Drug Benefits

Datapoint: FDA Approves Pfizer’s Neulasta Biosimilar

June 16, 2020

The FDA last week approved Pfizer’s Nyvepria, the fourth biosimilar to Amgen’s neutropenia drug Neulasta, and Pfizer’s sixth oncology biosimilar overall. For the treatment of neutropenia under the pharmacy benefit, Neulasta holds preferred formulary status for 8% of covered lives, growing to 34% with prior authorization and/or step therapy.

The FDA last week approved Pfizer’s Nyvepria, the fourth biosimilar to Amgen’s neutropenia drug Neulasta, and Pfizer’s sixth oncology biosimilar overall. For the treatment of neutropenia under the pharmacy benefit, Neulasta holds preferred formulary status for 8% of covered lives, growing to 34% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 6/15/20

MedImpact’s New Program Aims to Accelerate Pharmacogenomics

June 15, 2020

With precision medicine an increasingly hot topic in health care, MedImpact is betting that a newly launched program — which reviews every drug prescribed to patients against their genetic profile — will simultaneously give the PBM a competitive edge and improve care.

In a Feb. 26 press release, MedImpact describes its new program as the industry’s first “any drug, any time, any prescriber” approach to pharmacogenomics (PGx).

By Leslie Small

With precision medicine an increasingly hot topic in health care, MedImpact is betting that a newly launched program — which reviews every drug prescribed to patients against their genetic profile — will simultaneously give the PBM a competitive edge and improve care.

In a Feb. 26 press release, MedImpact describes its new program as the industry’s first “any drug, any time, any prescriber” approach to pharmacogenomics (PGx).

“Pharmacogenetics, in the most basic sense, is looking at someone’s genes to determine their drug-metabolizing enzymes,” explains Emily Cicali, a clinical assistant professor at the University of Florida’s College of Pharmacy. For people who have lower levels of drug-metabolizing enzymes, certain medications may be less effective or ineffective, and for those have too much of those enzymes, that could overactivate drugs and “put people at risk for toxicity,” Cicali adds.

The concept of a PBM having a PGx program isn’t new, MedImpact acknowledges in its release. But up until now, most PGx programs generally operated along the lines of “one gene being tested for one drug at one point in time” to determine if there’s a potential conflict, says Karen Geary, the company’s vice president of strategy and innovation. MedImpact’s program, however, screens for genetic interactions with more than 240 commonly prescribed medications and then reviews all future prescriptions for potential drug-gene issues.

Michael Schneider, a principal at Avalere Health, says that if a program like MedImpact’s is able to significantly avert problems like adverse drug events, “then I think this type of analysis could have a big impact on the PBM industry and potentially become the standard of care.”

However, if genetic testing becomes more commonplace across wider swaths of the population, there could be downsides, he suggests. For example, the expense of large-scale genetic testing might trickle down from plan sponsors to consumers in the form of higher premiums.

Since MedImpact rolled out its new program, client interest has been high, Geary says. However, “the challenge that I’ve recently run into is that employers are sitting there looking at what would be a benefit enrichment while, because of COVID-19, they’re having to lay off staff,” she adds.

Datapoint: Alexion Wards Off Soliris Competition With Amgen Settlement

June 8, 2020

Alexion Pharmaceuticals last week reached a settlement with Amgen that will keep its blockbuster complement C5 inhibitor Soliris from seeing U.S. generic competition until 2025. Amgen had previously challenged Alexion’s Soliris paroxysmal nocturnal hemoglobinuria (PNH) patents after seeing promising clinical results for its own biosimilar, which is still undergoing trials. For the treatment of neuromyelitis optica spectrum disorder, Soliris currently holds preferred status under the pharmacy benefit for just 2% of covered lives, growing to 15% with prior authorization and/or step therapy. Soliris is not covered or not listed for 40% of all covered lives.

Alexion Pharmaceuticals last week reached a settlement with Amgen that will keep its blockbuster complement C5 inhibitor Soliris from seeing U.S. generic competition until 2025. Amgen had previously challenged Alexion’s Soliris paroxysmal nocturnal hemoglobinuria (PNH) patents after seeing promising clinical results for its own biosimilar, which is still undergoing trials. For the treatment of neuromyelitis optica spectrum disorder, Soliris currently holds preferred status under the pharmacy benefit for just 2% of covered lives, growing to 15% with prior authorization and/or step therapy. Soliris is not covered or not listed for 40% of all covered lives.

