CVS Health Corp. is experimenting with
indication-based pricing as part of its new Transform Rheumatoid Arthritis Care
program, which could help enrollees see savings as high as 5% on their annual
spend for RA drugs.
PBMs say indication-based pricing, in
which medications are priced
differently depending on their effectiveness in different indications,
works for the anti-inflammatory class due to its high cost and growing
availability of biosimilars. Autoimmune drugs are some of the most expensive
therapeutic treatments, reaching several thousands of dollars per month.
CVS Health said the focus on RA among
the autoimmune disease class is a priority "given that the cost and
utilization of drugs to treat RA are a top drug and spend driver, accounting
for nearly half of overall specialty drug trend." The pharma giant said its multi-pronged approach in Transform RA
Care also includes a trend guarantee based on the program's ability to improve
both clinical care and cost management.
CVS Health's new Health program is
"very similar" to that of Express Scripts Holding Co.'s SafeguardRx
program, according to Josh Golden at Solid Benefit Guidance, a division of
Arthur J. Gallagher & Co. In
general, "these programs tend to steer members toward the PBM's owned
dispensing channels for the greatest effectiveness — which is obviously a win
for the PBM. Also, many of these condition-based programs rely on backend
pharmaceutical company revenue to subsidize the cost of administration. This
isn't inherently a problem, as long as the PBMs are willing to offer financial
transparency and full disclosure of these revenue streams," he says.
Read the full article. (Free
for RADAR ON DRUG BENEFITS subscribers; click here for information on subscribing to
AIS Health's newsletters.)
No comments:
Post a Comment