June

New York Bill Targets PBMs on Transparency, Spread Pricing

June 27, 2019

Lawmakers in New York this month approved wide-ranging legislation designed to require pricing transparency from PBMs and to eliminate key PBM practices, including so-called “spread pricing,” mid-year formulary shuffling and drug substitutions. But the bill could potentially limit plans’ ability to respond to pricing moves by manufacturers, one consultant says.

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States Plow Ahead on ‘Subscription’ Models for Hep C Therapy

June 27, 2019

Within the past two weeks, CMS approved Medicaid state plan amendments for Louisiana and Washington state, thus allowing the states to launch innovative value-based purchasing arrangements. Both states’ programs are aimed at working with partnering drug manufacturers to better handle the high costs for curative hepatitis C treatments, and may be the harbinger of similar initiatives by additional states.

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Conn., CVS Caremark Reach New ‘Full Transparency’ Pact

June 27, 2019

The state of Connecticut says it will save 10% on pharmacy costs under a new contract with CVS Caremark that provides the state with what it says is complete transparency into drug costs.The contract, which covers more than 200,000 state and municipal employees, dependents and retirees, forbids so-called “spread pricing” — whereby the PBM retains the difference between what it reimburses a pharmacy for a drug and the (usually higher) amount it charges a plan sponsor — and requires CVS Caremark to pass all rebates on to the state. It also includes a mandate that the PBM subsidiary of CVS Health share data with the state and prescribers.

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Two Reports Point to ‘Undue Financial Burden’ on Part D Enrollees

June 27, 2019

Nationwide, one million Medicare beneficiaries who didn’t receive a low-income subsidy (LIS) had out-of-pocket (OOP) prescription drug spending above the Part D catastrophic coverage threshold in 2017, with such spending averaging more than $3,200 per person. In fact, 3.6 million of the Part D program’s 44.6 million enrollees had drug spending above the catastrophic threshold that year, though 2.6 million of them were subsidized.

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Emerging Biopharma Companies Dominated R&D Activity in 2018, New IQVIA Report Shows

June 27, 2019

by Jinghong ChenEmerging biopharmaceutical companies (EBPs) increasingly contribute to research and development (R&D) activity and innovation, according to a recent IQVIA Institute for Human Data Science report. In 2018, EBPs represented 73% of the total late-stage R&D pipeline, up from 52% in 2003. When including both early- and late-stage R&D, EBPs accounted for 80% of activity, yet only 14% of medicine sales globally. Of the 59 new active substance (NAS) launches in 2018, 64% of them were originated by EBPs, up from 41% in 2009. The venture capital activity in life sciences in the U.S. also grew sharply over the past five years, with 1,308 deals closed with an overall value exceeding $23 billion in 2018. Looking ahead, the report notes that EBPs need to adopt varied strategies to meet the changing environment of clinical development and drug marketing.

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News Briefs

June 27, 2019

The Academy of Managed Care Pharmacy said June 14 it has developed a framework for effective prior authorization and utilization management practices in managed care pharmacy. Managed care organizations can follow nine concepts to ensure PA processes are “timely, transparent, collaborative and supportive of patient-centered care,” AMCP said. The concepts were developed by AMCP’s professional practice committee and published in the June 2019 issue of AMCP’s Journal of Managed Care & Specialty Pharmacy. Among the recommendations, MCOs are urged to use health IT solutions to reduce paperwork and waste; collaborate and communicate clearly with providers throughout the PA process; provide advanced notice of formulary changes to providers and patients; and avoid broad or inflexible PA requirements for drug therapies commonly used as part of emergency care. View the abstract at https://bit.ly/2ZI7uuL.

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