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, April 28, 2017

Building the Infrastructure for Outcomes-based Contracts

Today’s guest post comes from Scott Pribyl, CEO of mRx Ventures.

Scott discusses outcomes-based contracts for specialty drugs. He describes the challenges associated with data collection and collaboration among all the stakeholders—physicians, specialty pharmacies, pharmacy benefit managers (PBMs), third-party payers, Medication Therapy Management (MTM) companies, and patients.

To address these issues, Scott describes SamplifyRx, an outcomes infrastructure solution that allows all the stakeholders in the patient’s journey to track and manage patient outcomes and data. He argues that this technology can enable and manage outcomes-based contracts and reimbursement.

To learn more about the SamplifyRx outcomes infrastructure solution, email Scott Pribyl (Scott@SamplifyRx.com) or connect with him at Asembia’s 2017 Specialty Pharmacy Summit next week in Las Vegas.

Read on for Scott’s insights.

Thursday, April 27, 2017

Drug Channels News Roundup, April 2017: Teva, Diplomat Pharmacy, Oncology Practices, and Starbucks

Time for our monthly roundup of news stories that highlight key trends for U.S. drug channels. In this issue, get your claws into the following:
  • Teva launches an Advair competitor with a gross-to-net bubble busting strategy
  • A Diplomat Pharmacy exec gives us a great checklist for assessing specialty pharmacies
  • Wow! 60% of oncology practices are now owned by hospitals and health systems
Plus, Starbucks has some exciting news for insulin makers!

P.S. Stay up to date on the news and reports that I find intriguing by following @DrugChannels on Twitter.

Tuesday, April 25, 2017

Which PBM Best Managed Drug Spending in 2016: How Did OptumRx Compare?

In Which PBM Best Managed Drug Spending in 2016: CVS Health, Express Scripts, MedImpact, or Prime?, I examined the 2016 drug trend reports from four leading pharmacy benefit managers (PBMs). OptumRx, the PBM business of UnitedHealth, released its report too late to be included in that analysis.

The charts below remedy this omission. The data now include five major PBMs, which accounted for more than 80% of equivalent prescription claims in 2016. After we add OptumRx’s results, the claims-weighted average increase in drug spending for 2016 was only 3.3%.

These results again confirm that the supposed drug spending problem is a myth. However, some patients experience significant out-of-pocket cost increases, due largely to cost-shifting by plan sponsors. With such low overall spending growth, the next battle will be over how best to share the savings from PBM-negotiated rebates.

Monday, April 24, 2017

CBI’s 13th Commercial Contract & Chargeback Excellence

CBI's 13th Commercial Contract & Chargeback Excellence
June 21-22, 2017 | Parsippany, NJ

Take a deep dive into improving the wholesaler chargeback, navigating class of trade schema complexities, streamlining membership management and optimizing contract administration at CBI’s 13th Commercial Contract & Chargeback Excellence. By illustrating software solutions, case studies and perspectives from leading distribution partners, this conference is a comprehensive forum for pharmaceutical professionals to learn best practices and gain strategies to improve contract operations and administration.

Gain Actionable Takeaways From Speakers Including:
  • Marijo Bustos, Director, Government Programs and Commercial Compliance, ProMetic BioTherapeutics, Inc.
  • Lisa Ellington, Senior Manager, Contract and Chargeback Operations, McKesson
  • Leonard Fairfield, Director, Contract Operations and Analytics, Actelion Pharmaceuticals US
  • Harry Norsworthy, Associate Principal, Vizient
  • Todd Cox, Senior Manager, Government Pricing and Contracts, Gilead Sciences
  • Donna White, Vice President, Contracts and Compliance, Chiesi USA Inc.
  • Sherice Koonce, Director, Contracts, West-Ward Pharmaceuticals
  • Paula Martins, Director, Commercial Operations, Helsinn Therapeutics (U.S.), Inc.
  • Mandy Talley, Manager, Contract Administration – Managed Healthcare Services, Lilly USA, LLC
  • Jill Page, Director, Government Pricing Strategy Analysis, Fresenius Medical Care
  • Andrew Wilson, Vice President, 340B Solutions, McKesson
  • And more!
Interactive Discussions Surrounding:
  • Changing dynamics impacting the commercial pricing and contracting landscape
  • New strategies of risk-share agreements and value-based contracting
  • 340B Program changes impacting business operations and strategy
  • Benchmarking and organizational best practices for membership efficiency
  • Chargeback adjudication for 340B contract pharmacies
  • Efficiencies of med surg chargeback and roster management
  • Chargeback management innovations, system automation and contract analytics
  • Enhancing communication to facilitate wholesaler, GPO and manufacturer alignment
Download the complete agenda here, and visit www.cbinet.com/chargebacks for further details and to register. Drug Channels readers will save $400 off of the standard registration rate when they use discount code MHY489.

