The Pharmacy Benefit

Host JC Scott speaks with Claire Winiarek, the VP for Policy of PCMA, about the increased use of mail delivery for prescriptions. Winiarek discusses the value of mail service for prescriptions both relative to the pandemic and beyond it.

PBM Mail Service Increases During the Pandemic: The top-line trend is increased mail delivery by 20 percent through July, year on year. At the tail end of the first quarter, early refills drove an increase, as well as at the end of the second quarter as people reached the end of their 90-day prescriptions.

PBM Response to Increasing Demand for Home Delivery: Part of the response was working with pharmacies to provide home delivery as well as mail delivery and to make consumers aware of the service. In addition, educating consumers about 90-day refills and arranging auto-ship through the mail has been an essential contribution to slowing the spread of the virus by making it possible for people to stay home.

PBMs and Pharmacies Working Together: PBMs and pharmacies worked together early in the pandemic to develop practical, common sense alternatives to delivery signature requirements.

PBMs and Delivery Challenges: Some PBMs are trying alternative carriers or changing when prescriptions are shipped to allow for potential delays. They’re also allowing for early refills and transition fills at local pharmacies. Behind the scenes, there are proprietary systems mapping the transit of prescriptions through the system so that delivery can be continuously fine- tuned. A well-funded Postal Service is critical for the affordability of this option.

Home Delivery Benefits Consumers: Prescription adherence rates improve from 77 percent for pharmacy pick up to 87 percent for mail delivery. This adherence, in turn, drives improvements to other outcomes such as emergency room utilization and rehospitalizations. Dispensation of medication is also safer when performed en masse in a factory setting as opposed to in local pharmacies. Of course, the scale also drives costs down for consumers, as does the convenience itself. Having 24/7 access to prescription counseling through PBMs can be another benefit both in terms of convenience and confidentiality. Data from IQVIA suggest that these increases in home delivery will be here to stay, along with telehealth and tele-pharmacy options.

COVID-19 Test Kits Via PBMs: UnitedHealth Group is beginning to send lower-nose tests that are as effective as the tests developed earlier in the pandemic. CVS is also sending out test kits.

Outlook for a Vaccine: Winiarek leads a stakeholder group with other drug supply chain partners, including pharmacies, manufacturers, grocers, and hospital pharmacists that has been discussing drug shortages and now plans for a COVID-19 vaccine. The discussion has centered around how the supply chain can support a scientific and evidence-based process of evaluation of vaccines. Planning ahead for the fact that supplies of the vaccine will be limited and developing policies for allocation, access, and safety are central to the group’s efforts.

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Host JC Scott speaks with Tim Wentworth, the president of Cigna Express Scripts and Cigna Services, about how Cigna--along with the entire pharmaceutical industry--are addressing the COVID-19 pandemic. Wentworth is optimistic that the ingenuity of the US healthcare system can combat COVID-19 and that current industry-wide collaborations can survive beyond the current pandemic. Some key points from the conversation include:

Cigna Continues to Put the Patient First During COVID-19: Since the start of the outbreak in March, Cigna has focused on the safety of its employees, customers, and most of all, patients. Wentworth emphasizes that Cigna is dynamically managing the supply chain and acting flexibly and nimbly to ensure pharmaceutical access to the clients. It is also working with federal and state officials to ensure a balanced pharmaceutical policy.

The Pharmaceutical Industry is Collaborating To Address the Current Health Crisis: Wentworth is optimistic about the cooperation between industry members to ensure the patients continue to receive care. For example, Cigna is now collaborating with retail pharmacies to put in place a new program with deep discounts for uninsured patients. The entire industry is working to ensure that those suffering from healthcare and economic fallouts from COVID-19 are not forgotten. He believes that such collaboration can continue in the future.

US Health Sector Innovation Is the Best Bet Against COVID-19: US biotechnology and pharmaceutical companies are working in an unprecedented manner to find solutions to COVID-19. Wentworth believes that Cigna, and the entire industry, will find a way to ensure access to COVID-19 for its patients. He stresses that it is a public health decision more than it is a commercial decision.

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Host JC Scott speaks with Mostafa Kamal, CEO of Magellan Rx Management, about the evolving role of the PBM market in delivering solutions to its clients. JC and Mostafa also discuss challenges to Medicaid during the current economic downfall, as well as upcoming technological innovations to improve the patient experience.

