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...

Thursday, July 21, 2016

Latest CMS Forecast Shows Big Drug Spending Growth Through 2025

Last week, the Centers for Medicare & Medicaid Services (CMS) released its latest forecasts for national health expenditures. See the Health Affairs article: National Health Expenditure Projections, 2015–25: Economy, Prices, And Aging Expected To Shape Spending And Enrollment. (Available for free to subscribers and to others for purchase.)

The boffins at CMS have again raised their forecasts for spending on outpatient prescription drugs. Their new projections show that through 2025, drug spending will grow slightly faster than will total U.S. healthcare spending. By 2025, the U.S. is expected to spend about $615 billion annually on outpatient prescription drugs.

Despite this growth, outpatient prescription drugs will still account for only about one of every nine U.S. healthcare dollars. By comparison, spending in 2025 on hospitals and physicians is projected to be $3.2 trillion, or more than five times the spending on outpatient pharmaceuticals.

Below, I delve into the latest numbers, explore how the new forecasts compare with previous prognostications, and highlight the variables driving CMS’s model.

Tuesday, July 19, 2016

Reality Check: 340B is 4% (not 2%) of the U.S. Drug Market—And Growing Quickly

Many 340B lobbyists frequently claim that the 340B Drug Pricing Program amounts to “only 2%” of total U.S. drug purchases and is therefore not a significant issue.

This is an extremely careless misrepresentation of the truth. As I document below, 340B now accounts for at least 4% of the U.S. drug market. That’s twice as large as the lobbyists’ “only 2%” figure, which hasn’t been true for at least 7 years. You can check my math below.

Regardless of whether you believe that 340B should be a bigger or a smaller part of the market, we shouldn’t be debating its actual share. Just remember our Drug Channels philosophy, courtesy of the late senator Daniel Patrick Moynihan: "Everyone is entitled to his own opinion, but not his own facts."

Monday, July 18, 2016

Coupon and Co-Pay Offer Design Optimization

CBI’s 4th Annual Coupon and Co-Pay Offer Design Optimization 
September 15-16, 2016 | Philadelphia, PA

Think coupon and co-pay programs are going away? Think again!

CBI's flagship Coupon and Co-Pay Offer Design Optimization conference returns to the East Coast in September for its fourth installment. Benefit from the life sciences industry’s foremost event devoted exclusively to ROI-generating coupon and co-pay programs.

Join the who's who in life sciences and discover leading-edge strategies to maximize products throughout the lifecycle by leveraging these powerful discount opportunities. The 2016 agenda boasts a diverse, experienced faculty from AstraZeneca, Bayer, Cempra Pharmaceuticals, EnvisionRx, GlaxoSmithKline, Novo Nordisk, United Healthcare UV Health System and many more!

Don't miss your chance to unite with leading innovators in co-pay offer design on the most important topics facing coupon and co-pay programs, including:
  • Stakeholder opinions on the true value and benefit of manufacturer discount programs during a new Opening Luminary Showcase
  • Strategies for combating the negative implication and patient perception on pharmaceutical pricing through effective marketing and distribution of co-pay programs
  • Effective internal program management strategies for coupon and co-pay programs through a co-pay center of excellence
  • Utilization of data analytics to determine co-pay offer and prescription value to properly target distribution efforts
  • Streamlined and effective promotion of co-pay programs in large health systems to assist in patient first fill and reduction of re-admissions
  • Alignment of offer strategy with contracting efforts to avoid “double-dipping” of rebate and co-pay offerings

*Discount offer valid through 8/14/2016; 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.

Friday, July 15, 2016

MACRA: What Value-Based Payment Means to Pharmacists

Today’s guest post comes from Kylanne Green, President and CEO of URAC. Kylanne shares an interesting perspective on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). She explains how the transition from fee-for-service to value-based payment will impact various stakeholders, including pharmacists. And, she offers suggestions for success.

Visit to learn how URAC’s Specialty Pharmacy and Community Pharmacy accreditation programs can help you establish benchmarks, standards, and goals to prove the quality of your pharmacy practice.

Read on for Kylanne’s thoughts.

Tuesday, July 12, 2016

Walgreens to Valeant: You’ve Got a Friend in Me (PLUS: A Rite Aid Deal Update)

Last week, Walgreens Boots Alliance (WBA) provided a small but notable boost to Valeant Pharmaceuticals.

WBA co-COO Alex Gourlay said that the company was “satisfied” with its Valeant relationship. That’s no surprise, given the favorable economics for Walgreens. Gourlay went further, stating that WBA would be “very willing to help them in a positive way.” Hmmm.

WBA also gave a brief update on its planned Rite Aid acquisition, which it still expects to complete later this year. And the company still expects to divest only 500 stores to get the deal done.

Reach for the sky with my analysis and commentary on these topics below.

Monday, July 11, 2016

Ensure Compliance on Government Program Mandates at IIR’s MDRP Summit

Government rules and regulations affect every department at a pharmaceutical company. However, few areas are as directly-and as frequently-affected as the government programs, pricing, and reimbursement space.