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

Friday, April 21, 2017

How Manufacturers Can Benefit From Unified Specialty Support Services

Today’s guest post comes from Tom Doyle, Executive Vice President of Commercial Solutions at H. D. Smith.

To prepare for impending market changes, Tom suggests that a manufacturer’s commercial team partner with a flexible, integrated services provider to increase market share and optimize the patient journey. He also discusses mid-tier specialty products and the need for such cost-effective solutions as Triplefin's Hub-Lite approach.

Click here to download H.D. Smith’s free white paper on specialty product launch planning. You can also visit H.D. Smith’s companies at Booth #200 during Asembia’s 2017 Specialty Pharmacy Summit in Las Vegas.

Read on for Tom’s insights.

Wednesday, April 19, 2017

Cardinal Health’s Unhappy Profit Surprise: The Coevolution of Pharmacy Buying Groups and Wholesaler Economics

Yesterday probably didn’t turn out as well as Cardinal Health had expected.

The good news: The company announced the acquisition of Medtronic's Patient Care, Deep Vein Thrombosis and Nutritional Insufficiency businesses for $6.1 billion in cash.

The bad news: Cardinal sharply lowered its outlook for future profits from its pharmaceutical distribution business.

The company cited lower generic drugs prices and “sell-side" pressure from pharmacy customers as two primary causes of its financial woes. Wall Street was unhappy: Cardinal stock closed down a whopping 11%. McKesson and AmerisourceBergen stocks fell in sympathy.

Cardinal Health’s projected profit downturn illuminates a dilemma facing drug wholesalers:
  • Generic buying consortia of wholesalers and pharmacies have reduced wholesalers’ acquisition costs for generic drugs
  • Independent pharmacies—the most profitable customers of wholesalers—are successfully using their own buying groups to extract lower prices from wholesalers
Independent pharmacies have been backed into a corner—and have responded by pushing back against their wholesale suppliers. Cardinal’s warning highlights the coevolution of profits within the pharmacy channel ecosystem. Expect wholesalers to be increasingly desperate to make up these lost funds.

Monday, April 17, 2017

How to Connect With Drug Channels at #Asembia17

In two weeks, Drug Channels Institute and Pembroke Consulting will hit Las Vegas for Asembia’s 2017 Specialty Pharmacy Summit, being held at the wonderful Wynn Las Vegas.

Here are three ways that you can interact with us in Las Vegas:

1) Join me at the opening Featured Session.
On Monday May 1, I’ll help kick off the Summit with the Featured Session Specialty Pharmaceuticals and Pharmacy: Today, Tomorrow and Beyond. I'll be joined by Doug Long from QuintilesIMS and Eric Percher from Barclays Capital. See you in the Encore Ballroom at 8 AM!

2) Learn how Drug Channels can help you.
To discover how you can reach the large and growing Drug Channels audience, you can speak personally with my wife and business partner, Paula Fein, M.S.Ed. Paula is Drug Channels Institute’s VP of Business Development. FYI: In the picture, she's on the left.

Email her at paula@drugchannelsinstitute.com and she’ll be happy to meet with you.

In the meantime, check out the 2017 Drug Channels Media Kit for an overview of the site, our traffic, and opportunities for sponsored guest and event posts.

3) Just say hello!
I love meeting and talking with Drug Channels readers, so please introduce yourself. But don’t worry: It will all be off the record. What we discuss in Vegas will stay in Vegas. ;)

See you soon!

P.S. To prep for the Summit, check out Chapter 3 (“Specialty Drugs and Specialty Pharmacies”) of our 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Thursday, April 13, 2017

Exclusive Update: The State of Specialty Pharmacy Accreditation in 2017

We estimate that for 2016, retail, mail, specialty, and long-term care pharmacies dispensed about $115 billion in specialty pharmaceuticals. (See Our Exclusive 2021 Outlook for Specialty Pharmacy Prescription Revenues.) How many specialty pharmacies are operating in the market? What types of organizations own these pharmacies?

With the help of a renowned mathematician (pictured at right), we collected data about specialty pharmacy accreditation and then categorized each pharmacy location based on ownership. Our exclusive findings:
  • The number of accredited specialty pharmacies is still booming. We counted more than 2,500 pharmacy locations with specialty accreditation. (But see our important caveat about this figure below.)
  • Pharmacy locations owned by healthcare providers—such as hospitals, health systems, physician practices, and providers’ group purchasing organizations—were the fastest-growing category of accredited specialty pharmacies.
Bottom line: A growing number and diversity of pharmacies are battling for control of the specialty market. Pharmacies owned by PBMs, wholesalers, insurers, retailers, and providers can now prove that they are special. Manufacturers and payers will need to figure out how to handle this increased competition and the associated demands for new network designs.

