How Plan Sponsors Can Respond to Tamiflu Shortages



PSG, LLC

Widespread Influenza activity is occurring across the United States and the CDC is reporting that thirty nine (39) states plus Puerto Rico are currently experiencing high influenza activity. In response to the higher than normal influenza activity, prescriptions for generic Tamiflu, oseltamivir, have also increased. As a result, some pharmacies are having difficulty keeping up with the demand and are running into temporary shortages. The FDA has not indicated that there is an official shortage; however the CDC has confirmed that some manufacturers are delayed in filling orders, specifically for generic oseltamivir capsules and suspension.

Product Description AWP Effective Date Estimated Treatment Cost*
Start End
TAMIFLU      CAP 30MG 16.721 7/1/2017 12/31/2999 $167.00
OSELTAMIVIR  CAP 30MG 13.982 8/8/2017 12/31/2999 $140.00
TAMIFLU      CAP 45MG 16.721 7/1/2017 12/31/2999 $167.00
OSELTAMIVIR  CAP 45MG 14.18 12/5/2016 12/31/2999 $140.00
TAMIFLU      CAP 75MG 18.226 7/1/2017 12/31/2999 $182.00
OSELTAMIVIR  CAP 75MG 15.457 1/10/2018 12/31/2999 $155.00
TAMIFLU      SUS 6MG/ML1 3.03767 7/1/2017 12/31/2999 $182.00 – $364.00
OSELTAMIVIR  SUS 6MG/ML1 2.73083 11/1/2017 12/31/2999 $164.00 – $328.00
*Based on 5 day regimen for treatment of Influenza. Individual plan experience may differ due to plan design, pricing arrangements, and other factors
1 Dosing is based on weight, therefore number of bottles dispensed will vary

Considerations:

  1. Plan sponsors should be prepared for higher utilization of generic oseltamivir and brand Tamiflu.
    • If supply challenges worsen due to increased demand and result in product shortages impacting brand and generic formulations of Tamiflu, the utilization of two other antivirals may increase
      • Relenza – an oral inhalation product
      • Rapivab – an intravenous injection administered by a physician
  1. To minimize the financial impact to members affected by retail network shortages, plan sponsors may consider implementing one or more of the following solutions, if applicable. Please note, these changes may result in higher plan cost for the remainder of the flu season:
    • Suspending Dispense As Written (DAW) penalties
    • Allowing brand Tamiflu to pay at the generic oseltamivir member cost share
    • Removal of out-of-network (OON) pharmacy penalties if in-network pharmacies are experiencing a shortage
    • For HDHP or CDHP designs, allowing brand Tamiflu to bypass the deductible
  1. Flu season typically runs from October to April. Plan sponsors should work with their consultants to ensure the PBM is able to implement the types of temporary benefit changes outlined above accurately and in a timely manner. Additionally, any changes should be suspended by May 30th.
  1. Patients with prescriptions should consider calling their pharmacy in advance to confirm availability of the medication.


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