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Specialty Pharmacy on Strategies and Analysis for Managing High-Cost Specialty Products Specialty Pharmacy on Strategies and Analysis for Managing High-Cost Specialty Products Opinions Vary on How Useful Requiring WACs on TV Ads Will Be October 2018 While HHS has taken multiple steps toward lowering prescription drug prices, VOLUME 15 | NUMBER 10 the agency’s latest proposal has been its most contentious so far. And while it may succeed in providing consumers more information on drugs’ wholesale acquisition costs (WACs), industry experts wonder how effective it really will be in letting con- Cost of Care, Drug Burden 3 sumers know what they will pay for a drug. Can Be Challenge in Managing CF HHS Secretary Alex Azar unveiled the proposal during a speech at the National Academy of Medicine’s annual meeting Oct. 15. The proposed rule (83 Fed. Reg. 6 MDs May Be Prescribing 22698, Oct. 18, 2018) is scheduled to be published Oct. 18 in the Federal Register. IL-17 Inhibitors as The proposed rule would require direct-to-consumer (DTC) television ads for First-Line Drugs prescription drugs covered by Medicare or Medicaid that have a WAC of more than $35 per month to include that list price in the ad. Specifically, an ad “must contain 7 Coinsurance Continues to a statement or statements indicating the Wholesale Acquisition Cost (referred to Be Top Cost-Share Tactic as the ‘list price’) for a typical 30-day regimen or for a typical course of treatment, Among Specialty Tiers whichever is most appropriate, as determined on the first day of the quarter during which the advertisement is being aired or otherwise broadcast, as follows: ‘The list 8 New FDA Specialty Approvals price for a [30-day supply of ] [typical course of treatment with] [name of prescrip- tion drug or biological product] is [insert list price]. If you have health insurance 12 News Briefs that covers drugs, your cost may be different.’” continued on p. 10 Prime Inks Value-Based Agreement With Janssen for Stelara Prime Therapeutics LLC has added another value-based contract to its Care- Centered Contracting program. The newest participant is autoimmune therapy Stelara (ustekinumab) from the Janssen Pharmaceutical Companies of Johnson & Johnson. With that therapeutic class at the top in terms of spend among most pay- Subscribers to Radar on Specialty ers, understanding whether a medication is being taken appropriately is critical to Pharmacy can access searchable knowing whether a product is providing value. articles, infographics and more at AISHealth.com. If you need help The FDA has approved Stelara to treat moderately to severely active Crohn’s logging in, email support@ disease in adults, moderate or severe plaque psoriasis in people at least 12 years aishealth.com. old and active psoriatic arthritis in adults. The agency first approved the interleu- kin-12/23 inhibitor in September 2009 (RSP 10/09, p. 6). “The development of Prime’s value-based contracts is an iterative process, so it’s Managing Editor more about identifying therapeutic areas or drugs of interest and then collaborating Angela Maas with select manufacturers,” explains Kim Gwiazdzinski, R.Ph., senior director, trade [email protected] Executive Editor relations, value and outcomes contracting for Prime, in response to a question about Jill Brown how the deal came about. “Because autoimmune is one of our costlier therapeutic Director, Data Solutions areas, it made sense to explore a contract in that category.” Susan Namovicz-Peat Prime, which serves more than 27 million members, is owned by 18 Blues plans, subsidiaries or affiliates of those plans. According to Gwiazdzinski, the auto- Published by AIS Health, Washington, DC. An independent publication not affiliated with insurers, vendors, manufacturers or associations. 2 Radar on Specialty Pharmacy October 2018 immune class of medications was the the intended duration, as opposed to medical and pharmacy benefit can biggest driver of spend among specialty adherence, which is taking it as pre- provide insights such as member ad- drugs for Prime’s commercially insured scribed.” The PBM explains that “this herence levels and differences based on members in 2017. Specifically, the measure is important as it's only when which benefit (medical or pharmacy) it category was 14% of spend and 23% patients continue to take their medica- is covered” in. of trend. In Prime’s Fall 2017 Mid-Year tions for the prescribed amount of time “Our clients invest in specialty Update, released Oct. 12, 2017, Stelara that they obtain the intended benefit medications, and if members don't was ranked No. 9 among the top 10 from the therapy.” continue to take them, no one re- individual drugs driving drug spend, at Asked what length of persistence alizes the value of the investment,” 1.2% of spend (RSP 10/17, p. 