SOURCE: MMIT Analytics, as of 6/3/20

CVS Reports Lowest Drug Trend in Years

June 5, 2020

CVS Health Corp.’s 2019 drug trend report shows a 1.4% overall trend, the lowest in five years, and said 41% of its commercial clients saw negative trend. Specialty drugs accounted for almost half of all spending and remained the fastest growing spending category in the pharmacy benefit. Autoimmune treatments, including some of the highest volume medications — Humira, Enbrel, Rituxan and Remicade — comprised a third of specialty pharmacy spending. CVS’s Advanced Control Specialty Formulary (ACSF) helped its clients reach -9.4% price growth in the category. As 20 biosimilars are expected to come to the specialty marketplace by 2023, payers may see significant savings, according to CVS.

by Jinghong Chen

CVS Health Corp.’s 2019 drug trend report shows a 1.4% overall trend, the lowest in five years, and said 41% of its commercial clients saw negative trend. Specialty drugs accounted for almost half of all spending and remained the fastest growing spending category in the pharmacy benefit. Autoimmune treatments, including some of the highest volume medications — Humira, Enbrel, Rituxan and Remicade — comprised a third of specialty pharmacy spending. CVS’s Advanced Control Specialty Formulary (ACSF) helped its clients reach -9.4% price growth in the category. As 20 biosimilars are expected to come to the specialty marketplace by 2023, payers may see significant savings, according to CVS.

NOTE: CVS’s specialty generics utilization data represents results for commercial clients.

SOURCE: CVS Health 2019 Drug Trend Report. Visit https://bit.ly/36xHZks.

1.7K Plans Apply for Trump Admin’s Fixed-Insulin-Copay Program for Seniors

June 4, 2020

The Trump administration on May 26 shared new details about a program that offers diabetic seniors access to a variety of insulin products for a maximum $35-per-month copay.

More than 88 health insurers offering about 1,750 standalone Medicare Part D Prescription Drug Plans and Medicare Advantage plans with prescription drug coverage have now applied to participate in the Part D Senior Savings Model, which CMS unveiled in mid-March. Medicare beneficiaries in all 50 states, the District of Columbia and Puerto Rico will be able to enroll in a participating plan during the Medicare open enrollment period that lasts from Oct. 15 to Dec. 7, 2020, for Part D coverage that begins on Jan. 1, 2021.

By Leslie Small

The Trump administration on May 26 shared new details about a program that offers diabetic seniors access to a variety of insulin products for a maximum $35-per-month copay.

More than 88 health insurers offering about 1,750 standalone Medicare Part D Prescription Drug Plans and Medicare Advantage plans with prescription drug coverage have now applied to participate in the Part D Senior Savings Model, which CMS unveiled in mid-March. Medicare beneficiaries in all 50 states, the District of Columbia and Puerto Rico will be able to enroll in a participating plan during the Medicare open enrollment period that lasts from Oct. 15 to Dec. 7, 2020, for Part D coverage that begins on Jan. 1, 2021.

That “widespread voluntary participation” from health plans “was essential for the program’s success,” says Marc Guieb, Pharm.D., a consultant at Milliman, Inc. Still, “many plans were hesitant to participate in the inaugural year of this program due to uncertainty around its financial impact,” he says. “It is likely that, in future years, more plans will jump on the bandwagon.”

CMS estimates that Medicare beneficiaries who use insulin and join a plan participating in the Part D Senior Savings Model could save an average of $446 annually on out-of-pocket insulin costs, or 66%. Three insulin manufacturers — Eli Lilly and Co., Novo Nordisk Inc. and Sanofi U.S. — have agreed to participate.

On the one hand, the concept of a fixed insulin copay should be attractive to seniors and can improve medication adherence, says Brian Anderson, a principal at Milliman. Still, “the benefit coordination and claims processing is going to be tricky,” he suggests, adding that “the pharmacy reimbursements, manufacturer payments, application of the Part D benefit phases and reinsurance will all come into play.”

“Overall, this has the opportunity to improve the Part D benefit and drive formulary competition from a cost standpoint,” Anderson concludes.

America’s Health Insurance Plans (AHIP) gave the program a glowing assessment. “Innovative voluntary programs like this Part D Senior Savings Model are an excellent example of public-private partnerships where everyone wins, but especially patients,” AHIP President and CEO Matt Eyles said in a statement released May 26.

Datapoint: FDA Approves Roche Combo for Liver Cancer

June 3, 2020

The FDA last week approved a combination of two Roche drugs, Tecentriq and Avastin, as a frontline therapy for hepatocellular carcinoma, the most common form of liver cancer. The Roche combo will be the first major competitor to Bayer’s Nexavar since its 2007 approval. Nexavar currently holds preferred status under the pharmacy benefit for 9% of all covered lives, growing to 42% with prior authorization and/or step therapy.

The FDA last week approved a combination of two Roche drugs, Tecentriq and Avastin, as a frontline therapy for hepatocellular carcinoma, the most common form of liver cancer. The Roche combo will be the first major competitor to Bayer’s Nexavar since its 2007 approval. Nexavar currently holds preferred status under the pharmacy benefit for 9% of all covered lives, growing to 42% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 6/1/20