EpiPen Costs Skyrocket, Cause Outrage

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

We are sure you have heard some talk about the EpiPen lately, but in case you missed it, earlier this year Mylan raised the cost of a pack to be more than $600 - a significant hike from what it originally cost when the company first purchased the rights to the drug/device in 2007 (at that time, EpiPens cost about $57 each). Since 2007, NBC News reports that the following actions have been taken:

• In 2008 and 2009, Mylan raised the price of EpiPens by 5%.
• At the end of 2009, Mylan tried a 19% price hike.
• From 2010-2013, there was a succession of 10% price hikes.
• From Q4 of 2013 to Q2 of 2016, Mylan raised EpiPen prices by 15% every other quarter.

It is no surprise that consumers are outraged over the EpiPen's new cost, as these are used for life threatening allergic reactions. With the new school year approaching many have a need to purchase an EpiPen and provide it to the school nurse, but the cost has made this increasingly difficult.

So why is the price of EpiPens so inflated?

Although it only costs about a few dollars to make (CNBC reports that only about $1 worth of epinephrine is used in these devices), there is currently NO EpiPen generic available in the United States. However, after the uproar began and Mylan faced more scrutiny from both consumers and Congress, they just announced that they will be launching a generic version of EpiPens for about half of the current price ($300). Teva Pharmaceuticals is also working on its own generic version of the EpiPen, and expects to receive approval sometime next year.

Mylan has also taken other actions to try and make EpiPens more affordable to consumers and members, such as by increasing the consumer/member out of pocket cost reduction from "up to" $100 to "up to" $300 - more details available here.

All that said, it is important for payors to understand that increased costs will be experienced, not only because of the increase in prescription costs for EpiPens, but also because of increased and conceivably unnecessary utilization or stockpiling of the brand drug. Additionally, offering a coupon for EpiPens will result in higher costs because eliminating the member copay results in brand loyalty, even though a lower cost generic will be available soon.

This is where we at PBIRx come in. We fight for our clients to get the most value for their health care dollars, and are well aware of the tactics used by Big Pharma to take advantage of consumers. If you have questions about the recent EpiPen news or would like to learn more about how we can help you during this time, please call (888) 797-2479 today.

The Importance of Unused Medication Collection Receptacles

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

It is common practice to discard or recycle items when there is no longer a use for them; however, unused medications cannot be handled in the same manner as most other household items. Did you know that medications can be harmful to the environment and also pose a risk to others in the family (including pets) when they are not disposed of properly? The concern then becomes how unused medications should be discarded. In the opinions of many in the pharmaceutical industry, collection receptacles may be the answer.

Current disposal guidelines, as set forth by the FDA, include the use of take-back programs and U.S Drug Enforcement Agency (DEA) authorized collectors.  Although they do suggest that some select medications can be flushed down the sink or toilet to prevent accidental ingestion by unauthorized individuals (especially children), collection receptacles are becoming increasingly more important.

According to the Pharmacy Times and the National Institute on Drug Abuse, new methods of collecting unused medication are crucial -- the abuse of prescription drugs can lead to addiction. In September, 2014, the Department of Justice added a final rule to implement the Secure and Responsible Drug Disposal Act of 2010, which includes allowing “registered collectors, such as retail pharmacies, to update their DEA registration to become a collector and place receptacles at their pharmacies for the collection and disposal of ultimate users’ controlled substances.” These receptacles are to be securely attached to a permanent structure within the pharmacy and should be placed where employees can see them in order monitor their use. Additionally, they are to be designed in a way that patients can easily deposit the medications without accessing the contents.   Once filled, the receptacle inner liners are returned to a DEA registered reverse distributor facility for proper destruction.

Some companies that have already implemented collection receptacles are King Kullen (Long Island, New York) and Intermountain Healthcare (Salt Lake City, Utah). Hopefully more pharmacies will join this effort. “People understand their role in protecting our waters and getting unused medications out of the home," said Albert W. Hesse Jr., RPH, King Kullen's Director of Pharmacy.

As a company that takes great interest in new initiatives such as this, we wanted to be sure to share with our readers.

Zika Test Receives Emergency Use Authorization From The FDA

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

The Zika virus is a disease which is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosquito that carries yellow fever, dengue fever and chikungunya virus. The most common symptoms of Zika are fever, rash, joint pain, conjunctivitis (red eyes), muscle pain and headache. The Zika virus infection during pregnancy can cause a serious birth defect called microcephaly, as well as other severe fetal brain defects. In rare cases, Zika has been associated with Guillain-Barre syndrome, a disorder that can cause partial or complete paralysis, usually starting in the legs, most often temporary. So far, the only cases in the United States have been travel-associated. The CDC website offers prevention steps for adults and children as well as travel health notices.