PBM Tools Drive Affordability and Care for Medicaid: Recent unemployment hikes are expected to put severe strains on Medicaid. States across the US will have budgetary pressures to cope with the surge of new patients. Magellan Rx Management is delivering solutions to US States and DC to lower costs and improve efficiency for their Medicaid programs.

New PBM Market Disruptors Are Emerging: Innovators (i.e., “disruptors”) identify and eliminate market inefficiencies to improve customer experiences. In the age of COVID-19 and changing consumer expectations, Mostafa anticipates an increase in the pace of PBM market disruptions. JC and Mostafa discuss some major disruptions on the horizon, including drone home deliveries, real-time information sharing, and predictive modeling to identify medication non-adherence risks.

Greater Personalized Care in the Future: Mostafa believes that future PBM market disruptors will focus on the personalization of medicine. He foresees a customized, genetic-based pharmacy experience for each patient.

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Host JC Scott speaks with Megan Hauck, a former Health Policy Advisor to President George W. Bush, Senator Mitch McConnell, and Chris Jennings, former Senior Advisor for Health Policy for both the Clinton and Obama Administrations. In this episode, Scott, Hauck, and Jennings discuss the election results, what a new president and Congress will mean for healthcare policies, and speculate how shifts in the House and Senate will impact the future of healthcare.

The failure of polling. The results of the election, specifically regarding the performance of Republicans in the House and Senate, were a big surprise to many. Hauck calls for polling to be modernized while Jennings argues that the media and its consumers over-utilize polling. With the massive turnout, the voters clearly called for collaboration in fighting Covid-19.

Policies the Trump Administration might push in these final weeks. Regarding healthcare, the administration is currently examining the Rebate Rule and a proposal to tie drug prices to an international benchmark. It’s normal for an administration to push out prioritized regulations in their last eight weeks. Technically, Congress can overturn them under the Congressional Review Act, but this can be an arduous process. Hauck points out that the Trump administration will prioritize its own policies over those that will help Congress in the long run, something that is unusual compared to previous presidents’ administrations.

Narrow majority chambers, will they come together for healthcare? Jennings suggests that there will be bipartisan interest in preventing future pandemics, once we have control over the virus. Until then, Covid-19 is expected to be the primary focus regarding healthcare. The pandemic has also exposed the shortcomings of the healthcare system and exacerbated Medicare solvency, leaving public healthcare and Medicare as the next big issues to tackle. President-elect Biden will likely address states who have not expanded Medicaid. Hauck and Jennings also discuss how Biden’s previous experience in the Senate will impact his ability to navigate Congress as President.

Refusal to transition. With President Trump refusing to concede, there is an unprecedented lack of communication between the Trump and Biden teams. This means that the incoming Biden administration does not have access to key departments and information for fighting Covid-19, including the distribution of vaccines and testing dynamics. Hauck and Jennings both share experiences of their duties when they worked during presidential transitions, agreeing that it’s a patriotic duty to assist the next team coming in and that the delays are inexcusable — but not insurmountable.

More elections to come, more predictions. Midterm elections are coming in 2022. With narrow majorities in both chambers, Hauck and Jennings offer their predictions for the House and Senate outcomes.

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JC Scott speaks with Doug Long, Vice President of Industry Relations at IQVIA, about the impact of COVID-19 on the pharmaceutical market. Long discusses the data trends for pharmaceutical companies during COVID-19 and, most importantly, how these trends impact healthcare patients.

Prescription Stockpiling: With news of the impending pandemic, patients around the US began to stockpile 90-day prescriptions in March. As a consequence, the pharmaceutical marketplace experienced a major decrease in demand in the following two months. Long describes the effects of this “prescription rush” and subsequent demand decrease on the pharmaceutical industry.

Access Prescriptions and Shortages: JC and Long discuss methods by which patients are receiving their prescriptions during COVID-19. Mail-order and other socially distant methods (such as deliveries) have grown in popularity. Long also details how the pharmaceutical industry has responded to recent supply chain shortages. Overall, he is impressed by the resilience of the pharmaceutical supply chain (which includes manufacturing, PBMs, pharmacies, wholesalers, and logistics companies) during COVID-19.

Growth of TeleHealth: Long touches on the impact of telehealth on the healthcare marketplace and medical prescriptions. He notes the dramatic growth of telehealth in a matter of just a few months, and he believes that telehealth is here to stay. However, he cautions that telehealth may have a negative impact on prescription trends for patients.

You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.