Drug Benefits

Oncology Drugs Drive Price Growth in Medical-Benefit Spend

April 30, 2020

Spending on prescription drugs that are covered under the medical benefit increased by 65% between 2014 and 2018 for commercial insurers and 40% for Medicare, according to Magellan Rx Management’s annual Medical Pharmacy Trend Report.

“The increase in medical pharmacy spend seems to largely be driven by inflation,” says Kristen Reimers, Magellan’s senior vice president of specialty clinical solutions. “This can be a combination of two things, increasing costs of existing drugs and providers utilizing newer more expensive drugs. The pipeline was extremely robust and new therapies to market are contributing to inflation, driving the trend.”

By Peter Johnson

Spending on prescription drugs that are covered under the medical benefit increased by 65% between 2014 and 2018 for commercial insurers and 40% for Medicare, according to Magellan Rx Management’s annual Medical Pharmacy Trend Report.

“The increase in medical pharmacy spend seems to largely be driven by inflation,” says Kristen Reimers, Magellan’s senior vice president of specialty clinical solutions. “This can be a combination of two things, increasing costs of existing drugs and providers utilizing newer more expensive drugs. The pipeline was extremely robust and new therapies to market are contributing to inflation, driving the trend.”

According to the report, new oncology therapies are both emblematic and a primary driver of growth in drug prices. A new generation of highly effective, biologic oncology drugs have emerged in the last decade. However, these pioneering drugs are expensive. According to the report, oncology drugs and the drugs needed to support them accounted for 43% of per-patient per-month medical pharmacy spending for commercial carriers.

Like other biologic drugs, most biologic oncology drugs have yet to see significant biosimilar competition due to barriers in the biosimilar market and development pipeline.

“The most exciting biosimilars are those currently in the oncology space. Herceptin, Avastin and Rituxan have been the top five drugs in terms of spend for the last 10 years,” says Reimers. “Rituxan and Avastin now have two biosimilars on the market, and Herceptin has five marketed products. There will be competition, which will help to flatten the trend for these products, although there is still expected to be growth.”

Emerging competition could bolster the already-improving price outlook for more established biologic drugs. However, growth in oncology spending is not likely to stop any time soon. In some ways, this is good news for patients: according to Reimers and the Magellan report, promising new, targeted therapies for hard-to-treat cancers will account for much of the increased spending in coming years.

“The pipeline for oncology is extremely robust, with over 700 drugs being studied for a variety of different cancer types,” Reimers says.

Datapoint: AstraZeneca Is Testing Farxiga Against Coronavirus

April 29, 2020

AstraZeneca’s SGLT2 inhibitor, Farxiga, is now the subject of a phase III clinical trial testing its use against the novel coronavirus. About 900 severe COVID-19 patients at greater risk of cardiovascular, renal and kidney complications in both the U.S. and Europe will receive the drug. For the treatment of type 2 diabetes, Farxiga currently holds preferred status for 32% of covered lives in the U.S., growing to 58% with prior authorization and/or step therapy.

AstraZeneca’s SGLT2 inhibitor, Farxiga, is now the subject of a phase III clinical trial testing its use against the novel coronavirus. About 900 severe COVID-19 patients at greater risk of cardiovascular, renal and kidney complications in both the U.S. and Europe will receive the drug. For the treatment of type 2 diabetes, Farxiga currently holds preferred status for 32% of covered lives in the U.S., growing to 58% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 4/27/20

COVID-19 Pandemic May Change Autoimmune Disorders Care Delivery, Drive Costs Up

April 29, 2020

As a result of the COVID-19 pandemic, patients with autoimmune disorders who depend on caregiver-administered drugs face serious challenges to their safety, according to a recent analysis published by Avalere Health. Many patients who need to visit a clinical site to receive treatment for autoimmune disorders are confronted with a difficult choice: go out in public to face the danger of a virulent, fast-spreading pandemic for which they are at acute risk, or stay home and go without their medication.

“[Immunocompromised] patients are experiencing this maybe more acutely than any of us,” says Lance Grady, a managing director at Avalere and one of the authors of the white paper.

By Peter Johnson

As a result of the COVID-19 pandemic, patients with autoimmune disorders who depend on caregiver-administered drugs face serious challenges to their safety, according to a recent analysis published by Avalere Health. Many patients who need to visit a clinical site to receive treatment for autoimmune disorders are confronted with a difficult choice: go out in public to face the danger of a virulent, fast-spreading pandemic for which they are at acute risk, or stay home and go without their medication.

“[Immunocompromised] patients are experiencing this maybe more acutely than any of us,” says Lance Grady, a managing director at Avalere and one of the authors of the white paper.

Grady points out that some workaround treatments for autoimmune conditions are possible, but for the most part they would require a clinical visit for physical tests in addition to a telehealth consultation. Home care does offer fewer patient safety drawbacks than an on-site visit to a clinic or hospital, but for Medicare patients, that would require shifting medicines that are usually covered under Part B to Part D.

Home care may also be too expensive for or just plain unavailable to many patients, says Joe Paduda, founder and principal of Health Strategy Associates.

Given these challenges in administering care, some patients have simply not been able to get their treatment. According to the Avalere analysis, “early data following the COVID outbreak shows a reduction in physician office visits, driving a decrease in provider- administered drug utilization.”

Both the Avalere analysis and Paduda point out that costs to payers and patients could increase due to the expected shift in care sites for patients with autoimmune disorders.

