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...

Friday, November 21, 2014

Surprise? Once Again, FULs and AMP Final Rule Delayed

In what has become a semi-annual ritual, the Centers for Medicare & Medicaid Services (CMS) last night announced plans to delay the Federal Upper Limits (FUL) and the Final Rule on Covered Outpatient Drugs, a.k.a., the Average Manufacturer Price (AMP) Final Rule. Full text of the non-announcement email below.

You can read about the previous delays here…and here…and here…and, oh yes, here, too.

In its email, CMS confirms that it will do something, at some point in the future, and that it looks forward to partnering with stakeholders whenever it does the thing that it may or may not ever do.

Meanwhile, we'll all just muddle along without clarity on AMP computations, bona fide service fees, the definition of retail pharmacy, and more. It's enough to make any cat grumpy about the Affordable Care Act's implementation.

Thursday, November 20, 2014

News Roundup, November 2014: Salix, Merck, Co-Pay Cards, Part D Preferred Networks, and an Insurance Cartoon

Here's a pre-Thanksgiving news roundup, to stretch your mind before stretching your stomach next week. In this issue:
  • Stuffing—Salix Pharmaceuticals reminds investors why wholesaler agreements matter
  • Pumpkin Pie (in the Face)—How Merck beat co-pay card litigation
  • Gobble, Gobble—An important update on retail chains’ participation in Part D plans’ preferred networks
Plus, I share a surprisingly useful cartoon that explains the U.S. health insurance system. Next week, show it to your family, so they understand more about your job and the world around us. Happy Thanksgiving!

Tuesday, November 18, 2014

In the Third Quarter, Retail Generic Drug Inflation Kept on Truckin’

This Thursday, the Senate Subcommittee on Primary Health and Aging, currently led by U.S. Senator Bernie Sanders (I-VT), will hold a hearing titled “Why Are Some Generic Drugs Skyrocketing In Price?

The hearing is not a surprise. As I discuss in Congress Grills Generic Drug Makers Over Price Inflation, Senator Sanders and U.S. Representative Elijah E. Cummings (D-MD) have been probing generic manufacturers.

Our latest exclusive analysis (below) finds that generic inflation is alive and well. During the third quarter of 2014, more than one-third of generic drugs became more expensive. A small number of drugs have experienced mega-increases (exceeding 1,000 percent) over the past three months.

I’m skeptical, however, that the Congressional hearing will tell us anything we don’t already know—or anything that Congressmen Sanders and Cummings haven't already concluded.

Monday, November 17, 2014

2015 sPCMA Business Forum

2015 sPCMA Business Forum
March 16 – 17
Hilton Bonnet Creek, Orlando, Florida

The sPCMA Business Forum is a networking and educational conference designed for professionals of all levels engaged in the business of specialty pharmacy. From an educational standpoint, its speakers are among the industry's top thought leaders. According to PCMA, the sPCMA Business Forum attracts the highest number of pharmacy benefit manager (PBM) and specialty pharmacy decision makers than any other industry conference. The sPCMA offers an outstanding opportunity for networking and conducting business with industry partners and customers.

Conference Features:
  • Remarks by C-suite and other senior PBM, specialty pharmacy, and pharma executives
  • 25+ educational sessions, including 10+ hours of CPE sessions
  • Dedicated time and facilities for private meetings
  • Pre-Conference networking through PCMA-Connect http://www.pcmanet.org/pcma-connect
  • 10+ Networking Receptions
Who Should Attend:

Anyone interested in attending is welcome. The 1,200+ expected attendees will range from C-suite executives to mid-level professionals tasked with all aspects of the business of specialty pharmacy and overall pharmaceutical care. Companies in attendance will include specialty pharmacies of all sizes and composition, PBMs and payers, manufacturers, wholesalers and distributors, consultants, vendors, and other specialty pharmacy stakeholders.

Register Now!

Contact PCMA

Please contact Jenny Dawson (jdawson@pcmanet.org) with questions and to request information about the Affiliate Program or conference sponsorships.

Tuesday, November 11, 2014

New Walgreens Data Verifies That 340B Reduces Retail Generic Dispensing Rates

November’s Health Affairs includes The 340B Discount Program: Outpatient Prescription Dispensing Patterns Through Contract Pharmacies In 2012. (Sorry, the full article is available only to subscribers.)

The paper inadvertently provides compelling evidence that the 340B Drug Pricing Program’s crazy incentives are lowering generic dispensing rates at retail pharmacies. The two lead authors work at Walgreens, which perhaps explains why they try (unsuccessfully) to spin the results away from this unfortunate conclusion.

With few exceptions, third-party payers and PBMs have been minimally engaged in the public policy discussion about how the 340B program should be modernized. Walgreens’ unexpected disclosures about cost-shifting to managed care suggest that they should start paying attention. Read on and see if you agree.

