Member Content

PBMs Try to Stem Stockpiling of Trump-Touted Malaria Drugs

April 9, 2020

With the death toll from COVID-19 now surpassing 14,000 in the U.S., President Donald Trump and some of his advisers have repeatedly touted the promise of certain anti-malarial drugs to combat the disease caused by the novel coronavirus. That enthusiasm has sparked increasing concern that the surge in demand for such drugs, hydroxychloroquine and chloroquine, is imperiling access for patients who take them to treat autoimmune conditions such as lupus and rheumatoid arthritis. To help alleviate the issue, some major PBMs tell AIS Health that they’re placing utilization management controls on off-label use of hydroxychloroquine, chloroquine and other drugs with the potential to treat COVID-19.

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Extensive Savings Remain Elusive 10 Years Into Biosimilar Era

With Chart: Increased Biosimilar Use Could Offer Significant Savings for Employers

April 9, 2020

Biosimilar medications can offer meaningful cost savings for payers, but market and regulatory barriers are still preventing them from realizing their full economic potential, according to a March 31 Johns Hopkins University study funded by the ERISA Industry Committee (ERIC), a lobbying group for companies managing self-funded health insurance plans.

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Express Scripts’ Value-Based Programs Save Plans $4.3B

April 9, 2020

Express Scripts said it saved enrolled plans some $4.3 billion in 2019 through its SafeGuardRx programs, which combine multiple cost- containment strategies such as value- based contracting and payments from financial guarantees.

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As World Awaits Results From Remdesivir Trials, Pricing Questions Loom

April 9, 2020

Hydroxychloroquine and chloroquine are far from the only drugs being tested for their potential to treat COVID-19, the disease caused by the novel coronavirus that has ballooned into a pandemic.

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News Briefs

April 9, 2020

✦ A case before the U.S. Supreme Court, which will determine how far states can go in regulating PBMs, will be delayed due to the COVID-19 crisis. Oral arguments in Rutledge v. Pharmaceutical Care Management Association were scheduled for April 27 but have now been postponed to an unspecified date. The case, which challenges a 2015 law enacted in Arkansas, concerns whether PBMs are acting as agents under the Employee Retirement Income Security Act of 1974 (ERISA) and therefore are exempt from state-level regulation. Read more at https://bit.ly/2Rmyuyd.

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Experts: Pandemic Could Spark Higher Premiums, M&A

April 6, 2020

Many of the nation’s largest health insurers have now waived patient cost sharing and prior authorization requirements for treatment of COVID-19, the disease caused by the novel coronavirus. Experts praise payers for making the change, but say the moves could have negative financial impacts for some firms. The same experts believe consolidation is likely if payers and providers struggle with liquidity.

Payers waiving coinsurance include Anthem, Inc., UnitedHealth Group, Cigna Corp., Centene Corp., Humana Inc. and some Blue Cross Blue Shield plans. Companies that have relaxed prior authorization requirements include Anthem, Centene and Humana. (For a more complete list, see p. 5.)

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