Lower Cost Basaglar Will Compete with Higher Cost Basal Insulins

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Basaglar, a Lilly/BI (insulin glargine injection),  a “long acting human insulin product” for pediatric type 1 diabetes mellitus and adult type 2 diabetes mellitus,  is the first FDA approved “follow on biologic” in the insulin class launched on December 15, 2016.  Lantus, a Sanofi highly prescribed insulin glargine injection, alternative form to Basaglar, will definitely be affected due to Basaglar’s lower cost.  Lantus was the top selling insulin in the US for the past decade or more with over $5 billion in sales in 2013 and now its reign is finally coming to an end.

Long–acting insulin (basal insulin) plays an extremely important role in the treatment of diabetes in children and adults. Lantus was the first basal insulin approved by the FDA in 2000 and has dominated the insulin market for years.  Lantus had significant and consistent price increases throughout its tenure including two in 2013, which increased its cost by over 15 percent.  The cost of this life saving medication has taken a dramatic economic toll on payers and patients alike.  The impact of its price increases was most dramatic because diabetes is an ever growing epidemic that accounted for $245 billion in health care expenses in 2012.  Now there is finally some relief for those who have been so affected by the costs of insulin.

Basaglar’s current list price for a pack of five pens is $316.85, which puts it at a 15 percent lower cost to Lantus (Lilly/BI) and Toujeo (Sanofi), a 21 percent lower cost to Levemir (Novo Nordisk, insulin detemir injection) and a 28 percent lower cost to Tresiba (Novo, insulin degludec).  Plan Sponsors offering pharmacy benefits to their employees or members need to be talking to their PBMs and Pharmacy Benefit consulting partners to determine current Lantus utilization along with PBM Lantus rebates to determine if there is a significant cost savings by preferring Basaglar. 

Consulting firms like PBIRx, that focus both on how to achieve positive health outcomes and how to lower prescription drug costs for their clients, will discuss strategies that save money and improve health, versus PBM strategies that focus solely on optimal PBM profits.  Based on individual client’s needs and cultures, PBIRx’s strategies will include taking advantage of Basaglar’s lower cost while focusing on what is best for each client, i.e. do not restrict Lantus, but offer lower copay for Basaglar; implement exclusion that requires Basaglar for all new long acting insulin utilizers; implement Basaglar as first step for long acting insulin, etc.

Bagaslar has already been introduced in several countries under the name Abagaslar.   In some countries switching requires a managed care approach with blood glucose monitoring along with possible dosage adjustment.  Currently in the U.S., the doctor must write a Basaglar prescription; though many states are enacting laws and regulations that allow pharmacists, sometimes only with patient consent, to substitute with the new, or a similar product. 

Lantus cost per Rx is estimated at $600 to $800 per prescription and is in the top ten of plan drug costs.    With the estimated current Basaglar 15 percent lower and conceivably 30 percent lower cost in the future, clients are looking seriously at this savings opportunity. CVS/Caremark and United Health have already moved Lantus off of the 2017 national formularies in favor of Basaglar  

At the IDF conference in December, Dr. Matthew Riddle estimated that “50 percent of all people with type 2 diabetes would benefit from biosimilar insulin glargine (Bagaslar), compared to just 25 percent of patients benefiting from the reduced hypoglycemia and flatter glucose profile seen with next-generation brand name basal insulin analogs such as Novo Nordisk’s Tresiba and Sanofi’s Toujeo.” https://diatribe.org/fda-approves-new-insulin-glargine-basaglar-first-biosimilar-insulin-us.   

PBIRx can discuss with clients how to manage these new generation insulins to achieve protection of cost trends while allowing access to any patient that may benefit.  PBIRx does this through their custom RxSAVINGS clinical programs that are carefully constructed by their staff of PharmDs to utilize the latest product information, treatment guidelines, and the expertise of the prescribing physician.

PBIRx has identified all Lantus utilizers for all of our clients by plan cost, number of prescriptions, number of members and number of prescribers.  Along with our clinical team of pharmacists and the client’s PBM clinical team, strategies are currently being discussed so that our clients and their members can take advantage of savings sooner than later. 

Charitable Donations

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

PBIRx is proud to share our latest initiative.  In appreciation of our partnership with new clients, PBIRx is donating to a charity to benefit the client’s community and/or youth programs so that our efforts ensure diversity.  PBIRx researches area organizations that include a higher percentage of funds directly to the charity needs and not the administration fees whenever possible.   

In 2016, PBIRx has made donations to the following charities on behalf of our clients:

• Nashoba Learning Group (enables kids/adults with autism to function throughout their lives - Bedford MA)
• Stand Up for Kids (benefits homeless and street kids - Worcester MA)
• The Next Step Fund (benefits teens & young adults impacted by cancer & blood diseases - Cambridge, MA)
•  St Jude's Children's Research Hospital
• Chicopee Boys & Girls Club, MA
• Ronald MacDonald House, Providence, RI
• Friends of Acadia (Conservation organization, Acadia, Maine)
• Girls Write Now (NY creative writing and mentoring NP organization - matches teenage girls with profession women writers)
• Big Brothers/Big Sisters of Greater Houston, Texas

PBIRx is excited to continue this initiative in 2017 and we look forward to the opportunity to make contributions to non-profit organizations in new communities.

PBIRx has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts, PBIRx’s mission is to create optimal health care outcomes while minimizing overall health care costs. For more information, please visit www.pbirx.com or call (888) 797-2479.

