February

Providers Protest Tenn. Blues’ New White Bagging Policy

February 27, 2020

BlueCross BlueShield of Tennessee, Inc. has found itself in the news recently but likely not for reasons the health plan might like: The insurer has received tremendous pushback from physicians on its decision to implement a policy requiring them to get provider-administered therapies from specialty pharmacies.

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New Generic HIV Drug Will Affect Payer Coverage of PrEP

February 27, 2020

A generic version of Truvada coming on the market later this year will affect how payers cover pre-exposure prophylaxis (PrEP), experts tell AIS Health. PrEP is a daily medication used by people at risk of HIV to prevent infection. However, while the generic version will have an impact on PrEP coverage, experts say it will not significantly change how payers cover HIV drugs.

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Analysts Say Opaque Pricing Helps Drive Drug Cost Hikes

With Chart: Per-Person Prescription Drug Spending Increases Steadily From 2014 to 2018

February 27, 2020

A new study estimates that payers and patients spent a combined 26% more per person on prescription drugs in 2018 compared with 2014, with price growth far outstripping increased demand in driving drug spending. Analysts say a lack of price transparency and resulting market inefficiencies are contributing to the price growth.

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Express Scripts Report Touts 4.8% Drop in YoY Spending

February 27, 2020

In its annual drug spending report, PBM giant Express Scripts said it kept total pharmacy spending in line with the consumer price index while reducing year-over-year (YoY) spending by 4.8% for its most tightly managed plans. While one consultant said there’s no way to verify such claims without a full review of Express Scripts’ methodology, he conceded that the PBM’s management techniques are probably due some credit.

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News Briefs

February 27, 2020

✦ The Institute for Clinical and Economic Review (ICER) and health care technology company Aetion are partnering to advance the use of real-world evidence (RWE) in assessing the cost-effectiveness of medicines, STAT reports. Aetion’s database of insurance company claims and related analytics allow ICER to use data generated outside of clinical trials in its evaluations of how drugs perform in the real world. According to Steven Pearson, ICER’s founder and president, RWE could be particularly useful in post-marketing assessments of drugs that were approved under accelerated pathways. Some of those products, especially for cancer or rare diseases, may come to market without large amounts of clinical trial data. ICER, a nonprofit research organization, will not pay Aetion under the terms of their agreement. The benefit to Aetion, the company’s CEO Carolyn Magill says, is in establishing its methodologies as a data standard. See http://bit.ly/2v6a9VG.

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Ark. Ruling Leaves Little Path Forward for Work Requirements

with Chart: Medicaid Work Requirements, at a Glance

February 24, 2020

A three-judge federal appeals court panel on Feb. 14 sided with a lower court and unanimously ruled that Arkansas’ Medicaid work requirements are unlawful because they don’t align with the chief objective of the Medicaid program — providing access to medical care to those who can’t afford it. The ruling is likely to have implications for states, Medicaid managed care companies and other stakeholders beyond Arkansas’ borders, policy and legal experts tell AIS Health.

“This certainly puts a damper on their plans,” says Joan Alker, a research professor and executive director of the Georgetown Center for Children and Families, referring to other states’ hopes to set up similar Medicaid waiver demonstrations. “This is a signature initiative of [CMS] Administrator [Seema] Verma, and the court decision could not have been more clear that this was an unacceptable overreach by the administration and that they had moved into territory where only Congress could go

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