The Drug Channels blog 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. Learn more...

Tuesday, September 16, 2014

How Employers Are Managing Pharmacy Benefits in 2014

The just-released Kaiser/HRET 2014 Employer Health Benefits Survey (free download) delves into employer-sponsored health coverage at more than 2,000 companies.

Today, I profile the pharmacy benefit highlights from this excellent survey. The charts below summarize (1) cost-sharing tier structures, (2), average copayments, by formulary tier, and (3) type of cost-sharing (coinsurance and copayment).

Bottom line: employers didn’t make many major changes in the past year. Fourth-tier plans with substantial co-insurance remain a significant part of the market.

As a bonus, I also include a video with an intriguing forecast for the future of benefit tiers.

Monday, September 15, 2014

Elsevier Healthcare & Pharmaceutical Economics Conference- 2014

Elsevier Healthcare & Pharmaceutical Economics Conference- 2014
October 29-30, 2014 / Clearwater Beach, Florida

Join Elsevier as they bring together industry experts to share insight on issues and trends in the ever-evolving healthcare and pharmaceutical marketplace. Discover the new direction for healthcare and the obstacles and opportunities created for health plans, retail pharmacy chains and convenient care clinics, drug manufacturers, wholesalers and PBMs, and healthcare technology companies. Explore regulatory and compliance issues, cost savings measures, consumer-driven healthcare initiatives, alternative healthcare delivery models, and the impact these all have on the drug supply chain.

Featured sessions include:
  • Healthcare Regulation: Current Status and What’s Next in State & Federal Legislation, Adam Huftalen, Government Affairs, Reed Elsevier
  • Specialty Pharmacy and Reimbursement for Drugs under ACA and Outcome-Based Payments, Dean Erhardt, D2 Pharma Consulting
  • Alternative Healthcare Delivery and the Rise of Convenient Care Clinics, Tine Hansen-Turton, Executive Director, Convenient Care Association
  • The Next Big Thing: Genomics and Personalized Medicine, Scott Megill, President, Coriell Life Sciences
  • Current and Future Trends in Pharmaceuticals and Drug Supply Chain, Doug Long, IMS
  • The Empowered Patient: A New Paradigm for Healthcare and Pharmaceutical Marketing, Dorothy Wetzel, extrovetic
  • Taking the Mystery Out of Maximum Allowable Cost: Addressing the Transparency Trend, Anu Pathria and Todd Grover, Glassbox Analytics
  • Going Mobile: How Far and How Fast Will Healthcare Technology Go?, David Lee Scher,MD,FACC,FHRS, Penn State University College of Medicine and Digital Health Consultants
  • Coming Soon? Update on the Promise of Biosimilars, Ruey Tu, Abbott Laboratories
Plus: panel discussions with industry leaders about the big issues, updates on product innovations, and a sunset dinner reception overlooking the beautiful Gulf of Mexico.

Space is limited. Don’t forget to save the date!

Thursday, September 11, 2014

Inside Express Scripts’ Narrow Network Strategy—and How It Beat Walgreens

Last month, AIS Health held a fascinating webinar: Health Plan/Employer Strategies for Implementing Narrow Pharmacy Networks. (A CD and on-demand recording are available for purchase.)

The webinar featured a Milliman consultant, a Medicaid managed care health plan director, and the director of Network Solutions at Express Scripts, Andy Becker.

Becker explained Express Scripts' pharmacy network strategy, noting that 15% to 20% of the PBM’s claim volume now goes through a narrow network. He also revealed some previously-undisclosed insights into how Express Scripts outfoxed Walgreens during their 2012 imbroglio.

I highly recommend this webinar to anyone interested in the PBM/pharmacy/patient dynamics behind narrow networks. Excerpts below.

Tuesday, September 09, 2014

CMS Forecast: Big Drug Spending Growth, But Hospitals and Doctors Will Still Capture Most Healthcare Spending

Last week, the Centers for Medicare & Medicaid Services (CMS) released its latest forecasts for national health expenditures. The forecast is summarized in a new Health Affairs article: National Health Expenditure Projections, 2013−23: Faster Growth Expected With Expanded Coverage And Improving Economy (free download).

I crunch the prescription drug forecasts below. In 2013, prescription drug spending growth was again slower than the growth in total U.S. spending. Growth will accelerate as insurance coverage expands, the generic wave ends, and newer specialty drugs launch. By 2023, the U.S. will spend nearly $500 billion on drugs.

Despite this impressive growth, outpatient prescription drugs will account for less than one of every 10 U.S. healthcare dollars. Hospitals and physicians will remain at almost 60% of U.S. healthcare spending—or about six times as much as spending on pharmaceuticals.