Earlier this month, Quest Diagnostics received emergency use authorization for the Zika Virus RNA Qualitative Real-Time RT-PCR test (Zika RT-PCR test) from the U.S Food and Drug Administration, making it that much more important for tests and treatment to be discovered and available as soon as possible. 

The Zika RT-PCR test, which was “designed to detect RNA from the Zika virus in human serum specimens,” is the “first from a commercial laboratory provider to be granted emergency use authorization for testing patients for Zika virus RNA,” according to the Pharmacy Times. Previously, Zika tests were only available from the CDC and were only able to be used in qualified labs.

Zika Virus Education Initiative

The National Association of Chain Drug Stores (NACDS) Foundation is launching a Zika virus education initiative in Puerto Rico where the highest number of locally transmitted cases has been reported. The initiative encourages women to consult pharmacists and physicians to learn how they can protect themselves and their unborn children. Zika virus-infected patients are living in 50 of 78 municipalities in Puerto Rico.

Zika Virus Treatments

Although there are currently no approved drugs available to treat the Zika Virus, researchers have started to look at older approved drugs to determine if they may block the infection caused by the virus or prevent it from harming an individual’s brain or nervous system (as reported by USA Today). Virginia based Atheric Pharmaceuticals has already tested approximately a dozen compounds in lab dishes, and Raymond Schinazi of Emory’s biochemical pharmacology lab reported that he tested a 40-year-old drug that is safe to use during pregnancy. Mauro Martins Teixeira of the Federal University of Minas Gerais in Brazil has tested an Alzheimer’s drug to see how it works in protecting the brain from Zika’s toxic effects. US Phytotherapy Inc. recently finished their research on their drug candidate PROACT-Z and plans to move towards testing it in human trials.

Since 1993, PBIRx has been providing intelligent solutions to clients in the management of pharmacy benefit costs. To learn more about the services offered that are designed to create optimal health care outcomes while minimizing overall health care costs, call (888) 797-2479 today.

Why Connect With PBIRx On Social Media?

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

For over 22 years, the PBIRx staff has worked hard to develop solutions for our clients that allow them to get more control over their health care costs and specifically increased costs related to the pharmacy benefit. The pharmacy industry is very complex and changing rapidly with new games to increase profit by PBMs, a robust high cost Specialty Drug pipeline, eprescribing, average wholesale price increases, etc.

PBIRx has made it a priority to not only be accessible so that our clients can easily contact us and access all of the latest information we have to offer, but also to proactively provide new savings opportunities and important news quite immediately using all the benefits of social media. Thus, we encourage you to find us on the web at www.pbirx.com, read our weekly informative blogs and connect with us on social media as a way to keep in touch! If you send us a message or leave us a comment, we will be sure to get back to you as soon as possible!

Ready to get connected? We hope to see your name appear on our social media profiles soon!

Blog - PBIRx

You will need to subscribe to our blog in order to be the first to know when we have an update for you. Our blogs are focused on new information related to the pharmacy benefit and healthcare costs, along with services that we can provide to assist you with your pharmacy benefit costs. We know time can be limited, so we will always do our best to share the most pressing information first and keep our blogs short and to the point. You will not have to worry about reading pages and pages just to get the facts.

To subscribe, visit www.pbirx.blogspot.com and enter your email address into the box on the right side of our homepage where it states: “Subscribe To Our Blog!”

LinkedIn - PBIRx

Our priority is to help other companies with their pharmacy benefits, and as such, LinkedIn is a platform where we connect with other business leaders and share as much current and useful information as we can. Not only do we share our blog posts on our LinkedIn profile, but we also share industry articles and company updates that we believe are important for our clients and strategic consultant/broker partners to read.

To follow us on LinkedIn, sign into your personal profile and type PBIRx into the search bar at the top that states: “Search for people, jobs, companies, and more…” Then, just click on the “follow” button at the top of our page! Not on LinkedIn? Head on over to www.linkedin.com and sign up today!

Twitter - @PBIRx

Whether you are active on Twitter or not, you may know its reputation for being a social media platform that allows people to find and share “in-the-moment” updates. Here at PBIRx, we use this to our advantage by sharing the most important news as soon as we learn about it! Additionally, we also share our blog posts on Twitter so that you can read more about our company’s latest news, as well as the most pressing industry news.

To connect with us on Twitter, sign in with your account at www.twitter.com, then search for PBIRx in the search bar. Once our name appears in the drop down list, click on it and hit “follow” on our page. Not on Twitter? Visit www.twitter.com and click on the sign up button!

