On May 11, The Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs, along with a request for information. The Blueprint was framed as advancing four specific goals:
- Reducing list prices;
- Improving government’s ability to negotiate better prices;
- Encouraging competition through rapid entry to market of generics and biosimilars; and
- Lowering patient out-of-pocket expenses.
The Blueprint proposes a broad number of changes to prescription drug programs in several federal health care programs – such as Medicare, Medicaid and other safety net programs – as well as Food and Drug Administration policies that should impact commercial and federal health care program access to affordable prescription drugs.
While some of these proposals can be undertaken through immediate regulatory or subregulatory actions, others are still on the drawing boards at the U.S. Department of Health and Human Services and some will require congressional action to implement. The Blueprint proposes a select number of programmatic and design changes, yet the Administration is seeking feedback for a large number of lingering questions.
Initial review appears to show an increased access to lower-cost alternative generics. But closer review is needed on proposed changes to the Medicare Part D Prescription Drug Benefit Program and the Part B drug reimbursement methods to alleviate concerns the changes may limit patient access to medically necessary alternative brand or specialty treatments and result in additional administrative burdens on physicians and patients. The proposal may also eliminate the requirement that Part D plans include a minimum of two drugs proven to be effective in each therapeutic category or pharmacologic class, if available.
The Medical Association will be closely monitoring the Administration’s “American Patients First” Blueprint and will keep our members updated on any new developments as they become available.
UPDATED MARCH 21, 2018 — Blue Cross and Blue Shield of Alabama is launching an opioid management strategy in an effort to battle the growing opioid epidemic in Alabama, as well as a response to concerns for customers’ care and safety and the rising costs of health care. The new requirements will be effective April 1, 2018.
BCBS Alabama’s opioid management strategy implements the following requirements:
- Members will be limited to a seven-day supply the first time they fill a short-acting opioid medication. If an initial fill for a supply of more than seven days is needed, a member can ask his or her doctor to submit a one-time prior authorization for an initial fill of a supply greater than seven days. Short-acting opioid medications include Lortab, Vicodin, Percocet, etc.
- Members will be required to obtain a prior authorization for all first-time prescriptions for long-acting opioid medications, including OxyContin and MS Contin.
- Naloxone (the generic of Narcan), the antidote for an opioid overdose, will be available to most members for the generic copayment. This includes both the prefilled syringes and nasal spray. Evzio is no longer covered. Evzio is naloxone packaged in an auto-injector.
In 2015, Alabama ranked first in the nation in the number of opioid scripts per capita. The recent Blue Cross and Blue Shield Association’s Health of America report on the opioid epidemic showed over 26 percent of its commercial members in Alabama filled at least one opioid prescription in 2015, and 16 per 1,000 members were diagnosed with opioid use disorder. The Centers for Disease Control and Prevention reports between 2000 and 2015 more than half a million people across the U.S. died from drug overdoses, and 91 Americans die each day from an opioid overdose.
The Medical Association’s Third-Party Task Force and Board of Censors continue to collaborate with Blue Cross to help curb the growing epidemic of opioid misuse by offering support, resources and educational tools. For more information, please contact your Blue Cross representative.