Pharmacy Benefit Manager

Who Has the Power to Cut Drug Prices? Employers.

Posted on Tuesday, December 1, 2015

Harvard Business Review, December 1, 2015 by Robert Galvin, MD and Roger Longman Why do medications cost so much, particularly specialty drugs that treat the most serious conditions? Mostly because U.S. drug companies can price them however they want. But pharmaceutical companies don’t deserve all of the blame for high drug prices. Lots of other actors in purchasing, distribution, and brokerage have greater incentives to keep prices high than to lower prices or choose drugs that reduce longer-term medical and business costs, like absenteeism.  Employers have the greatest potential to influence some of those actors and, ultimately, to chip away at high drug prices. But to appreciate the power that employers have in this area, you must first understand how competing incentives work in the world of drug pricing. Click here to read full...

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‘DrugAbacus’, a Comparative Cancer Drug Pricing Platform Powered by Real Endpoints’ RxScorecard™, is Launched

Posted on Friday, June 19, 2015

Westport, CT, June 19, 2015 – Real Endpoints (RE) is pleased to announce that its RxScorecard™ is the information technology platform supporting Memorial Sloan Kettering Cancer Center’s DrugAbacus – an interactive tool for considering the basis of cancer drug prices. Conceived by Dr. Peter B. Bach, Director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering (MSK), DrugAbacus was launched at www.drugabacus.org. MSK’s DrugAbacus generates a dollar-value for cancer drugs available in the United States (beginning in 2001 with Gleevec) based on a user’s settings for six different domains of potential value including the treatment’s survival benefit, side effects, and the incidence of the condition targeted. Memorial Sloan Kettering licensed the Real Endpoints RxScorecard platform for research purposes so users can generate “Abacus prices” and compare them with actual prices of these drugs at the time of launch in a visual and intuitive format. “We believe RxScorecard is the only tool available that provides a 360 degree comparison of the multiple components of a drug’s value in an independent, objective and systematic approach. We developed the IT platform to make it very easy for users to access our analysis, and are delighted that Dr. Bach selected this platform for DrugAbacus,” said Julie Eskay Eagle, RE’s Vice...

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Wall Street Journal publishes article on new cancer pricing tool from Memorial Sloan Kettering using RE’s RxScorecard technology

Posted on Friday, June 19, 2015

June 19, 2015 – Memorial Sloan Kettering Cancer Center, one of the nation’s top cancer hospitals, has created an interactive calculator that compares the cost of more than 50 cancer drugs with what the prices would be if they were tied to factors such as the side effects the drugs produce, and the amount of extra life they give patients. Please click here to access the article....

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The Healthcare Round-up: July 30-Aug 3

Posted on Friday, August 3, 2012

Competition’s the theme for this week’s round-up, brought to you from Olympic city, London. While the world’s best and fastest athletes battle it out for gold (checked periodically for performance-enhancing drugs by our friends at GSK), so the competition’s hotting up among health insurers and providers, too — at least if (some) politicians get their way. The goal: ultra-efficient, cost-effective medical care. In Europe’s engine-economy, Germany (current Olympic medal-count: 18) the government’s pushing for more competition among the statutory health insurers, which are currently enjoying a surplus. As we reported earlier this week, more transparent pricing (and thus more consumer switching) has already sharpened up the country’s 150 or so SHIs. Tighter anti-monopoly laws could lead to an almost US-style free market — with both payers and pharma under pressure to deliver cost-effective solutions. Not that the health care system in the US (current medal count: 37) is a great example of market-competition-driven efficiency. If it were, it wouldn’t be facing lawsuits like that against Blue Cross and Blue Shield in Alabama, accused of conspiring with other Blues plans to avoid competition, thus driving up costs. This kind of behaviour — plus underlying structural issues — is why the US system is rapidly becoming unsustainable. That was the common message...

