Member: RADAR on Drug Benefits

Aduhelm Approval Prompts Backlash, Could Bring Investigation

July 22, 2021

Aduhelm (aducanumab), the Biogen Inc. Alzheimer’s drug recently approved by the FDA, seems less and less likely to be dispensed to patients, as prominent providers, practitioner groups and experts have all publicly argued against doing so. Several health insurers have said they will not pay for the drug unless patients pass strict prior authorization standards — and the FDA approval itself could be in jeopardy as the agency’s acting commissioner has called for the HHS Office of Inspector General (OIG) to investigate the process that led to the approval.

FDA Acting Commissioner Janet Woodcock, M.D., on July 9 asked the OIG to investigate the approval process for Aduhelm. (Woodcock was not involved in the decision to approve the drug.)

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Senate Will Likely Decide Fate of Drug Pricing, PBM Reforms

July 22, 2021

Even as Congress inches closer to passing the largest individual spending bill in U.S. history through budget reconciliation, health care insiders are still uncertain what drug pricing measures could make their way through both chambers. However, D.C. insiders say that some combination of Medicare Part D out-of-pocket spending caps, Medicare drug price negotiation, caps on launch prices and/or price growth, and PBM reform are all possible — though policies will have to make their way through the twin gauntlets of the preferences of Senate committees and the rules requirements of budget reconciliation.

Consideration of drug pricing measures has moved to the Senate. Insiders expect H.R. 3, the law introduced by Speaker Nancy Pelosi (D-Calif.), has the votes to make it out of the lower chamber. However, few expect that the bill would make it through the Senate intact. H.R. 3, titled the Lower Drug Costs Now Act, caps Part D out-of-pocket costs, allows Medicare to negotiate drug prices and bans the price of drugs from increasing faster than the annual rate of inflation. Some — but not all — of those provisions could clear the Senate.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Medicare ‘Overspent’ by 20% Compared With Costco Prices on Generic Drugs

July 22, 2021

Medicare spent $2.6 billion more on 184 most common generic drugs compared with Costco member prices for the same prescriptions in 2018, according to a recent research letter published in JAMA Internal Medicine. By analyzing more than 1.4 billion Part D claims, researchers estimated that Medicare spent 13.2% more in 2017 and 20.6% more in 2018 than Costco members paid for 30-day and 90-day prescription fills. In 2018, Medicare spending exceeded the Costco member price on 43.2% of all 30-day and 90-day fills of the generic drugs studied.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Navitus Debuts Predictive Tool To Prevent Opioid Misuse

July 22, 2021

COVID-19 presented the health care system with many challenges in 2020, but one of the most sobering was the impact on opioid misuse.

The Centers for Disease Control and Prevention (CDC) said earlier this month that more than 93,000 Americans died from a drug overdose in 2020. This represents a 29% increase compared to 2019. Only two states, New Hampshire and South Dakota, reported a decrease in drug overdose deaths.

According to CDC data, opioids represent the largest percentage of drug overdose deaths in 2020, at nearly 70,000. Meanwhile, a recent National Institute on Drug Abuse analysis estimated that more than 20% of these deaths involved prescription opioids. Beyond the increase in overdose deaths, a recent American Medical Association report concluded that every state faced concerns about access to care for substance use disorder and harm-reduction services in 2020.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Rezurock Is Approved With More Transplant Agents in Pipeline

July 22, 2021

When patients receive an organ or tissue transplant, a critical part of their treatment involves therapies that are used to ensure neither their bodies nor the transplanted material rejects the new arrangement. While many first-line treatments given to this patient population are low-cost generics, experts say there is a robust pipeline of treatments in development, including a just-approved treatment for chronic graft vs. host disease (GVHD).

Generally speaking, “maintenance treatment for prevention of organ transplant rejection revolves around immunosuppressive therapy,” explains Arash Sadeghi, a clinical pharmacist at UnitedHealth Group’s OptumRx.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.