March

New Postpartum Depression Drug Presents Payer Challenges

March 28, 2019

The FDA’s recent approval of the first medication specifically aimed at treating postpartum depression — coming two weeks after the agency’s green light on March 5 for a nasal spray for major depressive disorder in adults (RDB 3/14/19, p. 1) — is again drawing a favorable response from clinicians. However, similar to the new nasal spray, payers again could face challenges. The postpartum depression drug, Zulresso (brexanolone) injection, expected on the market this summer, is costly; it must be administered as a 60-hour continuous intravenous infusion; and federal regulators again are imposing strict parameters for the medication’s use.

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Insurer Tools Aim to Help Members Save on Prescription Drugs

March 28, 2019

As many Americans continue to struggle to afford their medications, health insurers and their PBMs are responding with tools that help consumers not only understand the cost of drugs before prescriptions are filled, but also find ways to spend less money on them.However payers choose to design such tools, two keys to their success include making improvements over time and making sure members know about them before they might need them, according to Nathan Foco, senior director of market and sales intelligence for Michigan-based Priority Health.

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Prime Therapeutics Reports 3.3% Commercial Trend in 2018

March 28, 2019

Prime Therapeutics’ recently issued annual drug trend results show commercial clients saw a 3.3% trend in 2018, while year-over-year trends for Medicare Part D and Medicaid plans were 4.7% and 7.3%, respectively. Despite increases year over year in utilization and spend, especially for specialty drugs, across all lines of business, the Eagan, Minn.-based PBM said it has been “consistently able to help lessen the cost burden for health plans and their members.”

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State Drug Affordability Boards Could Be Positive for Payers

March 28, 2019

In the ongoing effort to curb rising drug costs, several states have introduced legislation that would create “drug affordability review boards” tasked with establishing a maximum amount that insurers would pay for drugs when prices rise above a set threshold.In the eyes of the consultant who is helping states develop such measures, this approach to lowering drug costs will both benefit payers and avoid the legal issues that have stymied state efforts in the past.

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Utilization and Spending in Medicaid Outpatient Prescription Drugs Show Stable Increases

March 28, 2019

by Jinghong Chen Medicaid outpatient drug utilization increased from 621.7 million prescriptions in 2014 to 752.9 million in 2017, according to a Kaiser Family Foundation report. Over the same period of time, Medicaid spending before rebates increased 39%, with antivirals the most costly drug group before rebates. In recent years, antidepressants became the most frequently […]

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News Briefs

March 28, 2019

✦ Ohio Attorney General Dave Yost (R) on March 18 filed a lawsuit against UnitedHealth Group subsidiary OptumRx, alleging that the PBM overcharged the state by $16 million because it “failed to provide contractually agreed discounts on drugs.” Ohio has been conducting an ongoing investigation into the practices of PBMs, and in February, Republican Gov. Mike DeWine asked the state’s Department of Medicaid to rebid the state’s five long-running managed Medicaid contracts because of new state requirements around drug pricing transparency. Meanwhile, Kentucky Attorney General Andy Beshear (D) on March 21 said he was launching an investigation into allegations that PBMs “have overcharged the state health insurance programs for prescription drugs and discriminated against independent pharmacies.”

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