The right drugs for members

How pipeline management affects our customer experience

Capital Blue Cross and Prime work together to monitor the drug pipeline for both new-to-market and generic drug launches.

We work with Prime to identify possible and expected generic drug release dates. From there, we review brand name use and identify savings opportunities for groups, and help to transition groups and members to cost-saving generic drugs.

Below you can see when we expect generic versions of certain drugs to be released in 2020, including some that have already been released.

March 2020

Zortress (transplant, specialty)

  • Exclusive generic – expect 10-20% price reduction

Taytulla (pregnancy prevention)

  • Exclusive generic – expect 10-20% price reduction

April 2020

Proventil HFA (respiratory)

  • Exclusive generic – expect 10-20% price reduction

May 2020

Samsca (hyponatremia, specialty)

  • Exclusive generic – expect 10-20% price reduction

July 2020

Afinitor (kidney cancer, specialty)

  • Multiple generic manufacturers – expect 50-80% price reduction

Qudexy XR (seizures)

  • Exclusive generic – expect 10-20% price reduction

Saphris (bipolar)

  • Multiple generic manufacturers – expect 50-80% price reduction

August 2020

Velphoro (kidney disease)

  • Multiple generic manufacturers – expect 50-80% price reduction

September 2020

Ciprodex (ear infection)

  • Exclusive generic – expect 10-20% price reduction

Atripla (HIV)

  • Exclusive generic – expect 10-20% price reduction

Truvada (HIV)

  • Exclusive generic – expect 10-20% price reduction

October 2020

Kuvan (metabolic)

  • Exclusive generic – expect 10-20% price reduction

Tirosint (hypothyroidism)

  • Exclusive generic – expect 10-20% price reduction

November 2020

Risperdal Consta (bipolar)

  • Exclusive generic – expect 10-20% price reduction

Chantix (smoking cessation)

  • Multiple generic manufacturers – expect 50-80% price reduction

Tecfidera (MS, specialty)

  • Multiple generic manufacturers – expect 50-80% price reduction

End 2020

Byetta (diabetes)

  • Exclusive generic – expect 10-20% price reduction

In addition to monitoring the generic pipeline, we also keep a close watch on new drugs being developed.

It’s estimated there are currently 900 drugs in research and development today. In addition to our regularly scheduled drug pipeline publications and discussions, the following drug watch list has been developed to proactively communicate to our clients about the most notable drugs that may significantly affect the populations we serve, particularly those with complex conditions.

Generic name

Manufacturer

Conditions

Significance

Spend1

Net new impact to PMPM1

PDUFA2 approval date
 

Jul 1

Aug 1

Sep 1

Oct 1

Nov 1
inebilizumab Viela Bio Neuromyelitis Optica Spectrum Disorder (NMOSD) For use in patients with or without AQP4 antibodies. $$ Med: $$
       
risdiplam Genentech SMA type 1, 2, or 3 Would be the first at-home administered medication for SMA patients if approved. $$ Med: $$  
     
satralizumab Roche Neuromyelitis Optica Spectrum Disorder (NMOSD) For use in patients with or without AQP4 antibodies. $$ Med: $$  
     
Ocaliva™, obeticholic acid Intercept Pharmaceuticals NASH This is the only drug to meet the primary endpoint of a Phase 3 study in patients with NASH. $$ Med: $$
       
Trikafta™, elexacaftor, tezacaftor and ivacaftor Vertex CF 90% of CF mutations covered by this indication. 30% were not covered prior, or approximately 6000 U.S. patients. $$-$$$ Rx: $$-$$$        
Valrox™, valoctocogene roxaparvovec Biomarin Gene therapy for Hemophilia A/IV infusion Anticipated to be the first gene therapy for hemophilia $$-$$$ Rx: $$-$$$  
     
Viaskin Peanut™, peanut allergy patch DBV Technologies Peanut allergy/patch Reduce the frequency and severity of allergic reactions $$ Rx: $$  
     

With eyes on both the new and generic drug pipelines, Capital Blue Cross and Prime can better serve your clients and help to reduce their expenses.

Want to know what pharmacy coverage could look like for your clients?

Contact your Capital Blue Cross sales representative.

1$ = <$0.08 PMPM

2PDUFA dates represent the approximate deadline by which the FDA is expected to approve new drugs. The FDA normally takes 10 months to review new drugs.

$$ = $0.08-0.39 PMPM

$$$ = $0.40-2.00 PMPM

$$$$ = >$2.01 PMPM

These ranges represent estimates of impact one year post launch. Individual plan results may vary.