May 13, 2021

$ to Switch: What Brands Need to Know and Do About New PBM Tactics

glowing dollar signs

What’s Happened?
In a noteworthy move, some patients who have Cigna health insurance will be directly sent $500 debit cards if they switch from one psoriasis treatment to another. The switch being offered is from Novartis’s Cosentyx (secukinimab) injection monoclonal antibody, to Lilly’s Taltz (ixekizumab). Both drugs are systemic monoclonal antibody injections, and are used to treat moderate to severe plaque psoriasis. The move comes as Cosentyx was removed from Cigna’s preferred drug list earlier in 2021.

What’s the Reaction?
More than 60 patient-advocacy organizations, under the umbrella of the American Autoimmune Related Diseases Association, sent an open letter to Cigna, calling the policy harmful and disturbing, saying that it risks “undue stress, possible interruption of care, and potentially diminished health” for patients, and urging that the decision be reconsidered, and future ones be made, “with the Let My Doctors Decide patient-centered principles that put patients first to improve health and wellness.”

Drug Channels posed several questions about the unusual step, including: why a debit card sent directly to patients, instead of other strategies? If the formulary switches, or patients change plans, will patients be asked or forced to switch again?

Why Does It Matter?
 This matters not only for the immediately affected patients, but also for its importance as a precedent.

 Fierce Pharma quoted one Wall Street analyst, Bernstein’s Ronny Gal, as calling it “a general rehearsal for Humira.” Express Scripts, Cigna’s pharmacy benefit manager, “is working on their toolkit to switch patients from Humira to biosimilar Humira in 2023.”

Gal also noted that a similar move was tried three years ago, when UnitedHealthcare offered $500 to patients for switching to lower-cost HIV regimens, but that effort failed because of pushback from HIV drugmakers and patient groups. However, this time it could work, Gal suggests, in part because the two drugs are similar, and if it does, “the use of cash tools by payers will reasonably proliferate.”

If the incentive to switch drugs works for Cigna, the use of cash tools by payers will reasonably proliferate.

What Does This Mean for You?
This may be a “canary in a coal mine” with implications for all key stakeholders:

  • If this new tactic performs well, it may affect current 2022 formulary negotiations, with 2023 close on the horizon.
  • Payers might manage other conditions where they see opportunities for non-medical switching more aggressively. Their actions might be increasingly designed to circumvent HCPs and manufacturers if they do not believe a product is truly differentiated.
  • Patient brand loyalty may be further eroded if they’re able to find success with other treatments based on new non-clinical factors like financial incentives.
  • Providers may experience an erosion in their influence, as patient preferences and payer initiatives increase.

Reviewing and evolving your marketing mix and messaging to be more nimble is called for. Consider the prominence and focus of your patient-support tools and whether you’re prepared to quickly react if your brand becomes a focus for a new non-medical switching campaign. Re-evaluate your payer contracting approach, including potential scenario planning to determine risk levels and commercial readiness. And, as Drug Channels put it: “Get ready for a wild few years in the specialty channel.”

Author information: Peter Weissberg is vice president of market access at Intouch Group.