Managed Care Experts Weigh In

Significant change is still to come in the fight against COVID-19. First Report Managed Care received commentary from its editorial advisory board and sourced feedback from readers on the effects COVID-19 will have on managed markets. The following is a collection of shared top concerns and ideas on the days to come.

Daniel Sontupe, associate partner, managing director, The Bloc Value Builders, New York, NY, discussed the impact of COVID-19 on Market Access Marketing: 

We are all aware how COVID-19 is impacting the practice of medicine world-wide. Not only the practice of medicine, but the payment for the practice of medicine is changing. Health plans are waving costs and copays to ensure patients receive their medications. This pandemic has increased the need for payers and pharma to work more closely. Together, we can create partnerships and programs that focus on ensuring the right patient has the right drug at the right cost. 

Today, the value equation from pharma to health plans has to go well beyond a product’s attributes or functional benefits, we have to get beyond a brand positioning statement and figure out how we can work together with the payers to make health delivery better. So in the end, the patient receives the best care.

What are we doing during this pandemic? Like so many others, we are using social media and technology to share our messages, but more importantly we are executing on creative solutions. Partnering together to provide more access to telemedicine, creating programs to drive in-home infusions or in-home nursing programs, where pharma can create the logistics and health plans can ensure payment. It is the definition of a win-win as we ensure better compliance which creates better outcomes. Together pharma and payers can support lower copays based on data and adherence. Why not make the fourth prescription free, is that really an inducement? Every member should be getting a 90-day supply of a chronic medicine and a daily reminder to take that medicine. During this pandemic, the world is more aware of personal health. Let’s take advantage of an opportunity to partner and to offer programs that align to creating the best possible outcomes.

A Medicare managed care professional who wished to remain anonymous said:

The focus has been on assuring employee workforce readiness, training, support and protection, in addition to the other areas mentioned. Making certain that direct care workers have adequate personal protective equipment has been a priority. Support through enhanced approaches to forced absence/sick leave, etc. have been in place.

We have also made any delay in transitions of care (moving members/patients from acute hospital to post-acute care facilities [SNF, acute inpatient rehab, LTAC, home] as minimal as possible in order to free up limited bed supply or adjust to local resource needs and have adjusted processes to accommodate this urgent need. 

Telehealth capability has been emphasized. Planning has also been underway to assure that any projected limited supply of certain drugs (eg antimalarials) is minimized. There has been a concerted, well organized and rapidly evolving effort throughout the enterprise to ensure member, care provider, and employee needs are addressed within the context of the pandemic and its projected after effects. 

Art Shinn, PharmD, FASCP,  president, Managed Pharmacy Consultants, LLC,  offers perspective on current challenges and what can be done:

I run an administrative consulting company. I’ve worked with aging people a long time. The major thing I’ve seeing is around the pharmacy benefits. It’s really impacting and we’re having a lot of issues around prior authorizations, renewing, and drug shortages.

The big thing we have done—and the PBMs have come out with this focus—is extending the prior authorizations 90 days from when they are going to expire.

Big pharma is contacting the physicians’ offices. There’s no one working in the office. They’re not taking calls. They’re backlogged. They’re just going to voicemail and answering service.

We are putting in an extension for prior authorizations for 90 days. For example, if the prior authorization was going to expire May 15th, it now will be extended till August the 15th, and we’re doing that across the board.

Now there are certain prior authorizations that we are limiting and not renewing and extending, mainly Class 2 narcotics.

The other issue we’re seeing is there seems to be now a run on hydroxychloroquine and azithromycin, a few of the other drugs. We are putting quantity limits in place, and we’re working with a lot of the recommendations that CVS has come out with around that.

We are having quantity limits extended on some of the drugs that we’re noticing are becoming more in demand. Between that and the prior authorizations, that’s where we are at this point.

With new prior authorizations, for example, someone just gets put on a drug that has prior authorization necessary for it, trying to get that through the system is probably going to be an issue. It’s not only the extension of the prior authorization, it’s the new prior authorizations. 

The commentary included in this article was collected been March 25 and April 14, 2020. As events continue to change day-to-day, we invite our readers to continue the conversation by sending your thoughts to the managing editor at estanley@hmpglobal.com.