Payers, PBMs Play Crucial Roles in COVID-19 Vaccine Distribution

by Peter Johnson

As the pharmaceutical industry hurtles toward completing a COVID-19 vaccine, payers and PBMs have begun to draft vaccine distribution plans based on emerging guidance from federal public health leaders.

The National Academies of Sciences, Engineering and Medicine has initiated formal discussion of vaccine distribution, soliciting four days of public comment on its Sept. 1 Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine.

The framework suggests three phases of vaccine distribution:
✦ Group 1a: "High risk workers in health care facilities" and "first responders";
✦ Group 1b: "People with significant comorbid conditions," and "older adults in congregate or overcrowded settings";
✦ Group 2: "Critical risk workers (part 1)," "teachers and school staff," "people with moderate comorbid conditions," "all older adults," "people in homeless shelters or group homes," and "incarcerated/detained people and staff";
✦ Group 3: "Young adults," "children," and "critical risk workers (part 2)".

During a Sept. 17 session of the America's Health Insurance Plans National Conference on Medicare, Medicaid & Dual Eligibles, AHIP Senior Vice President of Clinical Innovation Kate Berry said state and federal public health officials will likely manage the first two phases, but she added that plans should expect to get involved in the third phase.

Berry said coordination and data sharing between public officials and plans will be essential to ensuring a fair and orderly vaccine distribution process, especially since some of the vaccine candidates in late stages of development will require a booster. She also indicated that the looming medical data interoperability rules, which mandate payers, providers and government stakeholders share patients’ medical history with each other via secure data clearinghouses by January 2022, will play a role in validating which patients get vaccines at what time.

During a Sept. 15 panel at AHIP's online conference, Sree Chaguturu, M.D., chief medical officer of CVS Health Corp.'s Caremark PBM, said he does not expect his firm to employ any utilization management tactics during the initial stages of vaccine rollout, though he later observed that PBMs and plans might eventually manage formularies to direct members away from first-generation vaccines to more effective drugs. He also observed that payers and PBMs should gather as much data as they can about the efficacy of vaccines in order to ensure that the right medication is delivered to the right populations in the future, when COVID-19 vaccines become a routine inoculation.

From RADAR on Drug Benefits