Skin Patch Proves Effective for Peanut Allergies, EpiPen Rival Is On Its Way

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

Did you know that as many as 8 million Americans, roughly 2.5% of the U.S. population, has food allergies? Focusing on children, peanut allergies are known to be the main cause of anaphylaxis, and EpiPens have long been used to aid such individuals when a severe and potentially life-threatening reaction occurs. However, with recent price hikes on the EpiPen, this type of treatment has become unaffordable for many.   An alternate form of treatment is necessary and, fortunately, there may be an answer to this (or two).

According to a recent article from the National Institutes of Health, “a wearable patch that delivers small amounts of peanut protein through the skin shows promise for treating children and young adults with peanut allergy, with greater benefits for younger children.” These findings come from a clinical trial that has been ongoing, and the treatment’s official name is epicutaneous immunotherapy (or EPIT). 

In the article, Daniel Rotrosen, M.D., director of NIAID’s Division of Allergy, Immunology and Transplantation (DAIT), explains how this treatment is designed to work. Ultimately, the goal of epicutaneous immunotherapy is to “engage the immune system in the skin to train the body to tolerate small amounts of allergen”.   Compared to other oral treatments that proved to be hard for about 10-15% of children and adults to tolerate, the patch appeared to be more effective and was found to be a safe and well-tolerated treatment.

Alongside this announcement comes the announcement of a rival to the EpiPen – Kaléo, Inc.’s Auvi-Q auto-injector. With the EpiPen’s recent increase in cost, Kaleo explains that they understand the challenges patients are currently facing, and it is their goal to provide affordable access to their auto-injector. The Auvi-Q device contains the same epinephrine drug that is found in Mylan’s EpiPens, comes with a voice-prompt system that helps patients as they use it, and is equipped with a needle that will automatically retract after administration is complete. Currently, no list price has been announced by Kaléo, Inc.

PBIRx has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts.

CMS Updates: New Emergency Preparedness Rule Announced

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

The Centers for Medicare & Medicaid Services (CMS) recently finalized a new rule to be implemented by November 15, 2017 to create consistent emergency preparedness requirements for participating Medicare and Medicaid health care providers, as well as a better coordinated response to both man-made and natural disasters in an effort to increase patient safety during times of emergency.

Before we dive into some of the specifics, let us answer the question: Why was this new rule proposed and officially finalized in September 2016? 

CMS explains that over the past few years, there have been several man-made and natural catastrophes that have resulted in the health and safety of Medicare and Medicaid beneficiaries being put at great risk. As a result, the purpose of the new emergency preparedness requirements is to have participating providers and suppliers be more prepared to cater to patients during any future disaster or other emergency. Ultimately, these providers and suppliers will need to work with state, tribal, regional, local and federal emergency preparedness systems in an effort to make sure that their facilities are ready to care for patients.

After an in-depth review of current emergency preparedness rules and regulations, CMS hopes to bridge any gaps that were originally present by requiring providers and suppliers, who participate in Medicare or Medicaid, to take the following actions:

1. Create an emergency plan. Participating providers must come up with an emergency plan using an all-hazards approach that focuses on “capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of a provider or supplier”.
2. Establish policies and procedures. Participating providers must create, and then implement, policies and procedures based upon their risk assessment and emergency plan.
3. Have a communication plan. Participating providers will need to come up with a communication plan that is aligned with Federal and State law. CMS explains that within this plan, “patient care must be well-coordinated within the facility, across health care providers, and with State and local public health departments and emergency systems”.
4. Develop a training and testing program. Participating providers are expected to create and maintain strong training and testing programs – both initial and annual trainings are to be included. They must also take part in drills and exercises OR take part in an incident that tests the success of the plan.

For additional specifics about the CMS’ new emergency preparedness requirements, check out this chart, where the requirements are outlined based on provider type.

PBIRx has been exclusively providing intelligent solutions to clients in the management of pharmacy benefit costs since 1993. With a staff that includes IT personnel, actuaries, financial analysts, clinical pharmacists, attorneys, HIPAA Compliance Officers and many more experts, PBIRx’s mission is to create optimal health care outcomes while minimizing overall health care costs. For more information, please visit www.pbirx.com or call (888) 797-2479.

October 22nd is National Prescription Drug Take Back Day!

PBIRx®

Intelligent Solutions in Pharmacy Benefits

612 Wheelers Farms Road, Milford, CT 06461

(888) 797-2479

On Saturday, October 22nd, the Drug Enforcement Administration (DEA) will be holding its 12th National Prescription Drug Take Back Day. At the end of this blog is a link to find a location by zip code. Held from 10:00 AM - 2:00 PM, the purpose of this event is to provide the public with a safe, responsible and convenient way to get rid of prescription drugs, while at the same time providing education on how medications can potentially be abused.

During the last event, which was held earlier this year in April, the DEA and its national, community and tribal law enforcement partners collected a total of 447 tons of unwanted medications. There were about 5,400 collection sites available across the United States. For the event on the 22nd of October, there will be 4,700 collection sites in operation nationwide, and the service provided by local law enforcement agencies and other community partners will be completely free of charge to the public.

Since the first National Prescription Drug Take Back Day six years ago, there have been approximately 6.4 million pounds of drugs collected – this alone just goes to show how successful the events have been. The DEA explains that 6.4 million Americans aged 12 and up abuse prescription drugs, and with drug overdoses being the leading cause of injury-related death in the U.S., it becomes increasingly more important for the public to have a safe way of disposing unwanted medications.

If you have unwanted medications at home, we highly encourage you to take advantage of this opportunity. Locating a collection site near you is easy. Simply click here, select "locate a collection site near you," and either enter your zip code or your county, city and state – upon submitting your information, you will be presented with a list of participants and the specifics of the collection site.

For more information, click here or give us a call at (888) 797-2479.