Navitus senior vice president and chief pharmacy officer Brent Eberle talks about how partnering with CivicaScript fits into its cost-plus model.
The pharmacy benefit manager Navitus Health Solutions has joined CivicaScript as a founding member. CivicaScript was created in 2020 to develop generic medicines with its manufacturing partners, then work with payers, PBMs and pharmacies to pass along the cost savings to their customers. Other CivicaScript founding members include Anthem, the Blue Cross Blue Shield Association and numerous Blue Cross Blue Shield health plans.
“For us, this is a way to directly tap into some lower-cost products and to be able to extend our cost-plus model,” Navitus senior vice president and chief pharmacy officer Brent Eberle said in an interview with Formulary Watch. “One of the challenges in the drug supply chain today is that there are all of these incentives that everyone benefits as drug prices increase. What Civica has come up with is a way to say ‘this is what we’re able to make this product for and this is the price.’ For us, we’ll be able to offer lower costs to both our clients, and their members will benefit as well.”
Eberle said Navitus will offer CivicaScript’s products alongside other therapies, and members will be incentivized to use those. Navitus, he said, is now working to partner with pharmacies to dispense the CivicaScript products. “Members will have an option. They’re never going to be forced to use a CivicaScript generic. We want to incentivize that by lowering the cost to pass some of the cost savings on to the members.”
Navitus has 8.7 million members and is owned by the Catholic not-for-profit health system SSM Health and Costco. The PBM charges an administration fee and has a pass-through model where all discounts and rebates go back to the client. “We’ve completely separated our revenue from drug prices,” Eberle said. “We’ve removed any situation in which we benefit from drug prices going up because our admin fee is completely disconnected from the drug costs. This partnership was CivicaScript allows us to do that, but at an even greater level.”
With Navitus, commercial plans achieved an all-in, total-net-cost per member per month (PMPM) cost of $84.3, a year-over-year increase of 1.5%, according to the Navitus’s 2021 Annual Drug Trend Report. Over the last five years, new clients have realized first-year savings ranging from 16% to 25%. One employer group with more than 16,000 members saw savings of $1.12 million in the first year and an additional $699,000 savings in year two.
Last year, plan sponsors who participated with Navitus saw their non-specialty drug spend decrease by 0.9% in 2021 despite an increase in utilization of 1.3% and manufacturer inflation of close to 4.6% on branded products. Navitus was able to offset these increases in spend through its pass-through, lowest-net-cost approach to spend management, which resulted in a decrease of 2.2% in unit-cost trend for its clients.
Navitus also offers services for rare and complex conditions through Lumicera Health Services, a fully owned specialty pharmacy. Lumicera also has a cost-plus and pass-through model for its services. Eberle said Lumicera leverages traditional PBM management tools, as well as the clinical tools available at the specialty pharmacy. Separating specialty therapies made sense, he said.
“If one of our clients its own specialty pharmacy, we absolutely encourage them to use their own assets. And similarly, Lumicera may, as a pharmacy, work with state Medicaid in situations where Navitus isn’t involved at all,” he said.
Nearly half of overall drug spend last year was driven by specialty medications even though they represent less than 1% of utilization, according to the PBM’s trend report. Specialty spend increased by 4.3%, driven by a 9.1% increase in utilization of high-cost specialty products with expanded indications of use. By preferring lower-net-cost options, including significant new generic releases, Navitus was able to lower the unit-cost trend by 4.8% and ultimately keep specialty trend to 4.3%, which is the lowest it has been in recent years.
This year, Navitus projects that specialty medications spending will surpass non-specialty drug spending. Increased use of specialty drugs is being driven by the approval of new drugs and expanded indications. In fact, four out of five new drug approvals in 2021 were specialty medications.
Navitus’s model has help to reduce spending on specialty medications as well. Last year, the PBM was able to reduce spending by 42% on one specialty class: targeted immunomodulators (TIMs), which are used to treat conditions such as rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, ulcerative colitis and Crohn’s disease. These therapies represented almost 25% of overall pharmacy spend for Navitus clients. They accomplished this through rebate enhancements that were passed on to clients and formulary changes such as moving utilization from Novartis’ Cosentyx (secukinumab) to Lilly’s Taltz (ixekizumab).
Both Navitus and Lumicera use a clinical care model that helps promote adherence and improve health outcomes. Both companies are able to leverage claims data to identify patients who could benefit from additional support. “We've designed our population health programs to leverage that data to look for opportunities to improve prescribing practices and improve care,” Eberle said.
On the Lumicera side, the company uses care pathways, for example, for rheumatoid arthritis oncology, and multiple sclerosis, that help patients manage their disease. They provide training videos, follow up with patients who start a new therapy, and provide support for managing side effects. In 2021, 44% of members improved their maintenance medication adherence after intervention.
Eberle said these care pathways are integrated with the electronic medical records to help make it easier for physicians, but they also try to engage physicians to provide actionable data about varies therapies.