Paduda says he expects immunodeficient patients, particularly those covered by MA and Part D plans, to bear higher out-of-pocket costs for their treatment. He adds that PBMs, too, will likely bear a higher cost burden in the autoimmune category. “PBMs almost certainly did not factor this shift into their pricing for 2020, an eventuality no one could have anticipated. Margins will deteriorate,” he says.

Datapoint: Imbruvica Nabs Sixth Indication for CLL

April 27, 2020

The FDA last week granted Johnson & Johnson and AbbVie’s Imbruvica its sixth indication for the treatment of chronic lymphocytic leukemia (CLL). The drug, already a blockbuster in the space, is now approved in combination with Roche’s Rituxan in CLL patients 70 or younger who have not tried another therapy. For the treatment of CLL, Imbruvica holds preferred status for 8% of covered lives in the pharmacy benefit, growing to 29% with prior authorization and/or step therapy. The drug is classified as a specialty product for 26% of all insured lives.

The FDA last week granted Johnson & Johnson and AbbVie’s Imbruvica its sixth indication for the treatment of chronic lymphocytic leukemia (CLL). The drug, already a blockbuster in the space, is now approved in combination with Roche’s Rituxan in CLL patients 70 or younger who have not tried another therapy. For the treatment of CLL, Imbruvica holds preferred status for 8% of covered lives in the pharmacy benefit, growing to 29% with prior authorization and/or step therapy. The drug is classified as a specialty product for 26% of all insured lives.

SOURCE: MMIT Analytics, as of 4/22/20

PBMs Say Use of Mental Health Meds Surges Amid COVID-19

April 27, 2020

Newly released data from Express Scripts shows that the number of prescriptions filled per week for antidepressants, anti-anxiety and anti-insomnia medications combined jumped 21% between mid-February and mid-March — reaching a zenith during the week ending March 15, when the COVID-19 outbreak officially reached pandemic status. And analytics from UnitedHealth Group’s OptumRx showed prescription increases of 15% for anti-anxiety medications, 14% for antidepressants and 5% for anti-insomnia medications during the month of March.

Industry consultants tell AIS Health that they’re not at all surprised that the use of such medications is spiking. And they say that situation creates an urgent opportunity for companies that combine a health insurer with a PBM — like Express Scripts parent company Cigna Corp. and its peers — to leverage their unique insights into members’ health.

By Leslie Small

Newly released data from Express Scripts shows that the number of prescriptions filled per week for antidepressants, anti-anxiety and anti-insomnia medications combined jumped 21% between mid-February and mid-March — reaching a zenith during the week ending March 15, when the COVID-19 outbreak officially reached pandemic status. And analytics from UnitedHealth Group’s OptumRx showed prescription increases of 15% for anti-anxiety medications, 14% for antidepressants and 5% for anti-insomnia medications during the month of March.

Industry consultants tell AIS Health that they’re not at all surprised that the use of such medications is spiking. And they say that situation creates an urgent opportunity for companies that combine a health insurer with a PBM — like Express Scripts parent company Cigna Corp. and its peers — to leverage their unique insights into members’ health.

“Pharmacies are often the most utilized part of the benefit compared to medical or behavioral, but now, an increase in some pharmacy utilization can actually signal a need to use more of the behavioral benefit,” Peter Manoogian, principal at the health care consulting firm ZS Associates, tells AIS Health.

Rita Numerof, Ph.D., president and founder of the consulting firm Numerof & Associates, says health care organizations should conduct generalized outreach to members that stresses non-pharmaceutical coping mechanisms when appropriate. “Practical guidance, and not looking at this as a mental illness or a mental health issue, in the face of this kind of crisis, is really important,” she tells AIS Health.

For its part, UnitedHealth opened up an emotional support help line and is offering a free on-demand emotional support mobile app called Sanvello to help people “cope with stress, anxiety and depression during the COVID-19 pandemic,” according to a company spokesperson.

Express Scripts, meanwhile, is offering a “digital mental health platform” to its clients at no cost, which “enables members to build resilience and develop skills to better manage stress and sleep issues,” according to Rochelle Henderson, Ph.D., vice president of health services research at the PBM.

Datapoint: Merck Launches Herceptin Biosimilar

April 22, 2020

Merck & Co. last week began its U.S. commercial launch of Ontruzant, a biosimilar to Roche’s Genentech division’s Herceptin. Ontruzant’s list price is set at $1,325 for a single 150 mg dose, which is about 15% cheaper than Genentech’s product. For the treatment of HR+ and HER2+ metastatic breast cancer, Herceptin is covered in the pharmacy benefit for 44% of covered lives, the medical benefit for 23% of covered lives, and both the medical and pharmacy benefit for 25% of covered lives. In the pharmacy benefit, Herceptin holds preferred status for 12% of covered lives, growing to 19% with prior authorization and/or step therapy.

Merck & Co. last week began its U.S. commercial launch of Ontruzant, a biosimilar to Roche’s Genentech division’s Herceptin. Ontruzant’s list price is set at $1,325 for a single 150 mg dose, which is about 15% cheaper than Genentech’s product. For the treatment of HR+ and HER2+ metastatic breast cancer, Herceptin is covered in the pharmacy benefit for 44% of covered lives, the medical benefit for 23% of covered lives, and both the medical and pharmacy benefit for 25% of covered lives. In the pharmacy benefit, Herceptin holds preferred status for 12% of covered lives, growing to 19% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 4/15/20