Monday, September 08, 2014

NORD’s Rare Diseases and Orphan Products Breakthrough Summit

NORD’s Rare Diseases and Orphan Products Breakthrough Summit
October 21-22, 2014 | Alexandria, VA
Brought to you by NORD; Powered by CBI

NORD’s Rare Diseases and Orphan Products Breakthrough Summit is the largest and most meaningful multistakeholder event of its kind – Featuring over 20 speakers from the FDA, over 80 patient organizations and the Pharma/Biotech industry’s foremost experts in orphan product innovation, investment and commercialization. The 2014 Breakthrough Summit is concentrated with innovative content and convenes the top leaders from the FDA, NIH, Industry, Patient Groups, Payers and Research Institutions to address the progress of rare disease diagnosis, genomics, drug development, patient engagement, product approvals, FDA oversight and market accessibility to orphan products.

Tracking for an unprecedented turnout, with hundreds of executives already registered to attend, the NORD 2014 Breakthrough Summit is crafted with multiple workshops and focused tracks of content to ensure high quality learning, networking and accessibility to thought leaders in the rare disease community.
  • Network, learn and benchmark from hundreds of industry counterparts, patient advocacy stakeholders, investors and FDA leadership to better align their thinking on complex issues
  • Gain insight into the strategic models for commercializing an orphan product
  • Learn strategies to stay ahead of the curve on the newest R&D advancements in rare diagnostics and treatment regimens
Drug Channels readers will save $200 off of the standard registration rate when they use code XRZ293.* Register today!

*Cannot be combined with other offers or used towards a current registration. Discount valid towards final, standard rate. Other restrictions may apply.

Wednesday, September 03, 2014

2013’s Fastest-Growing, Private Specialty Pharmacies

Time for our annual review of the Inc. 5000 list, Inc. magazine’s ranking of the fastest-growing private U.S. companies. Once again, the Inc. 5000 list highlights the boom in specialty drug dispensing.

The 2014 list, which is based upon revenue growth through 2013, includes 13 specialty pharmacies. The pharmacies and key stats are listed below. Total revenues for the group were $3.1 billion. Diplomat, with $1.5 billion in revenues, accounted for half of the total.

If you want to buy a specialty pharmacy, here’s your shopping list!

Tuesday, September 02, 2014

Specialty Brand Building and Sales Strategy

Specialty Brand Building and Sales Strategy
October 27-28, 2014 | Philadelphia, PA

CBI’s Specialty Brand Building and Sales Strategy conference is designed to help you optimize sales and marketing strategies to advance patient engagement and increase market share. Specialty products present a unique set of challenges compared to traditional pharmaceutical products and services. Coupled with increased scrutiny on product value as a result of the ACA, specialty drug manufacturers must develop go-to-market strategies unique to each product.

This conference provides manufacturers with comprehensive strategies to optimize sales and marketing tactics to grow specialty brands and ensure patient adherence. Speakers come from such organizations as Allergan, Avella Specialty Pharmacy, Boehringer Ingelheim, Merck, Novartis, and Occam Health Services.

Drug Channels subscribers will save $400 off of the standard registration rate when they use code FBH478.* Register today!

*Cannot be combined with other offers or used towards a current registration. Other restrictions may apply.

Friday, August 29, 2014

New OIG Report Confirms Our Worst Fears About 340B Contract Pharmacy Abuses (rerun)

I’m taking a break from blogging this week and rerunning some popular posts from the past 12 months. Click here to see the original post and comments from February 2014.

Moments after yesterday's post on the booming 340B contract pharmacy market, the Office of Inspector General (OIG) released the first of its three planned reports on the 340B drug discount program: Contract Pharmacy Arrangements in the 340B Program.

OIG’s research confirms many long-suspected problems regarding oversight, diversion, and the mystery methodologies for identifying 340B-eligible prescriptions.

But here's what's most troubling: the neediest patients are not benefiting from 340B discounts. In OIG’s sample, two-thirds of the hospitals do not offer the 340B price to uninsured patients. Wow.

These 340B contract pharmacy shenanigans need to stop. Based on the OIG report, uninsured and indigent patients aren’t benefiting from 340B drug discounts. Hospitals should stop hiding behind vague language about “stretching scare federal resources” and come clean about who really gains from 340B contract pharmacies.

Read on for highlights from this depressing report on the out-of-control 340B program.

Thursday, August 28, 2014

Which PBM Best Manages Drug Trend? Express Scripts vs. Caremark vs. Catamaran vs. Prime (rerun)

I’m taking a break from blogging this week and rerunning some of 2014's most popular posts. Click here to see the original post and comments from June 2014.

Four of the biggest pharmacy benefit managers (PBMs)—Catamaran, CVS Caremark, Express Scripts, and Prime Therapeutics—have now released their 2013 drug trend reports. The reports provide valuable marketplace insights. Just cite them with caution.

As the chart below shows, this year’s results are as mystifying as ever. Express Scripts had the highest overall drug trend, but the lowest specialty trend. Prime Therapeutics had a negative traditional trend, but the highest specialty trend. And so on.

Alas, the top-line figures don’t tell the full story, because of methodology and data presentation differences. As I noted last year, a PBM’s drug trend report is the bikini of pharmaceutical economics. What it reveals is interesting, but what it conceals is essential. Read on for the figure-hugging details.