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...

Wednesday, February 03, 2016

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

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.

Tuesday, February 02, 2016

NEW: 2016 Economic Report on Retail, Mail, and Specialty Pharmacies

I am pleased to announce the availability of our new 2016 Economic Report on Retail, Mail, and Specialty Pharmacies. We’re offering special discounts if you order before February 19, 2016.
The report is the most up-to-date, comprehensive, fact-based analysis of pharmacy and PBM channels. It's chock full o'data on prescription economics, reimbursement models, market structure, benefit designs, growth rates, payers, forces of change, and the U.S. healthcare system.

To better reflect a changing industry, I completely updated, reorganized, and expanded this year’s edition. There are now three major sections, comprising ten chapters. The first two chapters examine market structure, key trends, the largest industry participants, differences among dispensing formats, and more. In Chapter 3, I do a deep dive into specialty drugs and specialty pharmacies. The remaining seven chapters are organized around key channel flows, as illustrated in the chart below.

[Click to Enlarge]

Some other fun facts:
  • For the first time, we are offering the option to download a PowerPoint file with images of all 129 exhibits. Thanks to everyone who suggested this idea.
  • The chapters are self-contained and do not need to be read in order. (Really!) There are loads of internal hyperlinks to help you navigate the document and customize it to your specific needs. 
  • There are a staggering 394 endnotes, most of which have hyperlinks to original source materials. (Sorry, I couldn’t help myself.) Hope you find them useful.
  • Once again, I have reluctantly stripped out the corny jokes and pop culture references. You can decide for yourself whether such omissions are value-enhancing or not.
If you have any questions (before or after reading the report), please email me. Enjoy!

P.S. If you’ve purchased DCI reports in the past, you may notice a slight change to the download process. As always, you will receive an email with a link to your personal download page.

Monday, February 01, 2016

Bio/Pharmaceutical Pricing and Contracting

Bio/Pharmaceutical Pricing and Contracting
March 15-16, 2016 | Silver Spring, MD
www.cbinet.com/pharmpricing

Join CBI for their Bio/Pharmaceutical Pricing and Contracting conference, dedicated to exploring innovative commercial pricing trends, examining relationships between payers and pharmaceuticals, and evaluating strategies to improve your company’s pricing program.

Value-based initiatives are coming to the forefront of market trends in pricing and contracting. This comprehensive event will give you an opportunity to examine the benefits and challenges associated with value-based pricing and determine how your company can best strategize for a changing commercial landscape.

With the recent attention being given to pharmaceutical pricing in the media, how will future pricing and contracting evolve?

Key Benefits of Attending:
  • Discuss value-based initiatives and understand how risk-sharing agreements are coming to the forefront of market trends
  • Identify strategies for the conceptualization and construction of risk-sharing agreements
  • Understand best practices for contracting productively and collaboratively with health insurance and specialty pharmacies
  • Strategize ways to combat negative media attention when facing public concerns about pricing initiatives
  • Utilization of real-world evidence, outcomes and population-based data to support a value-based pricing system
  • Learn about the creation of a sustainable strategy for the uptake of biosimilars in the U.S. marketplace
Join industry leaders from Pfizer, Eli Lilly, BCBS, Alnylam and more to discuss the most critical issues for success in pricing and contracting in a value-based market.


Visit www.cbinet.com/pharmpricing for more information. Drug Channels readers will save $200 off the standard registration rate when they use code BNB955.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category 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, January 28, 2016

The Top 15 Pharmacies of 2015

Next week, Drug Channels Institute will release our updated, revised, and expanded 2016 Economic Report on Retail, Mail, and Specialty Pharmacies.

The exhibit below—one of 129 in our new report—provides a sneak peek at the largest pharmacies, ranked by total U.S. prescription dispensing revenues for calendar year 2015.

Read on for details—including a downloadable PDF that’s suitable for framing!

Tuesday, January 26, 2016

Seven Pharmacy and Channel Implications of the New AMP Final Rule

Well, pierce my ears and call me drafty! Late last week, the Centers for Medicare & Medicaid Services (CMS) finally released its long-overdue final rule regarding Average Manufacturer Price (AMP) under the Patient Protection and Affordable Care Act (ACA). Since 2012, CMS has announced—and then delayed—the release of the final rule at least five times. Makes you proud to be a taxpayer, doesn’t it?

Savor all of the bureaucratese for yourself in the oh-so-brief 658-page rule, known to the cool kids as CMS-2345-FC. (Note: Not the name of a new Star Wars droid.)

The rule is effective April 1, 2016. (Seriously.) Below, I highlight what it could mean for drug channels, including observations on:
  • Prescription reimbursement
  • Pharmacy profits
  • Manufacturers’ channel strategies
  • Bona fide service fees
  • Manufacturer-retail direct distribution arrangements
  • And more!
Enjoy.

