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CVS Health highlights potential impact of new class of cholesterol drugs

BY Antoinette Alexander

WOONSOCKET, R.I. — CVS Health weighs in on the next chapter in the debate about the impact of expensive drugs on the healthcare system in a commentary that appears today on the Health Affairs blog.

Currently in development, PCSK9 (proprotein convertase subtilisin/kexin 9) enzyme inhibitors could successfully treat millions of Americans with high cholesterol, but at great cost to the health care system, according to CVS Health. The authors describe the real challenge is not the cost per dose, but the large eligible patient population and the duration of chronic treatment, which could span decades.

"With the launch of Sovaldi to treat hepatitis C in 2013, we saw a first glimpse of the impact of high-priced specialty drugs that serve patient populations in the millions, but that was just the tip of the iceberg," said Troyen Brennan, chief medical officer, CVS Health. "Like the hepatitis C treatments, PCSK9 inhibitors represent a significant advance in treating intractable diseases convenient and highly effective with few side effects but they also pose a much more complex financial dilemma since, unlike the hepatitis C treatments which offer a cure in as little as 12 weeks, PCSK9 inhibitors will be prescribed as ongoing maintenance therapy for the duration of patients' lives."

Several pharmaceutical manufacturers are currently developing PCSK9 inhibitors, which are projected to gain FDA approval by mid-2015. Injected once or twice a month, evidence from clinical trials suggests they are well tolerated and highly effective in reducing low-density lipoprotein or bad cholesterol. Many believe these medicines will first be indicated for familial hypercholesterolemia, a genetic form of high cholesterol affecting approximately 620,000 Americans. Yet, there is a growing interest in additional patient subgroups where PCSK9 inhibitors may be appropriate, including for patients who are intolerant to statins, those who have more severe cases where statins are not effective, and those with a history of coronary artery disease. As a result, as many as 15 million Americans could eventually be considered candidates for this new class of drugs once approved.

Estimates of annual pricing for PCSK9 inhibitors are in the range of $7,000 to $12,000. Even if PCSK9 inhibitors are indicated for a very narrow patient population, cost estimates show that this new class of drugs will eclipse initial costs of Sovaldi seen at its launch. In addition, PCSK9 inhibitors are biologics, so there will not be a simple pathway to cheaper generics for at least a decade, according to CVS Health.

"High cholesterol is one of the most prevalent conditions in the developed world and with primary prevention of high cholesterol as the eventual target for manufacturers, PCSK9 inhibitors will likely be the highest selling class of medications in history," added William Shrank, chief scientific officer, CVS Health and co-author of the blog post. "With a robust pipeline of expensive specialty drugs this is just the beginning, and the resilience and ability of our health care system to absorb such high costs will be tested if rigid cost control mechanisms are not put in place."

The authors suggest that careful managed care oversight and compliance with clinical guidelines will be paramount to helping control health care costs once these drugs are approved. They also note that ideally this new class of drugs should spur discussion about the use of scarce resources on the behalf of patients and build consensus in the health care industry around how to approach the pricing of new specialty medicines that impact large patient populations.

At CVS Health, the company approaches specialty drug cost management with a comprehensive offering of tools to manage and control rising trend while ensuring quality of care and access for patients. These include strategic price negotiations at an enterprise level combined with aggressive formulary management, exclusive networks, total patient care coordination and identifying the most effective site of care.
 

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Walgreens talks retail payment technology on White House cybersecurity summit panel

BY Michael Johnsen

SAN FRANCISCO — Deputy Secretary Sarah Bloom Raskin, U.S. Department of Treasury, on Friday discussed next-generation retail payment technologies designed to protect the convenience and sense of trust consumers hold for what has become an increasingly digital marketplace with several industry leaders across the omnichannel supply chain at the White House Summit on Cybersecurity and Consumer Protection. Representing brick-and-click retailers was Alex Gourlay, president of Walgreens, who was joined on the panel by Richard Davis, chairman and CEO, U.S. Bank; Mike George, CEO and president, QVC; Charles Scharf, CEO Visa; and Dan Schulman, president and CEO, PayPal. 
 
