel, a principal and consulting actuary in the Milwaukee office of Milliman, Inc.

By Leslie Small

When it comes to Medicare Part D stand-alone Prescription Drug Plans (PDPs) in 2020, experts say the most notable trend is the rising prevalence of lower-cost enhanced plan offerings.

According to CMS’s recently released landscape files, there will be a total of 1,433 PDP plans in 2020, up from 1,369 in 2019.

That increase is “mainly due to additional enhanced, low-premium plans being offered this year, both through existing carriers offering new plans, and then there’s also a new entrant to the national PDP market,” says Shelly Brandel, a principal and consulting actuary in the Milwaukee office of Milliman, Inc.

The new carrier, Clear Spring Health, will offer PDPs for the first time in 2020 in 41 states and Washington, D.C. Brandel notes that Clear Spring’s Premier Rx plans, an enhanced offering, have an average premium of around $15.

Also worth noting is that Humana Inc. created a new offering called the Humana Walmart Value Rx Plan. The premium for that plan is $13.20 across all states.

WellCare Health Plans, Inc., meanwhile, is offering the new WellCare Wellness Rx plan, an enhanced plan that has an average premium of about $14, according to Brandel.

In general, Brandel says, “the enhanced plans with low premiums have been an area of growth in the PDP market.”

A regulatory change in 2018 — which said plan sponsors no longer have to demonstrate that their enhanced PDPs offered in the same region are “meaningfully different” regarding enrollee out-of-pocket costs — likely made it easier for insurers to offer low-premium enhanced plans, Brandel says. However, “the main reason more of these plans are being offered is because they are popular with members,” she adds.

Across all PDP offerings, the projected average monthly basic Part D premium in 2020 will be $30 — the lowest it’s been since 2013, according to CMS.

Datapoint: Novartis Scores FDA Approval for Beovu

October 10, 2019

Novartis is set to take on Roche and Regeneron in wet age-related macular degeneration (AMD) with its latest FDA approval for Beovu. In the pharmacy benefit, Roche’s Lucentis holds preferred status for just 2% of covered lives, growing to 18% with prior authorization and/or step therapy. Eylea is also preferred for 2% of lives, growing to 20% with prior authorization and/or step therapy. In the medical benefit, Lucentis is covered for 37% of insured lives, with Eylea at 29%.

Novartis is set to take on Roche and Regeneron in wet age-related macular degeneration (AMD) with its latest FDA approval for Beovu. In the pharmacy benefit, Roche’s Lucentis holds preferred status for just 2% of covered lives, growing to 18% with prior authorization and/or step therapy. Eylea is also preferred for 2% of lives, growing to 20% with prior authorization and/or step therapy. In the medical benefit, Lucentis is covered for 37% of insured lives, with Eylea at 29%.

SOURCE: MMIT Analytics, as of 10/9/19

Medicare Part D Drug Rebates Reduced Drug Spending, OIG Report Shows

October 4, 2019

Increases in rebates for brand-name drugs in Medicare Part D substantially reduced the growth in reimbursement for those drugs from 2011 to 2015, but not enough to prevent an overall spending increase, according to a new analysis by the HHS Office of Inspector General. Medicare Part D spent an additional $2 billion for more than 1,500 brand-name drugs with rebates in 2015 than it spent four years earlier, even though the total number of prescriptions for brand-name medications reviewed decreased 33%.

by Jinghong Chen

Increases in rebates for brand-name drugs in Medicare Part D substantially reduced the growth in reimbursement for those drugs from 2011 to 2015, but not enough to prevent an overall spending increase, according to a new analysis by the HHS Office of Inspector General. Medicare Part D spent an additional $2 billion for more than 1,500 brand-name drugs with rebates in 2015 than it spent four years earlier, even though the total number of prescriptions for brand-name medications reviewed decreased 33%. Over the same period, total rebates for drugs reviewed grew from $9 billion to $17 billion, whereas 42% of medications reviewed saw decreases in unit rebates. By analyzing spending on drugs with Part D reimbursement and rebates in every year from 2011 to 2015, the report found that although unit reimbursement increased for more than 95% of the drugs, unit rebates declined for 39% of those medications. In addition, unit rebates as a percentage of unit reimbursement dropped for over 50% of the drugs reviewed.

NOTE: Percentages do not sum to 100 because of rounding.

SOURCE: “Rebates for Brand-Name Drugs in Part D Substantially Reduced the Growth in Spending from 2011 to 2015,” Office of Inspector General, U.S. Department of Health & Human Services. Visit https://bit.ly/2kVktur.

Datapoint: Invokana Scores New Indication in Diabetes Patients

October 3, 2019

The FDA this week approved Janssen’s Invokana for a new indication, to prevent kidney disfunction and reduce the risk of developing end-stage kidney disease in type 2 diabetes patients. Invokana is the first drug to be approved for this indication almost 20 years. For the treatment of type 2 diabetes, Invokana holds preferred formulary status for 28% of covered lives, growing to 50% with prior authorization and/or step therapy.

The FDA this week approved Janssen’s Invokana for a new indication, to prevent kidney disfunction and reduce the risk of developing end-stage kidney disease in type 2 diabetes patients. Invokana is the first drug to be approved for this indication almost 20 years. For the treatment of type 2 diabetes, Invokana holds preferred formulary status for 28% of covered lives, growing to 50% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 10/2/19

Despite Approval of New Parkinson’s Drugs, Plans Still Prefer Generics

October 2, 2019

Although three new drugs for Parkinson’s disease have been approved over the last year, plans generally are sticking with the drugs they’ve included on formularies for several years, most of which are generic, experts say.

That may change in the long term as new gene therapies that currently are in development are approved and come online. But none of those potential new treatments are close to market right now, says Mesfin Tegenu, R.Ph., president of PerformRx.

By Jane Anderson

Although three new drugs for Parkinson’s disease have been approved over the last year, plans generally are sticking with the drugs they’ve included on formularies for several years, most of which are generic, experts say.

That may change in the long term as new gene therapies that currently are in development are approved and come online. But none of those potential new treatments are close to market right now, says Mesfin Tegenu, R.Ph., president of PerformRx.

“Many commonly used therapies for Parkinson’s disease — carbidopa-levodopa, MAO-Bs, dopamine agonists — have available generics, which on most plans would be considered formulary options, or one generic product within each class would be selected as formulary,” Tegenu tells AIS Health.

The FDA in August approved Kyowa Kirin, Inc.’s Nourianz (istradefylline) tablets as an add-on treatment to levodopa/carbidopa in adult patients with Parkinson’s disease experiencing motor fluctuations. In February, the FDA approved Osmotica Pharmaceutical US LLC’s Osmolex ER (amantadine) for the treatment of Parkinson’s disease. And in late December, the FDA approved Accorda Therapeutics’ Inbrija (levodopa inhalation powder) for intermittent treatment of off episodes in people with Parkinson’s disease taking carbidopa/levodopa.

Still, plans are stocking their formularies with less expensive generic medications. Parkinson’s disease treatment generally progresses through drugs that have a moderate effect but fewer side effects to drugs that are more effective, but have more significant side effects, Tegenu says.

“Choice of which pharmacotherapy to use initially is individualized based on the characteristics of the patient, the disease and the drugs,” he says. “There is no single preferred therapy, and trade-offs are common.”

Plans aren’t expected to cover Inbrija, Tegenu says. “Members would be able to request an exception through the prior authorization process for these products,” he adds. For Osmolex ER, plans generally require failure on trials of immediate-release amantadine.