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Citing the slow uptake of biosimilars, insurer Cigna is offering incentives for switching from biologic treatments to biosimilar versions. It is also moving two approved biosimilars for Remicade — Avsola and Inflectra — to preferred status.

Biologic medicines represent only 2% of prescriptions, but accounted for 43% of the total invoice-level medicine spending at $211 billion in the US in 2019, Steve Miller, MD, chief clinical officer for Cigna wrote in an 

accounted for more than half of the total pharmacy spend last

, driven largely by biologic medicines for inflammatory conditions and new treatments for cancer and rare diseases,

While biosimilars have the potential to reduce drug spending by an estimated $225 billion to $375 billion, according to 

, uptake of the more affordable biosimilars has been “far too slow,” Miller wrote. “New solutions are needed now to drive greater awareness and support patient access to these medicines.”

As a result, Cigna has developed two programs to push the adoption of biosimilar treatments forward and reduce costs.

Its new “Shared Savings Program” offers all eligible customers the option to receive a one-time $500 debit card for health care services and products if they decide to switch to a biosimilar or another preferred medication.

“Biosimilars can save patients, their employers, health plans and the health care system billions of dollars over the long term. We believe that patients should be the first to benefit, which is why we’re sharing these savings with them up front,” Miller told 

Plus, The Shared Savings Program spurs greater adoption of biosimilars and “serves as down payment on the future promise of biosimilars,” Miller wrote. “At a time when many people are having to make difficult decisions related to how to afford their medications, this program will offer some direct financial relief and position customers and their employers to recognize greater long-term cost savings.”

To Cigna’s knowledge, it is the only insurer offering eligible customers who consult with their doctors and switch from a high-priced biologic to one of its biosimilars this type of incentive, Miller said.

Cigna is also pledging to drive down costs for inflammatory conditions by moving two approved biosimilars for Remicade, Avsola and Inflectra, to preferred status.

“Over the past several years, brand-name biologic treatments for inflammatory conditions have been among the greatest contributors to drug trend growth,” Miller wrote, citing an average cost of $30,000 annually for Remicade per patient — and higher.

One year of Remicade infusions can cost between $65,000 and $75,000, Miller told 

 , which can be “financially devastating” for patients.

Cigna estimates that, in the short term, its clients will save at least 10% of the cost of Remicade for each patient who switches. “In the long term, the savings for clients and patients will continue to grow as biosimilars gain market share and drive down prices,” Miller said.

It is important to foster competition among brand name biologic medicines and biosimilars, according to Evernorth, which noted that the patents for 17 major biologics are set to expire over the next decade. In addition, 

73 biosimilars are in the drug pipeline, corresponding to 24 brand-name reference biologics.

“The rise of competitive alternatives to high-cost brand-name specialty medications will play an important role in lowering pharmaceutical costs overall,” Evernorth said in a 

. “Over the next decade, we expect biosimilar production and market launches to continue to increase. It is important to foster this competition in order to offer patients the most clinically viable medication options at the lowest net cost.”

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Insurer also moves two approved biosimilars for Remicade, Avsola and Inflectra, to preferred status. 

Cigna Offers $500 Incentive for Switching to Biosimilars 

Pharmaceutical manaufacturers raised prices on 52 brand name drugs in Jul, by an average of 3.1%, according to prescription savings company GoodRx. No generic drugs increased in prices this month, Tori Marsh, director of research, 

In January, more than 800 drugs brand and generic increased in price, according to GoodRx.“We saw the largest amount of increases in 

 during the pandemic and will likely see a significant amount this year,” Marsh told 

Many of the medications with price increases are specialty drugs or treatments for rare conditions, so they don’t affect a large percentage of patients. However, overall, Marsh said, “Drug price hikes are concerning as they have a trickle effect on consumers.”

 shows that 95% of all list price changes have downstream effects on prices that consumers pay at the pharmacy, especially those who purchase their medications without the aid of insurance, Marsh noted. “This makes already expensive drugs even more difficult to afford, resulting in a lack of accessibility and decreased medication adherence as consumers are forced to forego the medications they need due to ever-increasing prices.”

The biggest price increase was a 9.5% rise for Zogenix’s Fintepla (fenfluramine), used to treat seizures associated with Dravet syndrome.

“We are adjusting the price of Fintepla in the U.S. because costs have increased across different aspects of our business since its U.S. launch in July 2020,” Ruth Suter, Zogenix’s vice president of market access & public policy, told 

. “We believe the price supports the significant value that Fintepla provides through profound seizure reduction and durability of effect demonstrated in many Dravet syndrome patients, in both clinical trials and real-world use, relative to other anti-epileptic therapies.”

The price change also allows Zogenix to continue offering support programs to ensure access to Fintepla, such as its new 

, Marsh said. The increases will also help the manufacturer to continue investing in the development of Fintepla as a potential treatment for other severe, rare epilepsies and to continue studying other potentially transformative therapies—such as gene therapy for Dravet syndrome and other treatment-resistant rare epilepsies, she added.