"If you think through the volume and monetary value of what we're talking about in the retail sector, it's actually pretty mindblowing how much transfers through our nation's payment systems on a daily basis," Raskin said. "If you look at what the 12 federal reserve banks have published in terms of the transactions that have been flowing through their systems, the number is 4 trillion in dollars per day. To put it in context, that is almost 25% of our country's annual GDP. And this is just a floor; we know the number to be much greater."
 
Couple that sheer volume of transactions with the multitude of payment options a customer has today, and you have a complicated system that provides a "wide and diverse number of entry points for bad actors," Raskin said. 
 
"We're all paying for what's happening as bad actors come in and basically take goods and services and money from us individually and collectively," Gourlay said. "So as you reduce fraud, again I'll go back to the example in Europe where fraud has been reduced by something like 40% since the adoption of Chip and PIN, it means that the consumers pay less and the banks pay less as well in terms of interchange fees to the merchants."
 
"Depending on what stat you believe, somewhere between 500 million and 1 billion identities were compromised last year. And so, people come into your system with real credentials … they just stole them," noted Dan Schulman, president and CEO, PayPal. "What we need to do is really kind of sophisticated fraud detection through risk and data analytics," he said. "The average American company gets hit with about 7 million intrusion attemps per year. What you are really trying to do is create this defense and then authentication around credentials."
 
"[What] Walgreens has done in this area of offline is to continue to innovate, to join the offline and the online … to make sure that everything we invest in is securing the most important thing for us, which is our customer's details," Gourlay said. "We are built on trust, absolutely built on trust. Therefore, we've got to make sure that we do our very best to invest properly and stay ahead of the game for the customer. The customer is moving toward more convenience. … We are working hard with many partners both inside and outside the business to make sure we make it as easy and convenient as possible to do business with Walgreens."
 
There are two payment technologies that have evolved to help maintain convenient and trusted access to commerce for consumers while at the same time thwarting those bad actors: Chip and PIN and tokenization. Chip and PIN is a brand name adopted by the banking industries in the United Kingdom and Ireland for the EMV smart card payment system for credit, debit and ATM cards. "Chip" refers to a computer chip embedded in the smartcard, and "PIN" refers to a personal identification number that the customer must supply. Tokenization when applied to data security is the process of substituting a sensitive data element with a non-sensitive equivalent, referred to as a token, that has no extrinsic or exploitable meaning or value.
 
"The most important thing for Walgreens, even today, is the fact that we are 8,200 retail pharmacies dispensing 800,000 prescriptions annually on behalf of Americans," Gourlay said. "So what we tried to do really is to make sure that we integrate the physical environment with the digital environment," he said. "Three years ago, we completely leveraged all of our point-of-sale as we entered this new environment … which means we are completely enabled both online and offline for Chip and PIN. The other thing that we've done, again, connecting the online with the offline, is the work with Apple Pay," Gourlay said, which brings tokenization to Walgreens transactions. 
 
Since the introduction of Apple Pay in October, the number of transactions conducted by mobile phone has increased four-fold, Gourlay said. 
 
"I've never known a time where the innovation is so strong in this area. We've spoken already about a generation that's already there, Chip and PIN, a generation that's been trialed for 15 years, the tokens, and new generations, for example biometrics through the eye being able to treat people individually," Gourlay said. "So the opportunity to really invest properly and to give our customers individually and collectively a fantastic experience of speed and real personalization has never been greater," he added. "The truth of it is if we move to other new mobile systems like tokens and … biometrics, the whole experience can be very secure, very different and very personal for people which is what I think customers want." 
 
 

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Meats for the sweet?

BY Rob Eder

There’s a reason why shoppers love Wegman’s. A Valentine’s Day promotion spotted Friday, in a Buffalo-area store, featuring twin ribeye steaks, packaged ready-for-the-flame in a disposable, heart-shaped broiler pan is one small example as to why.
 
Wegman’s was voted the most popular company in America last week, finishing first among 100 other companies in the 16th annual Harris Poll Reputation Quotient Study — ahead of Apple, Google and Amazon — even though it operates just 85 stores in just a handful of states. 
 
“To be recognized in this way is just incredible,” noted Wegman’s CEO Danny Wegman. “It always starts with our people, who thrill our customers every day and extend a family feeling in our stores across six states.”
 
No doubt this Valentine’s Day promo really gets the juices flowing.

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