Due to the highly anticipated release of the AMP Final Rule, 340B Mega Guidance and Proposed Rule, HRSA's Rule on Dispute Resolution, and the recent release of CMS' Proposed Medicaid Managed Care Regulation, your day-to-day operations will fundamentally change.

Join IIR in Chicago this September 20-22 at IIR's Medicaid Drug Rebate Program (MDRP) Summit is a leading event for insights into the implications of these inevitable changes. It’s the longest running and the largest MDRP event where more than 600 industry, state, and federal government professionals come to get questions answered, gain clarity, and remain compliant.

Ensure you have the most comprehensive educational experience over three days with unparalleled access to government officials creating regulatory rules, the industry leaders interpreting them, and the pharmaceutical executives implementing them.

Use Code XP2158DRUG

Collaborate with your peers and benchmark best industry practices to:
  • Navigate Regulatory Hurdles
    • Address the implications of AMP Final Rule, 340B Guidance, along with State Policy changes
    • Critical legal trends affecting Pharma Manufacturers
    • Get updates directly from 4 key government agencies: CMS, HRSA, OIG, and VA
  • Benchmark Best Practices
    • Develop strategies to streamline pricing and reporting
    • Hear from the industry's leading service providers as they showcase new technologies and products to improve operations
  • Optimize Accounting & Gross-to-Net
    • Calculate liability and improve accuracy and accountability
    • Discover the latest in Automation & Customization of finance systems
    • EXCLUSIVE! Meet Face to Face with 13+ States in One-on-One Dispute Resolution Meetings where you can recoup or save millions of dollars in rebates and reimbursements
    Stay ahead of the curve by getting the best networking, education, and technology at IIR's MDRP Summit this September. There is no other MDRP event built like it.

    Be sure to use Priority Code: XP2158DRUG

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

    Friday, July 08, 2016

    Follow the Dollar: The U.S. Pharmacy Distribution and Reimbursement System (rerun)

    This week, I’m rerunning some popular posts while I'm on vacation. Click here to see the original post and comments from February 2016. P.S. This is one of my most frequently viewed articles!

    I received a bunch of emails asking about the channel flows chart that appears in yesterday’s blog post. That version had numbers corresponding to chapters in our new 2016 Economic Report on Retail, Mail, and Specialty Pharmacies.

    Below is the full version of the chart without the chapter numbers. I also provide a PDF version and some additional background. Feel free to use this chart to help others understand how money and product flow in the U.S. pharmacy distribution and reimbursement system for patient-administered, outpatient prescription drugs.

    And tip your hat to Mr. Goldberg for dreaming up this system. Details below.

    Thursday, July 07, 2016

    New Data: How Outrageous Hospital Markups Hike Drug Spending (rerun)

    This week, I’m rerunning some popular posts while I'm on vacation. Click here to see the original post and comments from April 2016.

    On Drug Channels, I highlight the two primary reasons pharmaceutical manufacturers’ list prices don’t represent what third-party payers actually spend for drugs: (1) channel intermediaries add markups that account for the costs, profits, and value of the channel's services, and (2) manufacturers provide rebates and discounts to third-party payers.

    The new 2015 Medical Pharmacy Trend Report (free download), from Magellan Rx Management, documents just how outrageous a channel’s markups can be.

    As I show below, the reimbursement approaches that commercial payers use permit hospitals to get paid two to three times as much as physician offices—and to inflate drug costs by thousands of dollars per claim. Naturally, the 340B program plays a part in this sordid tale.

    A few prominent hospital-based physicians have become very public critics of pharmaceutical list prices. It may come as no surprise that these physicians neglect the pricing behavior of their own employers, ignore the hospital-related factors affecting payers’ spending, and fail to examine drugs’ true net costs. I guess that when the media spotlight is shining, it’s better to take the money and run than be intellectually honest.

    Wednesday, July 06, 2016

    Four Takeaways on Drug Spending Realities from the New 2015 Express Scripts Drug Trend Report (rerun)

    This week, I’m rerunning some popular posts while I'm on vacation. Click here to see the original post and comments from March 2016.

    Last week, Express Scripts released its new 2015 Drug Trend Report. Click here to download the complete report. (Free download.) You should also read the press release, which offers additional information that is inexplicably excluded from the full report.

    For the first time, the Express Scripts data account for rebates—a meaningful and welcome improvement in reporting methodology. After accounting for rebates, the 2015 report reveals that drug spending growth is comparable to growth in other parts of the healthcare system. For some payers, utilization (script growth) was a bigger driver of spending than drug prices.

    So much for the myth of exploding drug costs! Our politicians may not believe it, but Martin Shkreli et al. are the exception in the pharmaceutical industry. Below, I review the four key highlights about traditional and specialty drug spending, trend patterns for different payers, and a red flag from upcoming biosimilar launches.

    Plus, diving into the numbers is more fun than contemplating the Anthem-Express Scripts kerfuffle and the meaning of such ill-defined terms as "competitive benchmark pricing."