Member: RADAR on Drug Benefits

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Part D Has Pricey Generic Drugs Problem With Murky Solutions

For Medicare Part D Beneficiaries, Generics May Not Always Be Cheaper

July 11, 2019

A recently published study shines a light on a peculiar quirk of the Medicare Part D benefit structure: For some high-priced specialty medications, seniors might pay less out-of-pocket for brand-name drugs than their generic counterparts.A leader from one Medicare-focused insurer tells AIS Health that while the issue doesn’t affect a very large swath of members, it’s still worth addressing.

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Maine MCOs Worry Over High Drug Costs Despite New Laws

July 11, 2019

Maine is “forging new ground” with its recent enactment of a comprehensive prescription drug reform legislative package, the National Academy for State Health Policy says. The Pine Tree State, however, is not alone in its efforts. NASHP reports that 47 states had filed 269 bills to control prescription drug costs as of July 7 — with 46 such laws enacted this year in 29 states.

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Senators Vow to Keep Fighting For Drug Cost Transparency

July 11, 2019

After a federal court on July 8 blocked a Trump administration rule — a day before it was set to take effect — requiring pharmaceutical manufacturers to disclose prescription drugs’ list prices in direct-to-consumer (DTC) television ads, HHS brushed aside the legal setback for its high-profile initiative as “disappointing.” The judge indicated that Congress would need to act on the matter, and on July 10 two senators said they intend to plow ahead and do just that.

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Plans Offer More $0 Copay Drugs to Boost Adherence

July 11, 2019

As various players in the health care industry sharpen their focus on disease prevention, some experts say they’re seeing health plans offering more and more “preventive” drugs at no cost to members.For example, in a June 28 press release, Dean Health Plan said it’s “adding even more preventive drugs to our list of drugs available to [members] for $0.” Additions to the list, which total more than 200, include Advair inhalers (fluticasone propionate and salmeterol) for asthma, the diabetes drug Januvia (sitagliptin), and Alendronate for osteoporosis, says Kevin Engelien, manager of large group product and market research at the Wisconsin-based insurer.

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News Briefs

July 11, 2019

✦ The Trump administration has withdrawn its controversial proposal to remove the safe harbor for drug manufacturer rebates to Medicare Part D plans and PBMs, a White House spokesperson confirmed to various media outlets on July 11. As first reported by Axios, the proposal was killed after facing resistance from White House domestic policy chief Joe Grogan “and other fiscal hawks on grounds that it was too expensive — costing the government nearly $180 billion over a decade,” Politico reported. “Based on careful analysis and thorough consideration, the president has decided to withdraw the rebate rule,” spokesperson Judd Deere said in a statement to Politico and others. HHS issued its own statement, citing ongoing efforts to lower prescription drug prices. Leerink analyst Ana Gupte told investors her firm expects Cigna Corp., CVS Health Corp. and UnitedHealth Group stocks to rally on the news. “We see this as positive for PBMs directly on margin sustainability in Medicare, and in the future on any potential spillover of the elimination of the safe harbor provision of rebates into the Commercial book,” she said. Read the Axios article at https://bit.ly/2XGO9gY and Politico article at https://politi.co/2XGl8NN.

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