Drug Channels delivers timely analysis and provocative opinions on pharmaceutical economics and the drug distribution system. It is written by Adam J. Fein, Ph.D., one of the country's foremost experts on pharmaceutical economics and channel strategy. Drug Channels reaches an engaged, loyal and growing audience of more than 18,000 subscribers. Learn more...

Wednesday, August 16, 2017

Diplomat Sees Declining DIR Fee Impact—and Perhaps Readies a PBM Strategy

Last week, Diplomat Pharmacy released its quarterly earnings, which included new details about the financial impact of Direct and Indirect Remuneration (DIR) fees. I provide some background on DIR fees below.

Diplomat, as a public company, is the only entity that is obligated to publish truthful information about DIR fees. While reviewing its data, let’s recall our Drug Channels philosophy, courtesy of the late senator Daniel Patrick Moynihan: "Everyone is entitled to his own opinion, but not his own facts."

As you will see below, Diplomat’s exposure to DIR fees remains relatively modest. DIR fees as a share of its gross profit has even declined since last year. This shift is driven by an evolving business mix along with better accounting of and management control over DIR fees.

In part to counter DIR fees and other payer pressures, Diplomat is signaling its intention to play a more significant role in the pharmacy benefit management (PBM) business. Let the rumors begin!

Monday, August 14, 2017

Electronic Benefit Verification & Prior Authorization Summit

Electronic Benefit Verification & Prior Authorization Summit
October 24-25, 2017 | San Francisco, CA

CBI’s Electronic Benefit Verification & Prior Authorization Summit provides attendees with an understanding of key issues and developments in electronic patient services, including electronic benefit verification, real-time benefit verification, prior authorizations, health records and prescribing services.

Gain Critical Insights and Strategies to Improve Patient Access
  • Examine challenges associated with ePA implementation, and understand planning and operational considerations associated with technology adoption
  • Understand the implementation steps needed to achieve real-time benefit verification
  • Compare innovations in electronic patient service technology to identify what solutions fit within company strategies
  • Determine how to leverage patient support programs to overcome formulary barriers, help patients stay on therapy and drive positive physician coverage perception
  • Discuss how to streamline electronic benefit verifications and prior authorization solutions into a hub model
  • Facilitate efficient information exchange between key stakeholders, including manufacturers, health plans, health systems, PBMs and physicians

Visit www.cbinet.com/eBenefit for more information. Drug Channels readers will save $400 off the standard registration rate when they use discount code PSK783*

*Discount expires October 24, 2017; applies to standard rates only and may not be combined with other offers, category rates, promotions or applied to an existing registration. Offer not valid on workshop only or academic/non-profit registrations.

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

Thursday, August 10, 2017

Generic Deflation Roils the Channel—And Will Get Worse

Deflation in generic drug prices dragged down second quarter earnings for drug wholesalers and generic manufacturers. Here’s a useful summary from The Wall Street Journal, which captures the grim marketplace realities in Falling U.S. Generic Drug Prices Hurt Manufacturers, Wholesalers. Yesterday, Mylan's earning release noted "high-single-digit erosion expected in North America."

Below, I review the state of the generic drug market. As you will see, the overall market for mature generic drugs is deflating by about 10% per year. Many generic drugs have dropped significantly in price over the past four years.

Surprisingly, the prices for about one in five generic drugs remain elevated. Scott Gottlieb, M.D., the new head of the Food and Drug Administration (FDA), has prioritized actions that should squeeze the remaining generic inflation out of the system. I expect generic drug deflation to continue—and possibly accelerate—over the next 12 to 24 months.

Payers and consumers will be the ultimate winners, but the drug channel faces significant disruption. In the meantime, let’s all hope that these price declines don’t trigger shortages if generic drug makers flee this sinking market.

Tuesday, August 08, 2017

Follow the Dollar Math: How Much Do Pharmacies, Wholesalers, and PBMs Make From a Prescription?

Yesterday,The Wall Street Journal published an intriguing article by Jonathan Rockoff titled Behind the Push to Keep Higher-Priced EpiPen in Consumers’ Hands.

The article includes a graphic attributed to me (cited as Pembroke Consulting). It shows that the drug channel—pharmacy benefit managers (PBMs), wholesalers, and pharmacies—receive more than $37 in gross profit for a brand-name drug with a $300 list price. PBMs capture about half of this amount.

The WSJ article doesn’t describe how I arrived at the figures. But now you, Drug Channels reader, will get the inside scoop.

Below, I go inside the box and trace these crucial computations. They determine the revenues and profits of the drug channel participants that operate between a brand-name drug maker and the patient. I also reveal how the figures affect the net prescription cost for a third-party payer.

As with many things, you'll have to observe the system to figure out the superposition.

Monday, August 07, 2017

CBI’s PAP Legal Update

CBI’s PAP Legal Update
September 25-26, 2017 | Arlington, VA

PAP Legal Update 2017 - Please join the patient assistance and access community for this critical update meeting which will provide important insight into key legal issues, including recent advisory opinions from the OIG, developments in the changing healthcare and regulatory landscapes, and opportunities for industry collaboration in the face of an increased need for risk mitigation. Learn more here.