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The RE Healthcare Round-Up

Posted on Friday, July 20, 2012

Real Endpoints’ Weekly Healthcare Round-Up has returned. Cue Carol Anne of the ’86 cult flick Poltergeist II – or, if you prefer, the infamous, avenging nerd Lewis (Revenge of the Nerds II) or the exuberant but dorky Stu Price (The Hangover). Feel free to mock our retro-culture cool, but don’t doubt our enthusiasm…or the importance of synthesis. In the six weeks since our last Round-Up, we’ve seen the approval of Qsymia and Belviq, two new obesity drugs that, thanks to their regulatory delays, now face a much bleaker reimbursement climate; WellPoint’s decision to purchase Amerigroup for a 43% premium to gain dominance in the so-called dual eligible population; and, oh yes, a 5-4 vote by the Supremes to uphold most of Obama’s landmark healthcare plan. As pundits continue to unpack the ramifications associated with the healthcare law, the hot-button issue now is how the constitutionally de-clawed portion of the law, Medicaid expansion, will unfurl. Already several governors, especially Texas’s Perry have spoken out about the downsides of Medicaid expansion, raising the specter of financial ruin.  Maine’s governor Paul LePage plans to go a step further, announcing the recent Supreme Court ruling provides him the power to cut thousands of Mainers from the state Medicaid rolls. Much of the US...

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Are We Really That Different? Transatlantic Lessons In Shopping For Value

Posted on Monday, May 21, 2012

The Americans and the English might think that their health care systems are very different: one, a commercial, private-insurer driven network whose incentives are as mis-aligned as its per-capita spend is high; the other, a state-funded, friendly-yet-inefficient model characterized by rationing. There are plenty of similarities, though. Firstly, the pressures – most obviously, spiraling costs — are the same, whether they’re hitting state-owned or private payers. England’s patchwork of regional, public payers (the Trusts) make local purchasing decisions (and, increasingly, coverage decisions, even though they’re not supposed to.)  That makes them look more like individual US commercial insurers. And like managed care groups or PBMs, most deal directly with drug manufacturers to negotiate local rebates. They have to stay within budget– if not make a profit. The UK may be spared the alphabet soup of MCOs, PBMs and ACOs. But the challenge of coordinating cost-effective care between general practitioners, hospital and home settings remains on both sides of the Atlantic. That’s clear from glancing at the range of initiatives underway in the US and UK to try to address spiraling healthcare costs. They may be called different things, but they’re similar enough to provide reciprocal lessons for both pharma and payers. While various US insurers experiment with cancer pathways,...

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The Healthcare Round-Up: 3/14 – 3/21

Posted on Thursday, March 22, 2012

Put a spring in your step and read Real Endpoints’s weekly round-up of reimbursement related news. Overseeing Cancer Drug Regimens: Here’s a scary find.  On March 16 researchers from Medco Research Institute reported new data at the American Society for Clinical Pharmacology and Therapeutics annual meeting showing that a high percentage of patients on oral kinase inhibitors like Gleevec or Tarceva are also taking medicines that reduce the effectiveness of the cancer treatment. In total, the Medco researchers looked at the pharmacy claims of 11,600 cancer patients taking one of nine oral kinase inhibitors during a 29-month period that ended mid-2010. The researchers specifically looked at the secondary drugs prescribed these patients, with an eye for those known to spark potential drug-drug interactions, for instance proton pump inhibitors (PPIs), steroids, calcium channel blockers, and some antibiotics and antifungal treatments.  Based on their analysis, 23-57% of the patients were simultaneously taking a drug that had the potential to reduce the effectiveness of the cancer treatment; even more unnerving, 23-74% of patients received secondary drugs that could have increased the toxic side-effects associated with the cancer medicine.  How could this happen? While oncologists prescribed the vast majority of cancer drugs, other therapies were the purview of primary care physicians; because of...

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Cancer Pathways Are Just One Tool To Managing Cost

Posted on Wednesday, February 29, 2012

According to the Medco Drug Trend report, by 2015 oncology drug costs will be the second or third costliest class that it tracks, up from seventh in 2011.  That’s why, in this relatively unmanaged category, many payers are turning to new cost-containment strategies. Of particular interest: cancer pathways, which standardize therapy based on recognized guidelines and outcomes data, as a vital mechanism to control out-of-control costs.  (To attend a free Value & Innovation webinar on the subject, click here.) The attention has caused a mini-boom in pathway program and software providers, like Cardinal’s P4 Healthcare and McKesson’s Innovent Oncology or newer groups like eviti and Proventys (which was acquired by McKesson in early February).  But other service providers also feel they have a role to play – and that pathways, while important, offer only partial solutions.  Self-interest aside, they’re probably right. Dr. Milanya Subar, national practice leader of Medco Health Solution’s Oncology Therapeutic Resource Center, notes that while pathway programs encompass many important elements of cancer treatment, they don’t deal with all the important details required in the treatment of such a complex disease. Those include eliminating waste, especially when it comes to filling prescription orders, and closing treatment gaps to ensure patients receive the right medicine at the...

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