Female pharmacist holding a drug vial

8/10/2023 | Expert Insight

Quarters 1 & 2 (2023) Market Update

Taking Quick Action on Rx Market Trends can save Money while Providing Greater Drug Access:

Scripius Quarters 1 & 2 (2023) Market Update

How quickly your Pharmacy Benefits Manager (PBM) reacts to prescription market trends is crucial, because the prescription drug benefits a company offers impact its bottom line. Below is our Q1 and Q2 update about how Scripius, the PBM that manages Select Health’s prescription drug benefits, made quick market reactions to lower costs and provide better access to effective medications.

Removing Dupixent® – Estimated savings $7 million

Scripius led the market in removing coverage for Dupixent from its commercial lines of business (in fact, Scripius may still be the only PBM in the nation that has removed Dupixent from its most common covered drug lists). Dupixent is a relatively new and increasingly popular drug used to treat conditions including severe asthma, atopic dermatitis, eosinophilic esophagitis, and nasal polyposis. Treatment with Dupixent costs approximately $46,000 per year with usage up approximately 43% nationwide.* By removing coverage of Dupixent and transitioning members to effective, lower-cost treatments, Scripius estimates commercial book of business savings at approximately $7 million annually ($8.75 Per Member Per Year (PMPY)).

*IQVIA® data on Dupixent 2022 trend.

Removing Xywav® – Estimated savings $1 million

We eliminated coverage of Xywav, which is used to treat narcolepsy, and has an annual cost of nearly $200,000. A recently launched generic version (sodium oxybate) will have a lower cost and create the entry of multiple manufacturers to the market, which will drive the cost of treatment for narcolepsy down. This change creates savings of almost $1 million per year for commercial customers ($1.25 PMPY).

Getting MS drugs for $50 per month

Multiple Sclerosis is a challenging disease that has (until very recently) required treatment with high-cost medications. Effective (but expensive) brand-name medications included: Aubagio® ($8,450 for a month’s supply), Gilenya® ($8,795), and Tecfidera® ($10,420). Balancing appropriate medication management requirements with allowing access for those who could use these medications has been challenging.

However, three new generics: dimethyl fumarate, fingolimod, and teriflunomide have come to market. While these generics are also not cheap, $200-600 per month, Scripius was able to renegotiate its contract with our specialty drug pharmacy so that members and plan sponsors will only pay $50 per month for the generic equivalents. To increase utilization of these low-cost generics and discourage copay assistance utilization for high-cost brands, we’ve added coverage without restrictions for the less expensive generics while removing coverage for expensive brands.

Removing insurance coverage for high-cost, low-value drugs and ones that are newly available without prescription

In the first quarter of 2023, we identified the lipid lowering agent fenofibrate as a high-cost, low-value drug and removed it from our covered, commercial formularies.

Scripius pharmacists also found products that are now available without prescription for a lower cost than the prescription versions, including: lidocaine patches and topical diclofenac which are used for pain. These were also removed from insurance coverage.

Easier access to lower-cost treatments for chronic conditions

Farxiga® and Jardiance® are important treatments for people with Type 2 Diabetes Mellitus (T2DM). These drugs have also demonstrated beneficial effects for people with heart failure and chronic kidney disease with or without a T2DM diagnosis. To provide better access to these products, Scripius removed step therapy requirements from both drugs so patients and prescribers have easy access.

Topical treatments for psoriasis

Psoriasis is a skin condition that affects millions of people nationwide. Traditionally, treatment with topical corticosteroids is the first line, but when these agents don’t work, many patients rely on high-cost injectable biologics. Two new topical products approved for moderate psoriasis have been added to our formulary to provide an alternative for members who need treatment beyond topical steroids. Having these products available has the potential to save clients significant dollars by delaying or preventing the need for high-cost treatments.

To learn more about what Scripius is doing to help clients achieve lowest-net cost management, visit scripius.org/industry-insight, or email us at GetSavingsNow@Scripius.org