Specialty pharmacy scrutiny hits again with state's focus on Horizon meds

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A Connecticut official is calling for the state attorney general to investigate two specialty pharmacies that dispense expensive Horizon medications.

Horizon has faced its share of trouble with formulary placement and specialty pharmacies, and now those woes could spread. Connecticut's state comptroller wants to block two pricey combination drugs, and he's calling for an investigation of Horizon's relationships with two specialty pharmacies.

Comptroller Kevin Lembo is targeting two Horizon pain drugs that have come up against payer pressure in the past: Duexis, which marries ibuprofen and generic Pepcid; and Vimovo, a combination of naproxen and the active ingredient in Nexium. 

In its 2015 and 2016 formularies, top pharmacy benefits manager Express Scripts excluded the pills, saying they were pricey substitutes for readily available, off-patent products. That's essentially Lembo's contention, and that's one reason he's calling for the health plan to reconsider its coverage. Obviously, the individual components of Horizon's pain remedies are cheap and even sold over the counter.

RELATED: Look out, Valeant, Horizon, et al.: Payers target pricey meds that combo cheap generics

Horizon, however, says its single-pill formulations aren't just more convenient for patients to take, but that the drugs' official FDA labels say the two brands have no ready substitutes. "[T]here are no FDA-approved generic, over-the-counter or clinically equivalent medicines to Duexis and Vimovo, so Mr. Lembo’s statement that those medicines" are repackaged versions of older meds is "completely inaccurate," Horizon SVP Geoffrey Curtis told FiercePharma via email.

Horizon has persuaded Express Scripts to adopt the products; both Duexis and Vimovo now have formulary status with that PBM as well as its chief rival, CVS Caremark, and another leading PBM, Prime Therapeutics, Curtis said.

Lembo also raised questions about two specialty pharmacies and their ties to Horizon. The health plan's claims data showed Horizon products accounted for the vast majority of prescriptions dispensed by the two pharmacies, Main Street Pharmacy of Bridgeport and Connecticut Pharmacy & Supply of Norwalk (formerly Hope Street Pharmacy of Stamford), Lembo's office told FiercePharma via email.

RELATED: Big three PBMs cut loose more specialty pharmacies as scrutiny grows

Such questions aren't entirely new in the pharma business; amid a controversy over specialty pharmacy use, touched off by Valeant's notoriously incestuous relationship with Philidor, pharmacy benefits managers cut loose some specialized distributors with "close relationships" with just one drugmaker. One of those pharmacies was Linden Care, which had focused on Horizon's Duexis painkiller.

Federal agencies launched investigations of those pharmacies for potential wrongdoing, with Horizon among the drugmakers scrutinized, according to securities filings. Some analysts say drugmakers are using specialty pharmacies—which handle copay coupons and collect payment from insurers, rather than putting the onus for those things onto patients—to help grow sales of drug brands that aren't significantly different from cheaper alternative treatments.

Lembo wants the state to follow suit by probing the relationships between Horizon and the two specialty pharmacies. He's also identified a particular doctor that alone accounted for $1.5 million in Horizon prescriptions, he said.

"This review is necessary to ensure that prescription and medical care decisions are motivated, first and foremost, by what’s best for the health of patients—and not motivated by the financial interests of drug corporations," Lembo's office told FiercePharma via email.

RELATED: Horizon Pharma joins Valeant in DOJ's specialty pharmacy probe

Curtis said he wasn't familiar with the dispensing data Lembo referenced in his announcement, but noted that the comptroller was citing numbers specific to the state's health plan rather than to the pharmacies' overall business.

"[A]ll pharmacies that distribute Horizon branded medicines are fully independent," Curtis said, "and we have policies and governance in place to ensure that any interactions with pharmacies, payers and providers comply with all state and federal laws."