Lawsuit updates: GoodRx and PBMs sued; Walgreens settles
Coupon aggregator GoodRx and PBMs including CVS Caremark and Express Scripts have been hit with at least three class action lawsuits accusing them of working together to suppress reimbursements to small pharmacies for generic prescription drugs. In other news, Walgreens has agreed to pay $100 million to settle a proposed class action lawsuit accusing it of fraudulently overcharging customers for a decade when they bought generic drugs through private insurance, Medicare or Medicaid. (Reuters; Reuters – Walgreens)
Regulatory and market trends driving biosimilar adoption
Biosimilars offer a significant opportunity to reduce biologic drug costs and make essential medications more affordable. Initially, the US biosimilar market underperformed, raising concerns about its viability. However, recent evidence shows that the post-approval biosimilar market is now thriving. Regulatory and market forces are driving adoption of biosimilars, as demonstrated by the entry of biosimilars for adalimumab. (Health Affairs)
Practice Transformation
Survey: Employers don’t understand how drug benefits are managed
A KFF survey of 2,142 companies reveals that many employers lack insight into how much of the rebates negotiated by pharmacy benefit managers (PBMs) are returned to them as savings. Among employers with 500+ employees, only 19% said they received most of the rebates, while 27% received some, 16% received little, and 37% didn’t know. This lack of transparency fuels confusion and skepticism about PBMs’ cost-saving claims. “I don’t think they can ever know all the ways the money moves around because there are so many layers, between the wholesalers and the pharmacies and the manufacturers,” says KFF SVP Gary Claxton.(KFF Health News; survey results)
Study find benefits of incorporating CMM and SDOH screening
A pilot study published in the Journal of Managed Care Pharmacy suggests that incorporating social determinants of health (SDoH) screening and referral into CMM may lead to clinical improvements in patients with SDoH needs. Researcher found better control of blood pressure and diabetes in patients with SDoH barriers who saw a pharmacist within a group of Federally Qualified Health Centers. “[O]ur results suggest that patients with SDoH needs may experience larger clinical improvements in diabetes and hypertension control than patients without SDoH needs when they receive CMM.” The findings were not statistically significant. (Journal of Managed Care Pharmacy)
Evidence & Innovation
Nothing compares to pseudoephedrine, evidently
Thursday, the FDA announced a proposed order to remove oral phenylephrine as an active ingredient in OTC nasal decongestants. A comprehensive review showed it was not effective. The change won’t affect nasal sprays. When pseudoephedrine was moved behind the counter nearly 20 years ago, products containing oral phenylephrine became the only nasal decongestants available without pharmacy assistance, MedPage Today reports. Public comments are open through May 7. (MedPage Today; proposed order and comment form)
Policy Solutions
Election impact on the policy front
Donald Trump’s election win suggests healthcare policy rollbacks, particularly on ACA regulations, reproductive rights and Medicaid expansions, Modern Healthcare reports. Trump plans to “improve” the ACA, likely restoring less-regulated health plans. A big question: Will enhanced subsidies for marketplace plans be maintained after 2025? He could also support price transparency and stricter oversight of PBMs to control drug costs. One wildcard: What happens if figures like Robert F. Kennedy, Jr. assume influential roles? “If RFK Jr. gets a major role in healthcare in the administration, we could see the government being an accelerator for misinformation,” KFF SVP Larry Levitt warns. (Modern Healthcare)
Election roundup: Expect big changes in healthcare
KFF News provided a roundup of articles exploring what the new administration could do — or undo — to programs such as the Affordable Care Act, Medicaid, Medicare, abortion and prescription drug costs. (KFF Health News)