In this quarter’s edition, we take a detailed trip around the healthcare industry and find out what’s happening with:

• GLP-1 utilization and the role of PBMs

• Price cuts from the IRA

• Words we’re happy to see go from healthcare lingo

• A German manufacturer offering 92% discounts

• The rapid rise of infusion centers across the country in 2024

Let’s dive in… 

GLP-1s, Employers, and the role of utilization

With the rise in popularity of GLP-1 agonists, plans, employers, and their PBMs are weighing coverage options against rising demand and fluctuating costs. 

A recent study found 71% of employers are taking their PBM’s recommendations into account when it comes to covering GLP-1s for weight loss. 

Among employer-sponsored insurance plans, around 34% cover both diabetes and weight loss treatment with a GLP-1. 

• 8.9% of total annual claims are for GLP-1 drugs for weight loss. 

• 1 in 8 Americans have used a GLP-1 agonist. 

• 41% discounts on list price are being offered for GLP-1s for weight loss

• ~54% discounts are being offered for treating type-2 diabetes. 

Utilization management is being leveraged heavily to control costs as demand soars. PBMs are leveraging competition to bring down net costs for employers. It’s also been noted that access and rebates may be impacted by step therapy or BMI requirements. Other considerations for employers include the long-term health complications associated with obesity, lending to the increasing adoption of GLP-1s among employer-sponsored plans. 

Rebates and benefit design are featured prominently across the discussion, showing the importance of PBMs and their ability to drive competition in the market that brings down net costs for plan sponsors and CMS. 

Our Services for PBMs

IRA price cuts become clear

Quick reminder: these price cuts will come into effect in 2026. In 2027, Medicare will add another 15 drugs to the list and negotiate their prices down.

Here’s an overview of who and what’s been reduced by the Inflation Reduction Act and Medicare drug price negotiation

Source: fiercepharma.com

It’s time to put these phrases to bed

Becker’s recently asked some CEOs which buzzwords have come to the end of their half-life, so here’s what you should scale back on as we bring 2024 to an end:

• Workforce crisis 

• Bandwidth

• Providers

• Burnout 

• Population health

• Value-based care 

German Humira Competitor Offering 92% Discount for Out Of Pocket

Boehringer Ingelheim’s biosimilar will be offered at a steep discount for cash-paying patients through a partnership with GoodRx. The move indicates strong competition is coming to the market with AbbVie’s patent expiration last year. 

Other manufacturers entering the market with discounted biosimilars:

• Sandoz

• Alvotech

• Amgen

• Fresnius 

40% – Humira sales down YoY at the beginning of 2024

Infusion Centers Are Opening Across the Country

• Kettering Health opens a non-oncology infusion center in Troy, OH.

• UC Irvine opens a major cancer center with 40 infusion bays.

• Baystate Health opens an outpatient infusion center. 

• IVX Health is planning to open nine infusion centers in Houston, Austin, San Antonio.

• Hospitals of Providence opens an infusion center in El Paso, TX.

• Two infusion centers open in Maui, HI, developed by Hawai'i Specialty Pharmacy and Maui Care Physicians

Did you know Vista provides technology, strategy, and partnerships that make the buy-and-bill model more effective for infusion center operators?