Monday, November 10, 2014

Forging ACO Partnerships

Forging ACO Partnerships
December 9-10, 2014 | Philadelphia, PA
www.cbinet.com/ACO

Forging Accountable Care Organization (ACO) Partnerships offers participants a unique forum for:
  • Developing strategies for partnering with ACOs
  • Understanding the various ACO models
  • Discovering how ACOs are impacting purchasing decisions and physician prescribing behavior
The conference is being held December 9-10 in Philadelphia. Join CBI and your colleagues to convene with peers and discover best practices for adopting accountable care models in the healthcare industry.

The program features two informative case studies, four in-depth workshops, an ACO executive round robin, and a diverse group of pharma and ACOs representing Astellas, Bayer, Pfizer, Premier, Ferring, Amarillo Legacy Medical ACO, MHA ACO Network and many more, discussing innovative solutions to the most significant challenges affecting industry today:
  • Discover how to effectively build out a business strategy that aligns to the accountable care models in order to effectively leverage ACO purchasing power
  • Review the current climate of patient costs and access and analyze how effective ACOs are, economically, as part of a product sales strategy
  • Examine how ACOs are driving physician prescribing behavior for medical groups, health systems and hospitals and understand the impact of adapting procedures to align with value-based contracting
  • And much, much more!
CBI is offering Drug Channels readers an exclusive $300 discount when you register with discount code CBI061.*

Register today!

*Offer valid through December 5, 2014, applies to standard rates only and may not be combined with other offers, category rates, promotions or applied to a current registration.

Thursday, November 06, 2014

Express Scripts Looks at a “No Sin” Preferred Pharmacy Network

Yesterday, The Wall Street Journal revealed that pharmacy benefit manager Express Scripts is now evaluating a network of pharmacies that don’t sell tobacco products or alcohol. See Express Scripts Eyes Forming Alcohol and Tobacco-Free Pharmacy Networks.

The move is clearly a reaction to Caremark’s no-tobacco preferred pharmacy network. Express Scripts however has gone further with its concept for a “no sin” network.

Below, I ask whether payers really want pharmacies to be goody two shoes. Instead of writing your thoughts on a pound note, let me know what you think by posting a comment below.

Tuesday, November 04, 2014

Here’s Who Will Pay For Prescription Drugs in 2023

In CMS Forecast: Big Drug Spending Growth, But Hospitals and Doctors Will Still Capture Most Healthcare Spending, I examined the September 2014 drug spending forecasts from the Centers for Medicare and Medicaid Services (CMS).

After crunching the numbers again, I identified new insights into the 2023 drug market. As the charts below show, CMS expects that the employer-sponsored insurance market will shrink more than it had previously projected, while Medicare and Medicaid will grow even faster. CMS is still projecting that individually-purchased private insurance (via both public and private exchanges) will account for a small share of drug spending.

Is your organization prepared for the government’s unprecedented growth?

Monday, November 03, 2014

Life Sciences Trade and Channel Strategies

10th Life Sciences Trade and Channel Strategies
December 10-11, 2014 | Philadelphia, PA
www.cbinet.com/trade

I want to remind you about CBI’s upcoming Trade and Channel Strategies conference, being held this December in Philadelphia. This annual event has great networking opportunities and loads of solid content. Check out the agenda.

Drug Channels readers will save $400 off of the standard registration rate when they use code AUX474.* Hope you’ll join me in Philadelphia this December!

PERSPECTIVES FROM: AmerisourceBergen | Blue Fin Group | Boehringer Ingelheim | Depomed, Inc. | Deutsche Bank | Drug Channels Institute | IntegriChain | Jazz Pharmaceuticals | Johnson & Johnson Healthcare Systems Inc. | Mallinckridt Pharmaceuticals | McKesson Specialty Health | Pembroke Consulting, Inc. | RQ Global Pharma Strategies, LLC | RxTrace | SonexusHealth | Sunovion | Therapeutics MD | Therigy | Vertex Pharmaceuticals, Inc.

TOPICS: Specialty Channel Strategies | Alternative Go-to-Market Approaches | Economic Factors Impacting the Drug Channel | Impact of ABC, CAH and MCK Business Changes | Distribution Models Reshaping Trade Dynamics | Impact of ACA, CMS Final Rule, 340B and Shift from AWP Reimbursement | U.S. Serialization Requirements | Globalization, Vertical Integration and Product Specific Implications | and more!

You may be especially interested in the Trade Throwdown: Battle of the Experts. This year, Bill Roth of Blue Fin Group and Allen Dunehew or RQ Global Pharma Strategies will join me in CBI’s XTreme Battle Cage™. Three consultants will enter…but only three will leave!


Register today for this awesome event!

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