Managed Care Organizations are reviewing drugs well before a product is approved. According to a survey conducted by Dymaxium (the company behind the AMCP eDossier System) and presented in a recent webinar, two out of three healthcare decision makers begin to evaluate a drug at least six months prior to approval. The survey also indicates that the primary source of information that payers are using for these pre-approval evaluations is clinicaltrials.gov (CT.gov), and that manufacturers are not always responsive to requests for information pre-approval.
I’m writing this in the lobby of a car dealership, waiting for my vehicle to get serviced. I brought a couple of sales books with me so I could utilize the 2 hour wait. I recently took on the added role of part-time sales rep within Advera Health as I have experienced successful case studies first-hand through being our client-facing Product Specialist over the past two years: I’ve built relationships with our existing clients, received their feedback on our data tools & analytics to see how they’ve implemented the information, and witnessed how our Evidex platform has become an integral part of their workflow.
It’s been a tough few weeks for music fans with the deaths of David Bowie to liver cancer and Glen Frey to complications from rheumatoid arthritis and ulcerative colitis. These are just two of the millions of people worldwide suffering from these diseases, but I’m sure I’m not the only one who felt a sense of loss from the passing of these two men. Both profoundly influenced my adolescence and early adulthood through their music.
In the days following the news of Frey’s death, news stories emerged sourcing his longtime manager Irving Azoff and medical professionals unrelated to his treatment that assigned some degree of blame on Frey’s death to the medications he was taking to treat his conditions.
It’s that time of year again. It’s August, the summer is winding down and people are taking their last vacations before the kids go back to school. Football players are in training camp and baseball pennant races are coming down to the wire. And most importantly to all of us at AdverseEvents, Prescription Benefit Managers (PBMs) are telling the world which drugs they are excluding from their preferred drug formulary coverage in 2015.
Last week, we found out that Express Scripts and CVS Caremark will be excluding two drugs from their respective formularies, Vimovo (naproxen/esomeprazole) and Duexis (ibuprofen/famotidine). The news was not so good for the maker of those drugs, Horizon Pharma, whose stock is down more than 30% since the announcement was made. Horizon stated in their 8-K that these formulary deletions could cost them 30% of their revenue and the market reacted accordingly. These drugs both combine an anti-inflammatory agent with an anti-ulcer agent, seemingly a very logical and safer combination since heavy anti-inflammatory use can sometimes cause ulcers. However, each individual component of these drugs is available much cheaper if they were prescribed separately. Based on this, Express Scripts and CVS decided the combination drug was a waste of money (namely theirs) and they weren’t going to tolerate it anymore. Now, everybody is speculating whether other combination drugs that combine cheap generic individual components are next on the PBMs’ chopping block.
In my post last week, I wondered why Express Scripts’ decision to drop certain medications from its formulary was such big news.
In response, a reader was kind enough to send me the exclusion list.
After performing our formulary optimization analysis on the exclusions, I think that some of the decisions were made without any insight into the true medical cost.
We came across an interview with Steven Miller, the Chief Medical Officer at Express Scripts recently about the stir his company has created in its decision to remove 48 medications from its national preferred formulary.
Our immediate reaction: Why is this news?
OK, we understand why it’s news. The biggest PBM has decided to remove certain medications from its formulary. That has real and significant revenue implications for the drugs’ manufacturers and potential implications for patients in reduced medication choice (although Dr. Miller goes to great length to refute that latter point).