Tuesday, April 11, 2017

Our Exclusive 2021 Outlook for Specialty Pharmacy Prescription Revenues

The specialty boom continues to drive the pharmacy industry’s revenue growth. We estimate that in 2016, retail, mail, long-term care, and specialty pharmacies dispensed about $115 billion in specialty pharmaceuticals. Specialty drugs accounted for 28% of the pharmacy industry’s prescription dispensing revenues.

We project that in 2021, the pharmacy industry’s revenues will be about $572 billion—and that specialty drugs will account for 42% of that figure. More details below.

The growth of specialty drugs is reshaping the pharmacy and pharmacy benefit management (PBM) industries. This expansion is also drawing hospitals, health systems, and physician practices into the market. Later this week, we’ll take a closer look at the evolving landscape of specialty pharmacy providers.

Monday, April 10, 2017

Medicaid Drug Rebate Program Summit

Medicaid Drug Rebate Program Summit
September 11-13, 2017 | Chicago, IL

Join KNect365 for the 22nd year of MDRP this September 11-13, 2017 at the Marriott Magnificent Mile in Downtown Chicago, IL. This is your opportunity to benchmark best practices and gain solutions to overcome new operational challenges brought on by AMP Final Rule, 340B, Medicaid Expansion, Class of Trade, Fair Market Value, FSS, VA, OIG, and other critical government programs.

See why this is THE ONE MDRP event you can’t afford to miss!

Year after year, MDRP Chicago has continued to be the authoritative gathering for everything pricing, rebates, contracting, and collaboration. 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.

Register Now to SAVE an additional $100 off the Current Rates!
(A total of $700 in savings!)
Use Code P2258DRUG

Collaborate with your peers and benchmark best industry practices to:
  • Navigate Regulatory Hurdles
    • Understand and comply with state processes, operations and requirements
    • Address the impact of AMP Final Rule, 340B Guidance, along with State Policy changes
  • Minimize Wasted Resources
    • Develop strategies to streamline pricing and reporting
    • New Interactive Think Tank & Innovation Theatre - Hear from the industry's leading service providers as they showcase new technologies and products to improve operations
  • Optimize Finances
    • Calculate liability and improve accuracy and accountability
    • Discover the latest in Automation & Customization of finance systems
MDRP offers attendees the opportunity for face-to-face meetings between states and manufacturers during our exclusive Dispute Resolution Meetings. These one-on-one meetings can help you realize millions in potential savings!

For 2017, KNect365 has 14 confirmed states participating in MDRP:
  • Alaska
  • Arizona
  • Arkansas
  • Colorado
  • Delaware
  • Idaho
  • Kentucky
  • Michigan
  • Oregon
  • New Hampshire
  • North Carolina
  • South Carolina
  • Tennessee
  • Utah
Stay ahead of the curve by getting the best networking, education, and technology at MDRP Summit 2017.



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

Friday, April 07, 2017

Health Systems Disrupt the Specialty Pharmacy Market to Improve Patient Care

Today’s guest post comes from Vizient™ University Health System Consortium, the nation's largest network of academic medical centers (AMCs) who collaborate to exchange and advance knowledge. Vizient is the nation's largest healthcare performance improvement company.

The five authors of this article are employees of Vizient AMC members. Four of the five are leaders and participants of the organization's Pharmacy Network and its Specialty Pharmacy Committee.

The authors argue that specialty pharmacy programs at health systems provide significant advantages to hospitals, health systems, and patients. They highlight the specific benefits for organ transplant and hepatitis C patients.

Read on for their interesting perspectives.

Thursday, April 06, 2017

For Walgreens, Narrow Network PBM Partnering Pays Off

Yesterday, Walgreens Boots Alliance (WBA) reported its financial results for the fiscal quarter ending February 28, 2017.

The big news: Prescription activity spiked in Walgreens drugstores. It looks like Stefano Pessina, our global channels overlord and executive vice chairman and chief executive officer of WBA, has a solid strategy for winning U.S. prescription market share.

Back in November, I told The Wall Street Journal: “Walgreens is trying to be the best friend of every PBM that’s not named Caremark.” These latest results show that this aggressive partnering is paying off for its pharmacy business—although its front-end growth was weak and per-prescription profits appear to be down.

Read on for more details—and expect a competitive reaction.