6). Prime is looking for as part of the says Susan Scheid, vice president of “While not the highest in utili- contract and whether the companies pharmaceutical trade relations for zation among commercial members, would analyze other benchmarks, Prime. “Prime uses insights from its Stelara use is growing, and we want Gwiazdzinski replies, “Persistency is a value-based contracts to build clinical to ensure that members taking Stelara foundation for the contract and a good programs to improve member health are continuing therapy to be able to starting point for both parties to enter outcomes.” maximize the benefits of the drug,” into a value-based agreement. Prime’s Gwiazdzinski declined to respond Gwiazdzinski tells AIS Health. objective is to subsequently build to questions about whether the con- Under the Stelara arrangement, on these contracts and move toward tract applies only to new starts on the which already has started, Prime will agreements that measure the impact of drug, as well as whether Prime has any analyze both pharmacy and medical a product on the overall cost of care, other value-based deals with Janssen. rather than one single outcome.” claims data in order to track how long Prime Contracting Program Began in 2010 members remain on therapy. Gwiazdz- According to Gwiazdzinski, “As The agreement is part of Prime’s inski clarifies that “this contract mea- we advance our efforts in value-based CareCentered Contracting program, a sures persistence, which is more about contracting, looking at drugs like Ste- value-based contracting program that continuing to take a medication for lara that are covered under both the the PBM launched in 2010. Asked how many value-based contracts that Radar on Specialty Pharmacy (ISSN: 2576-4438) is published 12 times a year by AIS Health, 2101 L Street, Prime has as part of the program, Gwi- NW, Suite 400, Washington, D.C. 20037, 800-521-4323, www.AISHealth.com. azdzinski says that “while the number Copyright © 2018 by Managed Markets Insight & Technology, LLC. All rights reserved. On matters of fair use, of contracts fluctuates at any given you may copy, fax or email an excerpt from an article from Radar on Specialty Pharmacy. But unless you have time, we have entered into more than AIS Health’s permission, it violates federal law to copy or email an entire issue, share your AISHealth.com password, or post content on any website or network. Please contact [email protected] for more a dozen value-based contracts since the information. program’s inception.” Radar on Specialty Pharmacy is published with the understanding that the publisher is not engaged in Prime’s first two contracts were rendering legal, accounting or other professional services. If legal advice or other expert assistance is required, with Warner Chilcott Co. for osteopo- the services of a competent professional person should be sought. rosis drug Actonel (risedronate sodi- Subscriptions to Radar on Specialty Pharmacy include free electronic delivery in addition to the print copy um) and with Merck & Co., Inc. for access to online content at www.AISHealth.com. To renew your annual subscription, please order online at its diabetes drug Januvia (sitagliptin). www.AISHealth.com. For subscriptions for five or more users, contact [email protected]. That was followed by an agreement with EMD Serono, Inc. for its multiple Managing Editor, Angela Maas; Executive Editor, Jill Brown; Director, Data Solutions, Susan Namovicz-Peat sclerosis drug Rebif (interferon be- EDITORIAL ADVISORY BOARD: Al Heaton, Pharm.D., Director of Pharmacy Management, UCare, Chris Nee, ta-1a) (RSP 4/11, p. 1). Pharm.D., President, PharMedQuest, Lee Newcomer, M.D., Senior Vice President of Oncology Services, In response to a question about UnitedHealthcare, Bill Noyes, Vice President, Health Information Policy, National Home Infusion Association, how the program has evolved, Gwi- Nicholas Opalich, President and Chief Operating Officer, Western Operations, ProCare Rx,Elan Rubinstein, Pharm.D., Principal, EB Rubinstein Associates, Rebecca Shanahan, CEO, Avella Specialty Pharmacy, Debbie azdzinski tells AIS Health that “the Stern, Senior Vice President of Strategy and Business Development, CareCore National, William Sullivan, CareCentered Contract signed in Principal Consultant, Specialty Pharmacy Solutions, LLC, David Willcutts, President and General Manager, 2010 has provided valuable learnings Integrated Home Care, Univita Health regarding the operational aspects of Contact [email protected] if you’d like to review our rates for group subscriptions. October 2018 Radar on Specialty Pharmacy 3 these contracts. In addition, we now could be overburdened with costs, par- Academy of Managed Care Pharmacy have several data points to measure ticularly if there are no means-testing
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