Thursday, September 22, 2016

Drug Channels News Roundup, September 2016: Walgreens Specialty Pharmacy, CVS Caremark, Drug Spending, Theranos, and an EpiPen joke

Autumn is almost here! Curl up with your favorite extra hot skim grande Pumpkin Spice blog and savor our latest seasonal harvest of Drug Channels news:
  • Walgreens Specialty Pharmacy tells us a teeny bit about its business
  • Dispensing oncology practices battle PBM CVS Caremark
  • The uncertain forecast for drug spending and gross-to-net pricing
  • A fascinating peek behind the downfall of Elizabeth Holmes and Theranos
Plus, Jimmy Kimmel tells an EpiPen pricing joke at the Emmys. Can’t wait for him to riff on AMP!

P.S. Join our nearly 3,000 @DrugChannels followers on Twitter for my daily tweets about intriguing and insightful stuff from the interwebs.

A Conversation with Gerry Gleeson, Walgreens Specialty Pharmacy, Pharmaceutical Commerce

Here’s an interesting interview with Gerry Gleeson, group vice president for Walgreens Specialty Pharmacy. Walgreens Boots Alliance (WBA) is highly secretive about its specialty business, so even the minimal data in this article are the most disclosure I’ve seen.

Note that the interview was conducted before WBA and Prime Therapeutics announced the formation of a new mail and specialty pharmacy business. See Why the Walgreens/Prime Deal Could Transform the PBM Industry

Pharmacy Benefit Managers’ Attack on Physician Dispensing and Impact on Patient Care: Case Study of CVS Caremark’s Efforts to Restrict Access to Cancer Care, Community Oncology Alliance

The Community Oncology Alliance (COA), an organization that advocates for community oncology practices, commissioned this white paper. It highlights a fascinating case study in the conflicts between payer-owned specialty pharmacies and physician dispensing.

CVS Caremark, one of the largest PBMs and the largest specialty pharmacy, now interprets federal regulations to mean that physician offices not otherwise licensed as a pharmacy are out-of-network in Medicare Part D networks. CVS Caremark therefore notified dispensing physicians that under the PBM’s interpretation of Part D regulations, practices without a pharmacy license would be excluded beginning January 1, 2017.

The white paper attacks CVS Caremark’s interpretation of CMS regulations as “wrong and unsupported.” (Fair warning: The white paper is quite wordy and would have benefited from some tight editing.) Meanwhile, CVS Caremark contends that it checked with CMS before going ahead with this change, per this OncLive article. More to come!

Has The Era Of Slow Growth For Prescription Drug Spending Ended?, Health Affairs

This article provides a concise summary of factors that could either increase or decrease drug spending. After carefully analyzing the data, the authors—from IMS Health, MIT, and Harvard—boldly conclude that “future spending trends remain highly uncertain.” Wow, really?

Nonetheless, this article nicely illustrates the aphorism “A good forecaster is not smarter than everyone else. He merely has his ignorance better organized.” Consider the author’s eye-opening chart showing rebates in the Medicaid program:

[Click to Enlarge]

As a percentage of gross Medicaid drug expenditures, rebates increased dramatically from 17.6% in 2003 to 47.6% in 2013. That’s a perfect illustration of the gross-to-net bubble that is pressuring channel economics, as I consider in EpiPen, Channel Economics, and the Great PBM Rebate Debate.

How Elizabeth Holmes’s House Of Cards Came Tumbling DownVanity Fair

Vanity Fair is carving out a nice niche as a purveyor of pharmaceutical industry schadenfreude. This time, it’s the hubris-filled story of Elizabeth Holmes, founder, chairwoman, and CEO of Theranos. The previous management of Walgreens famously invested in Theranos with only minimal due diligence. (See Craving Growth, Walgreens Dismissed Its Doubts About Theranos, from The Wall Street Journal.) It reminds us to be careful with sexy but unproven technology—and the prophets who hype these "revolutions.".

Jimmy Kimmel's Mom Makes PB&J for Emmys Audience, Jimmy Kimmel Live

Some silly Hollywood nonsense from Jimmy Kimmel…with a bonus joke about drug pricing! Pay attention at 1:30. Click here if you can’t see the video.

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