Overall, none of the July price hikes resulted in tier changes, according to Marsh, but that will likely change in the new year when new formularies are released. “With that said, we are continuing to monitor price hikes throughout the month and may see a change here as new data comes in,” she said.

Pharma Makers Hike Drug Prices 3.1% in July

Leading hepatology researchers unveiled new developments in the treatment of nonalcoholic fatty liver disease (NAFLD) at the International Liver Congress 2021 meeting in Geneva, Switzerland, during late June.

Linked to growing rates of obesity and diabetes, NAFLD has emerged as the most important cause of chronic liver disease worldwide and occurs in about a quarter of the global population, the European Association for the Study of the Liver (EASL), the organizer of meeting, said in a 

. Experts predict that over the next decade, the condition will become the leading cause of end-stage liver disease and liver transplantation, according to the statement.

“We are clearly in a race against time to develop new drugs and treatment for NAFLD before the epidemic worsens,” said Philip Newsome, general secretary of EASL and professor of experimental hepatology and director of the Centre for Liver Research at the University of Birmingham in the United Kingdom.

One of the major developments discussed at meeting was a study showing that noninvasively identified nonalcoholic steatohepatitis (NASH) patients treated with 100 mg per day of resmetirom for up to 52 weeks demonstrated rapid and sustained reduction in hepatic fat, fibrosis stage, LDL and atherogenic lipids, liver enzymes and inflammatory biomarkers.

 is a form NAFLD characterized by inflammation in the liver as well as a build-up of fat.

Madrigal Pharmaceuticals, a biotech company in suburban Philadelphia, is developing 

, a drug designed to increase the metabolism of fat in the liver. The company is conducting two phase 3 trial of the drug, MAESTRO-NASH and MAESTRO-NAFLD-1. A 

 issued by the company said that the target enrollment of 900 patients with biopsy-proven NASH had been reached and that it expects to report topline results in the third quarter of 2022.

The results reported at the International Liver Congress meeting supported the use of noninvasive tests to monitor individual NASH patient response to resmetirom treatment, said Stephen Harrison, visiting professor of hepatology at the University of Oxford in the United Kingdom.

“News that resmetirom appears to make inroads against NASH is most welcome. We are hopefully beginning to draw a line in the sand on the treatment of fatty liver disease,” Newsome said.

Researchers also reported positive findings for 

 at the International Liver Congress meeting. Icosabutate is an oral, engineered eicosapentaenoic 

 derivative with anti-inflammatory and antifibrotic effects.

Results from an ongoing 52-week, phase 2b study of icosabutate showed dose-dependent effects on several liver disease biomarkers, according to the press release. Arun Sanyal with Virginia Commonwealth University noted that treatment of NASH patients with icosabutate for 16 weeks had a dose-dependent improvement in multiple relevant biologic pathways, with broad and potent effects on markers of liver injury, inflammation and fibrogenesis along with improvements in glycemic control and atherogenic lipids.

"Sanyal concluded that these data, combined with a favorable safety profile to date, support a potential for impacting liver histology at 52 weeks as well as improving common comorbid conditions seen in NASH patients,” said a press release from the organizers of the International Liver Congress meeting.

Positive findings for resmetirom and icosabutate were presented at the meeting in June.

Advances in Nonalcoholic Fatty Liver Disease Unveiled at International Liver Congress

Especially during the COVID-19 pandemic, healthcare systems and a variety of other healthcare entities have been sending lots of text messages to patients. Reminders about appointment, prompts to take medications, health information updates — they are part of healthcare’s new enthusiasm for all things digital and remote.

For example, customer communication and payments platform Podium recently 

, a large healthcare system in southern California, which will use Podium’s tools to automatically invite patients to leave a review via text or the messaging app of their choice.

“Research shows that fast and easy to complete review requests are ideal, and result in more accurate feedback. This integration will save caregivers’ time as well as increase the number and quality of their online reviews on Google, Facebook, Healthgrades and other key sites,” Podium said in a press release.

While text messaging can be effective in communicating with patients, is there such a thing as text message fatigue?

, patients who receive multiple text and interactive voice response (IVR) telephone messages from healthcare systems are more likely to opt out of future messages.

Researchers at Kaiser Permanente Colorado conducted a retrospective study of members who received 1 or more automated text or IVR message between October 2018 and September 2019.

In the cohort study of more than 428,000 patients, 84.1% received 1 or more text messages while the median was 4 messages and 67.8% received 1 or more IVR messages (a median of 3 messages).

Nearly 3% (2.5%) of members opted out of future text messages and 1.5% opted out of interactive voice response messages. Individuals who received 10 to 20 text messages per year or 2 or more IVR phone calls were significantly more likely to opt out.

Individuals opting out of text messages were also more likely to opt out of IVR messages and vice versa, the researchers found.

“The findings suggest that a high volume of automated health care messages may be associated with a greater likelihood of patients opting out of future messages and that health care systems should use these messages judiciously to minimize message fatigue,” the researchers wrote.