Changes coming to our commercial medical plan drug lists, Aetna
Is Aetna’s latest white bagging move designed to save money or shift margin?
On July 1, CVS Health’s Aetna business moved five provider-administered drugs—Evenity, Ocrevus/Ocrevus Zunovo, Remicade, Tezspire, and Xolair—from the medical benefit to the pharmacy benefit coverage.
This shift enables fulfillment through specialty pharmacies, a.k.a. white bagging. As a result, buy-and-bill margins transfer from infusion centers, physician practices, and hospital outpatient departments and flow instead toward CVS-affiliated specialty pharmacies.
Click here to review a passionate debate among the Drug Channels community on LinkedIn about this latest chapter in the ongoing battle for drug channel margin.
ICYMI: The American Medical Association and American Society of Clinical Oncology (ASCO) recently released a strongly worded issue brief: Mandatory White Bagging and Brown Bagging Policies Threaten Patient Access to Care. The brief outlines their opposition to these payer-mandated practices, citing concerns about delays, waste, patient safety, and cost-shifting. Noticeably absent: any mention of the cost savings or utilization control these policies provide to payers.
On July 1, CVS Health’s Aetna business moved five provider-administered drugs—Evenity, Ocrevus/Ocrevus Zunovo, Remicade, Tezspire, and Xolair—from the medical benefit to the pharmacy benefit coverage.
[Click to Enlarge]
This shift enables fulfillment through specialty pharmacies, a.k.a. white bagging. As a result, buy-and-bill margins transfer from infusion centers, physician practices, and hospital outpatient departments and flow instead toward CVS-affiliated specialty pharmacies.
Click here to review a passionate debate among the Drug Channels community on LinkedIn about this latest chapter in the ongoing battle for drug channel margin.
ICYMI: The American Medical Association and American Society of Clinical Oncology (ASCO) recently released a strongly worded issue brief: Mandatory White Bagging and Brown Bagging Policies Threaten Patient Access to Care. The brief outlines their opposition to these payer-mandated practices, citing concerns about delays, waste, patient safety, and cost-shifting. Noticeably absent: any mention of the cost savings or utilization control these policies provide to payers.
Do Patients Receive 340B Drug Discounts at the Contract Pharmacy Counter?, IQVIA
Yikes. 340B covered entities are still not sharing discounts with needy patients.
Per this new IQVIA study, only 3% to 5% of branded 340B prescriptions at retail and mail-order contract pharmacies were filled using a 340B drug discount card. That’s shockingly low—especially in a country where 32% of the population is uninsured or underinsured.
DSH hospitals have the biggest discrepancy between 340B prescriptions (74.7%) and card usage (42.8%). Perhaps not coincidentally, many of the contract pharmacies are located in higher-income areas.
This study is consistent with the Senate report that I reviewed in Follow the 340B Dollar: Senator Cassidy Exposes How CVS Health and Walgreens Profit as 340B Contract Pharmacies.
These data highlight yet another massive disconnect between the program’s benefits and patient access. Transparency and accountability are long overdue. The 340B Drug Pricing Program desperately needs to be modernized so that it benefits the genuine safety-net services of healthcare providers, while appropriately supporting low-income and uninsured patients.
Per this new IQVIA study, only 3% to 5% of branded 340B prescriptions at retail and mail-order contract pharmacies were filled using a 340B drug discount card. That’s shockingly low—especially in a country where 32% of the population is uninsured or underinsured.
DSH hospitals have the biggest discrepancy between 340B prescriptions (74.7%) and card usage (42.8%). Perhaps not coincidentally, many of the contract pharmacies are located in higher-income areas.
[Click to Enlarge]
This study is consistent with the Senate report that I reviewed in Follow the 340B Dollar: Senator Cassidy Exposes How CVS Health and Walgreens Profit as 340B Contract Pharmacies.
These data highlight yet another massive disconnect between the program’s benefits and patient access. Transparency and accountability are long overdue. The 340B Drug Pricing Program desperately needs to be modernized so that it benefits the genuine safety-net services of healthcare providers, while appropriately supporting low-income and uninsured patients.
PCMA Statement on Trump Administration’s Actions to Lower Drug Prices for Americans, Pharmaceutical Care Management Association (PCMA)
Hmm. The Pharmaceutical Care Management Association (PCMA) recently claimed:
But it does raise a critical question:
"Drug companies alone set and raise drug prices and can lower the list prices at any time."That's a misleading simplification.
But it does raise a critical question:
Who, exactly, sets the prices at PBM-affiliate private label companies Cordavis, Nuvaila, and Quallent—especially when their list prices exceed those of competing products?For some examples, see The Stelara Biosimilar Price War: How PBM-Affiliated Private Labels Are Reshaping the Market.
UnitedHealth Has 2,694 Subsidiaries and Affiliates. Is It Too Big to Manage?, The American Prospect
If you think UnitedHealth Group has become a bloated, unmanageable company that's more interested in profit mining than patient care, then you'll enjoy this takedown from The American Prospect. YMMV.
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