Each month, we round up the latest FDA approvals and regulations to give you an expert take on what you need to know.
Cigna to Purchase Express Scripts
Cigna Corporation and Express Scripts Holding Company on March 8, 2018 announced that they have entered into a definitive agreement whereby Cigna will acquire Express Scripts in a cash and stock transaction valued at approximately $67 billion. This follows the announcement in December 2017 of CVS buying Aetna for $69 billion.
Optum has both medical and pharmacy benefits. These three largest providers of prescription benefits have about 70% of PBM market. There are plenty of regulatory hurdles left for both of these deals but there is never a dull moment.
Much Anticipated Results of a Cholesterol Drug Trial are Positive
In 2015, a new category of medication for the treatment of high cholesterol was approved by the FDA. The proprotein convertase subtilisin kexin type 9 (also known as PCSK-9) products were going to take the drug world by storm. Analysts were forecasting annual sales in the billions. With the price tag of about $14,000 per year, payers (health plans, employer groups, pharmacy benefit managers) pushed back. Prior authorization, step therapy, coverage exclusions were only some of the tools applied to control the utilization.
Fast forward to 2018; after nearly three years of lack-luster sales ($200-$300 million per year), new clinical information is available that could change the landscape. Praluent (evolocumab) was shown to decrease the risk of cardiovascular death, myocardial infarction (MI), stroke, hospitalization for unstable angina, or coronary revascularization by about 15% when compared to placebo. Are these results compelling enough to change prescribing habits? Will these results ease the current restrictions? These questions are among the many surrounding this category of medication which will be answered in the coming years.
Healthcare Spending in the United States
A recent article published in the Journal of the American Medical Association (JAMA) looked at how the United States compared to other high-income countries when it comes to health care spending. As you may have guessed, the US spent more than all other countries, about 17.8% of its gross domestic product. This article looked at all health care spending, however two areas were of particular interest: administrative costs and the spend on pharmaceuticals. Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs a range of 1% to 3% in the other countries. Also pharmaceutical spending per capita was $1,443 in the US vs a range of $466 to $939 in other countries.