US Market Access Delivers Big – New HA Commercial Plan Covers More than 40 Million Lives with DUROLANE and GELSYN-3

A key objective on the 2019 Company Scorecard is Bioventus becoming the #1 US HA company by 2022 and a measure of progress against this objective was to secure a new HA commercial plan covering 10 million new lives.

“We did that and then some,” said Tim Donovan, Vice President, Market Access. “Beginning October 1, DUROLANE and GELSYN-3 will be preferred choices for treating knee osteoarthritis with 13.9 million UnitedHealthcare and 6.4 million managed Medicaid lives through their medical and pharmacy benefits plans.”

UnitedHealthcare is the largest health insurance carrier in the US with a footprint that spans the entire country.  This win also includes an additional 21.6 million pharmacy lives managed by OptumRx PBM beginning on January 1, 2020. OptumRx is a pharmacy benefit management arm of UnitedHealthcare and it will also be enrolling some health plans under the medical benefit into the agreement which will include 1.1 million Harvard Pilgrim Health Plan lives and 1.3 million lives with Independence Blue Cross beginning on January 1.

“It all adds up to more than 40 million lives covered,” said Tim. “This means that DUROLANE and GELSYN-3 join Euflexxa from Ferring Pharmaceuticals as the only products that will be preferred and covered through both buy and bill, and the specialty pharmacy for UnitedHealthcare members.”

This new contract with UnitedHealthcare will last four years and between DUROLANE and GELSYN-3 it should cover more than 130,000 lives annually.

Medical benefits are used when a patient’s clinic has elected to purchase DUROLANE or GELSYN-3 directly from Bioventus. The clinic purchases the HA product from Bioventus then bills the payer after treating a patient. Pharmacy Benefit Managers (PBMs) are a third-party administrators of prescription drug programs for all manner of healthcare plans, including Medicare and other federal and state government employee plans. When pharmacy benefits are used by patients, the PBMs handle all aspects of the billing of the prescription for both the patient and the payer.

Successes like this are often a team effort and Senior National Account Director, Sean Leddy drove this change beginning in January 2018, eventually convincing his contacts at UnitedHealthcare, even though the contract was not open, to consider adding Bioventus HA products. He did this highlighting the usual attributes of both DUROLANE and GELSYN-3 while also bringing attention to service levels.

Previously, in addition to Euflexxa, United Healthcare was supporting Synvisc and Synvisc-One from Sanofi as a preferred HA option for its patients and physicians. This included working with Dr. Peter Heeckt and Angela Nasto, Segment Marketing Manager, Market Access, who, along with Tim and Sean, met with UnitedHealthcare to deliver a clinical overview and the value proposition of partnering with Bioventus.

Sean also leveraged the analysis of Theo McCormick, Senior Manager, Market Insights, to underscore that the sales department restructuring recently undertaken by Sanofi would underserve UnitedHealthcare and its members.

A lot of advance work was also done by John Nosenzo and Greg Anglum to ensure pricing and contract terms would be favorable to both parties. In addition, Tony Bihl and Alessandra Pavesio also traveled to Minnesota to meet with Dr Richard Migliori, Executive Vice President, Medical Affairs and Chief Medical Officer, UnitedHealthcare and convinced him of the commitment Bioventus has to OA treatments for patients.

“This is a huge win for Bioventus and the results are thanks to a collective effort from so many,” said Tim. “In the coming weeks, the Market Access team will work to develop pull-through strategies with Bioventus sales representatives so they may help educate HCPs of the preferred option status of DUROLANE and GELSYN-3 for patients with knee osteoarthritis.”