Monday, August 31, 2015

Entresto® FAQs

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

What is Entresto®?
Entresto® (sacubitril / valsartan) is a combination of two oral agents used for the treatment of heart failure. It belongs to a new class of drugs called the ARNI’s (angiotensin receptor and neprilysin inhibitors).

What is special about this drug?
One of its two agents – sacubitril - is a new type of drug that, in combination with valsartan, has been shown to have efficacy over existing heart failure treatments.

How much will it cost?
Expected cost is $15/day; $5000/year.

Is Entresto® currently available? 
Entresto® is expected to be on the market 3Q15.

How many people will use Entresto®?
Heart failure affects 5.7 million Americans. Over 800,000 cases are newly diagnosed each year. Entresto® has an estimated market of over 2 million U.S. lives.

What are the current drug treatments for heart failure?
Heart failure is currently treated with a series of older agents, most available generically. They have varying degrees of efficacy and side effects.

Is Entresto® safe?
Initial testing did not reveal any unknown side effects versus the therapy it was tested against. As with any drug there is the potential of side effects and adverse events. As new drugs are dispensed to a wider population we can expect more reports of side effects and adverse events.

What will the FDA do to ensure drug safety?
The FDA has required post-marketing studies to observe certain adverse trends noted in the drug testing.

For more information, please contact PBIRx at (888) 797-2479.

Tuesday, August 11, 2015

The Benefits Of Working With PBIRx

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

As health care costs continue to rise, the need for a team who can help ensure that you are paying the right price for various services is extremely important now more than ever. Though you likely contract with a Pharmacy Benefit Manager that adjudicates pharmacy claims at a significant profit margin and a "Medical" broker/consultant, there is a significant cost savings opportunity in working with PBIRx, an independent Pharmacy Benefit Auditing and Consulting firm, that can assist in returning some of that profit back to your benefits budget. After 25 years, PBIRx is proud of our growth of successful clients, who use our intelligence in the form of proprietary clinical algorithms and technology along with a dedicated team of experienced professionals with longevity in the pharmacy benefit industry.  

But why is PBIRx the right partner to move your PBMs profits to your budget? 

To start, PBIRx's proprietary AuditRx program and experience in hours of negotiating pharmacy benefit recoveries with various PBMs at a senior level gives clients a unique edge in understanding how discounts, guarantees and other fees in a PBM Agreement change with language in fine print. This experience translates to starting with an optimal PBM Agreement giving clients an immediate 10%- 15% savings adjunct to implementation of proprietary clinical algorithms, which identify client specific clinical programs resulting in an additional 10% -15% savings.

Next, pharmacy claims data is reviewed monthly so that plan design and clinical savings opportunities can be identified on a continuum. A recent example is when the manufacturer of the drug Glumetza for diabetes increased the AWP by 500% in late June of 2015. For one client with one member, the cost for one prescription increased to $9,300 from $1,700. PBIRx immediately reached out so that the prescribing physician was made aware of the significant cost increase with alternative lower cost therapeutic alternatives saving the client what could have been a $100,000 cost increase for one member with one prescription. 

All plan design recommendations are provided with member disruption (if any) and estimated savings, which is measured and provided back to the client comparing PBIRx projected savings to actual savings. This is a huge benefit to our clients because it provides them with the opportunity to truly see how much money they have saved as a result of our ongoing analyses. PBIRx has several proven proprietary plan design savings that go well beyond optimal PBM contract discounts and clinical programs with an increase in member cost share as a very last option.

Furthermore, facilitation of implementation of all recommendations are provided by PBIRx experts that pay attention to the detail required including physician and member communication materials. PBIRx becomes a team member for all our clients specializing in all aspects of the pharmacy benefit from their in house pharmacy, if any, to 340B audit and compliance, PBM contract negotiation and management of all financial terms and reconciliation of guarantees, invoices and rebates. PBIRx experts are also face to face with members to present all aspects of the pharmacy benefit and to be available to answer any questions at all open enrollment meetings.

Last, but certainly not least, the PBIRx team of experts provides several ad hoc reports including allocation rates, disease/drug compliance metrics, cost increase or decrease based on various copay options, patient assistance program facilitation, and challenges when PBMs recommend programs that actually increase client costs under the guise of pharmacy benefit management "cost savings" recommendations. For our Accountable Care Organization clients projected metrics have always been within 1% of accuracy.

To learn more about our services, ask questions, or request a courtesy PBM contract review, please visit us on our website or dial (888) 797-2479 today.

Wednesday, August 5, 2015

Cost of Praluent for High Cholesterol Announced

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

Those who suffer from high cholesterol may soon have a new treatment available to them - but at a very high cost to the Plan Sponsor. Praluent, a PCSK9 inhibitor developed by Sanofi and Regeneron Pharmaceuticals Inc., recently received FDA approval to be used for the purpose of lowering cholesterol and will be available through a limited number of specialty pharmacies. As reported by CBS News, it is "considered the first major advance in cholesterol treatment since statins were first introduced more than 20 years ago." However, though this may be a major breakthrough for certain patients who struggle with cholesterol on a daily basis, the benefits it can bring will come at a high price.

Designed to be injected into only a subset of patients who meet very specific criteria for this treatment, it was announced that Praluent will cost $40 for every day of treatment, which comes out to a whopping $14,600 per year. Unfortunately, this cost is higher than the already costly predictions - most were in the $10,000 range according to CBS. 

In addition to this new drug, also keep an eye out for another new PCSK9, which is due to be launched within the next 60 days and two other PCSK9s are expected to follow in 2016.

What this means for you...

For entities that provide pharmacy benefits to their employees or members, the introduction of this drug could certainly impact your plan and the price you pay for certain services if you provide pharmacy benefit coverage for individuals who require cholesterol lowering treatments. Of particular interest is the diversity amongst Pharmacy Benefit Managers pertaining to the clinical protocol for approval of PCSK9s along with some PBMs that are encouraging or mandating mail order only and/or offering a Per Member Per Month fee for PCSK9 Program clinical services. As a result of Pharmacy Benefit Manager increased costs for prior authorization, a Per Member Per Month Fee and the increased utilization of this high cost drug, Plan Sponsors will inevitably feel the effects of higher pharmacy benefit costs.

On another note, for covered individuals, this approval could also mean an increase in their cost share/copayment versus generic statins, another cholesterol treatment, which are known to only be about $100 per year.

As experts in the pharmaceutical industry, the team here at PBIRx is constantly working to find out how our current clients and future clients will be impacted by new drug approvals. Therefore, to learn more about how you may be affected when this new drug makes its way to the market, give us a call at (888) 797-2479 or visit us on our website to learn how our pharmacy benefit consulting and auditing services can help you in more ways than one.