Facebook - PBIRx

Connecting with us on Facebook is one of the easiest ways to discover our latest blog posts. Any time a new post is published, we will share it on Facebook! Additionally, Facebook is our go-to outlet for sharing our company’s initiatives and teaching you how all of our tools (such as our cutting edge web based technology) can benefit you and your company; you can even find a breakdown of our services here! By “LIKING” our page, you can count on receiving all of our updates within minutes of them being posted!

To “LIKE” us on Facebook, log into your personal Facebook account and search for PBIRx in the top search bar. Once you click on our page, all you have to do is click the “LIKE” button you see towards the top. Not on Facebook? Go to www.facebook.com and start entering your information!

Google+ - PBIRx

Adding us to your circles on Google+ is another way to have access to our blogs. We will always preview our latest posts and share their corresponding links with you so that you can get the inside scoop on what has been happening within PBIRx and within the pharmaceutical industry.

To add us to your circles on Google+, log into your gmail account and visit www.plus.google.com. Then, search for PBIRx in the top search bar, click on our page, hover over the red “follow” button, and select the circle you would like to add us to! Not on Google+? Visit www.gmail.com to create an account!

Now that you know where you can find us, we hope you will start following us! If you have any questions, remember that you can always send us a message or talk to us by using social media. The PBIRx team can also be reached at (888) 797-2479.

FDA Approves Inflectra, First Monoclonal Antibody Biosimilar

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

On April 5, 2016, the U.S Food and Drug Administration approved the second biosimilar in the United States, which is infliximab-dyyb (Inflectra), a biosimilar to inflixamab (Remicade). Inflectra is manufactured by Celltrion, Inc. for Hospira, a Pfizer company, and will be administered by intravenous injection for many of the same indications as Remicade, the originator/reference drug. 

Although the biosimilar of Remicade has just been introduced to the U.S market, Inflectra and other Remicade biosimilars have already been introduced to major European markets such as Germany, France, Italy, Greece, Spain and Austria.

According to the FDA, Inflectra can be prescribed to treat the following patients:

• Adult and pediatric patients over age 6 who have moderate to severely active Crohn's disease and have not had success with conventional therapy
• Adult patients who have moderate to severely active ulcerative colitis and have not had success with conventional therapy
• Adult patients who have chronic severe plaque psoriasis
• Patients who have moderate to severely active rheumatoid arthritis - to be used in combination with methotrexate
• Patients who have active arthritis of the spine
• Patients who have active psoriatic arthritis

As a reminder, biosimilars are biological products, meaning they are derived from living organisms such as humans, animals, yeast and microorganisms. In order to be approved, biosimilars must be extremely similar to a biological product that has already been approved, and clinically speaking, there must be no differences in safety and effectiveness when compared to the biologic or reference product.

In addition to being only the second biosimilar approved by the FDA, Inflectra is the first monoclonal antibody biosimilar to be approved. Monoclonal antibodies are made by just a single clone of cells or cell lines from a parent cell, and though they are very expensive, they are utilized widely for different disease states such as cancer, psoriasis and rheumatoid arthritis.

Regarding the dispensing of Inflectra, it is important to note that it must receive approval for dispensing by a physician since the FDA guidance states that it has “not” been approved as an interchangeable product.

With a new biosimilar hitting the market, it is important for entities that provide pharmacy benefits to be aware of how this could affect future pharmacy benefit spend. There is a good chance that pharmacy benefit managers will hold up the dispensing of biosimilars in order to maintain the hefty rebates they receive from the high cost specialty brand/originator products. As such, this is an example of the value of retaining an expert in the pharmacy benefit industry, like PBIRx, to review your PBM contract language so that you have a clear understanding of how biosimilars are being treated, i.e. excluded/included from formularies, pricing guarantees, discounts, and copay tier appropriation.  

For help understanding your PBM Agreement, call and request a courtesy review of your PBM Agreement with one of our friendly and experienced PBM Experts prior to signing a three year PBM Agreement, which could be great for the PBM profitability, but not as good for your bottom line pharmacy benefit spend. Please call (888) 797-2479 or fill out our contact form on our website.

Anthem Express Scripts’ Lawsuit Should Incentivize Municipalities to Seek Independent Pharmacy Benefit Consulting Firm

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Pharmacy benefit lack of expertise by using a Medical/Employee Benefit consultant, Carrier or TPA, versus an independent pharmacy benefit expert like PBIRx, hits municipalities’ and taxpayers’ bottom line. There is so much money left on the table and no one seems to care! 