Monday, January 25, 2016

GPO Membership, 340B and Class of Trade Management

CBI’s GPO Membership, 340B and Class of Trade Management
March 23-24, 2016 | Philadelphia, PA
www.cbinet.com/GPOCOT

CBI’s Summit on GPO Membership, 340B and Class of Trade Management debuted last year to rave reviews from manufacturers, GPOs, wholesalers, distributors, legal counsel and others. The March 2016 event promises to build on that momentum, advancing the conversation to provide strategic approaches to the operational challenges faced everyday – proper management of GPO data, mitigating membership risk, ensuring accuracy in COT designation, optimizing data processes and more.

Multistakeholder Perspectives and Innovative Insights From:

Amerinet • Apexus • AstraZeneca • Bayer HealthCare Pharmaceuticals • Cardinal Health
Chiesi USA, Inc. • Fresenius Kabi USA, LLC • Healthcare Supply Chain Association
Managed Health Care Associates (MHA) • McKesson Corporation • Novation
Octapharma USA, Inc • Pfizer Inc • Sunovion Pharmaceuticals • And More!

For more information, please download the complete agenda or visit www.cbinet.com/GPOCOT. Drug Channels readers will save $200 off of the standard registration rate when they use discount code QHJ775.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category 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.

Wednesday, January 20, 2016

Medicare Part D 2016: 75% of Seniors in a Preferred Pharmacy Network (PLUS: Which Plans Won and Lost)

Narrow pharmacy networks—either preferred or limited models—are now a widely accepted element of benefit design.

Just released data from the Centers for Medicare & Medicaid Services (CMS) confirms that preferred cost-sharing networks continue to dominate Medicare Part D. According to our exclusive analysis, 75% of seniors are enrolled in Prescription Drug Plans (PDPs) with preferred cost sharing pharmacy networks for 2016.

The top two companies—Humana and UnitedHealthcare—will enroll almost half of Part D beneficiaries in PDPs. Meanwhile, CVS Health’s SilverScript enrolled almost 80% of beneficiaries in an open network plan.

Read on for our latest look at the biggest companies and plans. In a future post, I’ll examine how Part D plans are building performance-based pharmacy networks.

Tuesday, January 19, 2016

Oncology Commercialization and Market Access

9th Annual Oncology Commercialization and Market Access 2016
March 22-23, 2016 | San Francisco, CA
www.cbinet.com/oncology

Are you ready to tackle the market?

Commercializing oncology products is becoming much more complex due to the influx of innovative new therapies, combination therapies and the increased fragmentation of cancer types. With mounting pressures on the cost vs. value of these products from various stakeholders, it is now impacting the way bio/pharmaceutical companies are planning for the rising development costs, product reimbursement and market access hurdles as well as combating toxicity levels to ensure overall patient benefit. Within this high-risk, high-reward market, the development of a commercialization playbook is becoming one of the keys to success.

CBI’s 9th Annual Oncology Commercialization and Market Access meeting remains the go-to event to gain strategic insight from peers on the most pressing commercialization hurdles that executives face today. Join your industry colleagues for this in-depth and dynamic meeting to benchmark with all key stakeholders, gain best practices to successfully execute a global product launch and walk away with an actionable commercialization playbook to bring back to your organization!

Visit www.cbinet.com/oncology for more information.

Speakers Include Representatives from:
Celgene | Churchill Pharmaceuticals LLC | Eli Lilly & Co. | EMD Serono | Guard Dog Brand Development | Halozyme Therapeutics | Infinity Pharmaceuticals | Mayo Clinic | and more!

Drug Channels readers will save $400 off of the standard registration rate when they register with code NXP494.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category 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, January 14, 2016

Solving the Mystery of Employer-PBM Rebate Pass-Through

Manufacturers pay billions in rebates to pharmacy benefit managers (PBMs). How much of that money do PBMs share with their plan sponsor clients?

As far as I know, the only public answer comes from the Pharmacy Benefit Management Institute’s (PBMI) new 2015-2016 Prescription Drug Benefit Cost and Plan Design Report. (Free download with registration.) Drug Channels again toasts Takeda Pharmaceuticals North America for having sponsored the research.

According to the PBMI’s survey data, only three-quarters of employers directly receive a piece of manufacturer rebates. Some employers get 100% of the rebates. Others get a portion, sometimes with a guaranteed minimum amount.

Below, I also highlight PBMI data about the prevalence of spread pricing (as opposed to pass-through pricing) as a means for employers to compensate PBMs. Despite what you may have heard, many employers still seem to prefer spread pricing models. Ruh roh!