Compelling Discussions, Pivotal Insights and Interactive Sessions for Forward-Thinking Compliance
  • Hear an analysis of recent OIG advisory opinions related to PAPs
  • Examine the legal and enforcement environment impacting the relationships between manufacturers and 501(c)(3)s
  • Hear insights from advocates on efficient and effective PAPs and identify ways to strengthen your PAP with stakeholder engagement
  • Improve brand image and messaging for PAPs in the era of public scrutiny
  • Discuss policies for reducing risks associated with working with Medicare and Medicaid patients
  • Remain compliant with design and development of co-pay assistance programs
Download the complete agenda here. Visit www.cbinet.com/PAPUpdate for further details and to register. Drug Channels readers will save $300 off of the standard registration rate when they use code RKN333.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rate or non-profit rates. Other restrictions may apply.

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

Thursday, August 03, 2017

What’s In, What’s Out: The New 2018 CVS Health and Express Scripts Formulary Exclusion Lists (Plus: A Sneak Peek From Prime)

This week, the two largest pharmacy benefit managers (PBMs)—Express Scripts and the CVS/caremark business of CVS Health—released updates to their 2018 formulary exclusion lists. They are available below for your downloading pleasure.

For 2018, Express Scripts was more aggressive, expanding its list to 159 excluded products. At CVS Health, however, the total number of excluded remained steady. The Prime Therapeutics list won’t be available until September, but it will apparently exclude more drugs that either of its PBM peers.

Read on for my 2018 head-to-head comparison, including comments on inflammatory conditions, multiple sclerosis, epinephrine, biosimilars, and more. I also review the reported savings from formulary exclusions. I conclude with some questions about patients. Remember them?

If I have missed anything important, please comment below.

Tuesday, August 01, 2017

New Part B Buy-and-Bill Data: Physician Offices Are Losing to Hospital Outpatient Sites

The Medicare Payment Advisory Commission (MedPAC), the independent agency that advises Congress on the Medicare program, recently released its June 2017 Data Book: Health Care Spending and the Medicare Program. The report is a 201-page wonktastic data dump. Chapter 10 focuses on prescription drugs.

In 2015, the most recent year available, Part B spending on drugs reached $25.7 billion. Hospital outpatient sites now constitute more than one-third of Medicare spending and have been crowding out physician offices. Part B payments to physician practices are growing much more slowly than payments to hospitals.

For some time, I have been tracking the evolution of the buy-and-bill system for provider-administered drugs. These new data confirm my predictions that physician offices’ will account for a declining share of the buy-and-bill market. Still unknown: Is this good or bad for patients?

Monday, July 31, 2017

CBI’s 5th Annual Coupon and Copay

CBI’s 5th Annual Coupon and Copay
September 14-15, 2017 | Philadelphia, PA

Exclusive Offer – Register by 8/25/2017 and save $500*
Use discount code COUPDC

In the midst of a turbulent healthcare system, with drug prices continuing to escalate, patient affordability and access programs have become more critical than ever. Coupon and copay programs are one of the most effective tools for life sciences manufacturers to minimize patient out of pocket costs, while driving access and adherence.

As such, CBI's flagship Coupon and Copay conference, taking place September 14-15 in Philadelphia, PA, serves as the life sciences industry’s foremost event devoted exclusively to manufacturer-driven coupon and copay programs. Join the best of the best in life sciences and discover pioneering strategies to maximize ROI by leveraging these powerful discount opportunities.

The 2017 agenda boasts a diverse, experienced faculty from Otsuka Pharmaceuticals, United Healthcare Pharmacy, Healthwell Foundation, Coherus Biosciences, BioPlus Specialty Pharmacy, Community Health Network, UVA Cancer Center and many more!

Don't miss your chance to unite with leading innovators in copay design to discuss the future of patient assistance and access:
  • Hear multi-stakeholder perspectives on the future of assistance and access for patients needing high-cost specialty therapies
  • Discuss key analyses (abandonment, redemption, competitive offerings) used to improve the value of copay programs
  • Identify new challenges in an evolving environment including deductible reset, LOE, real-time measurement for launches, distribution channel, OIG risk, denial conversion and e-coupons
  • Navigate the OIG modifications on contributions to charitable patient programs
  • Learn more about copayment assistance funds for Medicare patients
  • Alignment of offer strategy with contracting efforts to avoid “double-dipping” of rebate and copay offerings
  • Consider strategies for fast tracking prior authorization and copay assistance for specialty prescriptions to increase speed to therapy

*Discount offer valid through 8/25/2017; applies to standard rates only and may not be combined with other offers, categories, promotions or applied to an existing registration.

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

Thursday, July 27, 2017

Drug Channels News Roundup, July 2017: CVS, Anthem, Specialty Pharmacy, INSYS, and Big Box Pharmacy

Cut through the steamy summer haze with our refreshing selection of articles and insights. In this issue:
  • CVS drugstores aim for a healthier look
  • Anthem dissects specialty pharmacy management
  • Takeaways from an Insys employee’s guilty plea over prior authorization
  • Profiling pharmacies inside supermarkets and mass merchants
Plus, The Onion reports on the launch of generic internets following patent loss. Scary!

P.S. Follow @DrugChannels on Twitter for my daily curated selection of news and commentary.