After several attempts at negotiation and using an independent third party pharmacy benefit expert, Anthem is now suing Express Scripts for an estimated $13 billion in overpayment of pharmacy benefit costs. If Anthem is using an independent pharmacy benefit expert, why are the many municipality clients they serve not doing the same? Why are their municipality clients not concerned about what percentage of the $13 billion that Anthem is trying to get from Express Scripts is representative of their budget? Does anyone think that if Anthem gets a concession from Express Scripts that Anthem will credit the pharmacy benefit costs for their municipality clients? We do not think so!

Municipalities typically go out to bid for their medical benefits by requesting an RFP for a Health or Other Employee Benefit/Medical Consultant or their TPA/Carrier recommends a PBM; however, they rarely request an RFP for an independent Pharmacy Benefit Consultant, even though pharmacy costs now represent up to 30%-40% of total employee benefit costs and is increasing annually.     

Taxpayers, just like us, have no idea what is going on at our local Town Hall or Board of Education even though our taxes go up every year for the rich benefits that municipal workers and their unions demand. With an independent Pharmacy Benefit Consulting firm like PBIRx, municipalities’ budgets would benefit, while employees and union members maintain their benefits and taxpayers save money…a win, win, win situation!

An Employee Benefit, Medical Consultant, Carrier or TPA cannot possibly know and follow all the complexities that are involved and constantly changing in pricing for the pharmacy benefit, along with the ability to analyze and audit like an independent Pharmacy Benefit Consulting firm. Employee Benefit/Medical brokers/consultants and TPAs/Carriers typically go the easy route of a spreadsheet, when like most things, i.e. the PBM profit, is buried in the details in the Pharmacy Benefit Agreement or when using a TPA or Carrier “very little” information related to the pharmacy benefit pricing is stated in the TPA or Carrier Agreement.    

Auditing the pharmacy benefit, which is integrated in with the medical TPA or Carrier, is almost impossible because of the lack of language and calculation methodology of pricing in their TPA/ Carrier Agreements. Even when municipalities contract directly with a PBM, they rarely audit that Pharmacy Benefit Agreement, which typically allows only auditing of the previous 12 months, even though pharmacy benefit drug spend is in the millions of dollars.  An independent Pharmacy Benefit Audit will also provide information related to the competiveness of the PBM contract.

For over 25 years, PBIRx, an independent third party Pharmacy Benefit Consulting and Audit Company, works directly with municipalities and has “Strategic Broker/Consultant Partnerships”, as well as “TPA Strategic Partnerships”. These PBIRx Strategic Partners understand  the need to work with an expert that employs a staff of mature and seasoned professionals with a sole focus only on pharmacy costs. To speak with one of  the PBIRx experts and learn how you can be helped next with your pharmacy benefits, please visit www.pbirx.com or call (888) 797-2479.

Three Reasons To Work With PBIRx In 2016

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

For those of you who are unfamiliar with our business, we are a pharmacy benefit auditing and consulting firm that strives to establish and maintain professional relationships with brokerage firms, consulting firms and various other entities that provide pharmacy benefits to their employees or members. Our main goal is to aid with the management of pharmacy benefit costs, and we work closely with each client to ensure that they are receiving optimal health care outcomes at the lowest possible costs. But what makes us the ideal candidate to work with your company? Below, we discuss a few advantages of partnering with our team.

Pharmacy Benefit Consulting Is Our Specialty

For over thirty years, PBIRx has specialized exclusively in consulting for pharmacy benefits. That means our attention is 100% on finding and delivering solutions that will aid in the management of pharmacy benefit costs specifically! With us, you can feel confident that we are solely focused on the outcomes that best meet the specific goals you require.

Our Staff Is Top Notch

We are not just staffed with a few pharmacy benefit management experts; we also have actuaries, financial analysts, clinical pharmacists, HIPAA compliance officers and IT personnel on hand to assist with each of our services. Did you know that our actuary is even a Fellow in the Society of Actuaries and a Member of the American Academy of Actuaries? At PBIRx, we are only staffed with the best!

We Are Efficient and Honest

Data processing can be time consuming, but we have developed a strategy that allows us to be as efficient as possible in processing any information we are working with. Additionally, through each of our services, we will always offer an unbiased and objective financial analysis that considers the client’s best interests, rather than the PBM’s. If you are looking for a reliable consulting firm that will provide you with honest answers, we are surely the one to turn to.

Interested in learning more about our team and the services we can offer you in 2016? For further information, please visit www.pbirx.com or give us a call at (888) 797-2479 today.