Tuesday, April 04, 2017

Latest Data Show That Hospitals Are Still Specialty Drug Profiteers

The new 2016 Medical Pharmacy Trend Report (free download), from Magellan Rx Management, was released yesterday. As always, the report includes a boatload of useful data on medical benefit spending and claims. Click here to read the press release.

Unfortunately, the latest edition also shows how hospitals continue to earn outrageous profits on specialty drugs. Commercial payers still use reimbursement approaches that permit hospitals to inflate specialty drug costs by thousands of dollars per claim.

These hospital mark-ups translate directly into higher drug spending—regardless of how manufacturers set list prices. Using some fairly conservative assumptions about Remicade, I show below how hospitals are earning thousands of dollars more than the drug’s manufacturer does.

Meanwhile, health plans are struggling to shift patients from hospital outpatient settings to physician offices—where costs are lower, at least until those sites are acquired by hospitals.

I suppose that the charts below should be troubling to hospital-based physicians, who can barely control their righteous indignation over drug prices. Alas, it’s always easier to blame pharma companies than to admit that their own hospital employers are driving up healthcare costs.

Monday, April 03, 2017

PCMA PBM Policy Forum 2017

PCMA PBM Policy Forum 2017
May 1, 2017 | The Newseum | Washington, DC

In this era of high drug prices and expensive specialty medicines, the role of pharmacy benefit managers (PBMs) has never been more important. PBMs provide employers, unions, public programs, physicians, and consumers with cost savings strategies and clinical services that are essential to the affordability and efficacy of prescription drugs.

Typically, PBMs reduce drug costs by 30 percent for more than 266 million Americans enrolled in private and public plans, most notably Medicare Part D.

PCMA's annual PBM Policy Forum brings together the private and public sector to deliver important insights into the prescription drug marketplace and to highlight the role of PBMs in managing prescription drug costs and improving health outcomes.

Confirmed speakers:
  • Amy Bricker, Vice President, Supply Chain Strategy, Express Scripts
  • Alex Brill, Research Fellow, American Enterprise Institute
  • William Fleming, Segment President, Healthcare Services, Humana Inc.
  • Doug Holtz-Eakin, President, American Action Forum
  • Andrea Marks, Chief Analytics Officer, OptumRx
  • Mark Merritt, President & Chief Executive Officer, PCMA
  • Surya Singh, Executive Vice President & Chief Medical Officer, CVS/Specialty, CVS Heath
  • Moderator: Susan Dentzer, President & Chief Executive Officer, Network for Excellence in Health Innovation
Who Should Attend?
The PCMA PBM Policy Forum is designed for policy makers and staff from Capitol Hill and the Administration, as well as healthcare and drug industry advocates from think tanks, patient advocacy groups, industry trade associations, and the media.


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

Thursday, March 30, 2017

Drug Channels News Roundup, March 2017: Eli Lilly, CVS Health, Novo Nordisk, and Specialty Pharmacies

Spring has finally reached Drug Channels' worldwide headquarters in lovely downtown Philadelphia! (See photo at right.) Before your allergies kick in, please enjoy this month’s selection of noteworthy news stories.
  • What has Eli Lilly revealed about its gross-to-net discounts?
  • Are CVS Health and Novo Nordisk starting to pop the gross-to-net bubble?
  • Who will win the 2017 specialty pharmacy award?
Plus, we celebrate healthcare nonreform by revisiting an innovative infinite-deductible health plan.

P.S. Follow @DrugChannels for my daily curated selection of stories and articles from the drug channels multiverse.

Tuesday, March 28, 2017

A Tale as Old as Time: Examining Employer-PBM Rebate Relationships for Specialty Drugs

Pharmaceutical manufacturers pay billions in rebates to pharmacy benefit managers (PBMs). These beastly rebates are the largest single component of the gap between a drug’s list price and the net price received by the manufacturer. But one question comes up every day in this little town: For specialty drugs, how much of that money do PBMs share with their plan sponsor clients?

To find out, let’s put the Pharmacy Benefit Management Institute’s (PBMI) new 2017 Trends in Specialty Drug Benefits Report to the test. (Free download after unnecessarily complicated registration process.) Drug Channels thanks Walgreens Specialty Pharmacy for having sponsored this enchanted research.

According to the PBMI’s survey data, many (but not all) employers receive a portion of manufacturer rebates for specialty drugs. Large employers are most likely to get the entire rebate amounts. Others get a share of the rebates or a flat guaranteed amount.

As more specialty drugs are launched, specialty therapeutic categories will become more crowded. Expect the value of manufacturer rebates for specialty drugs to grow and formulary exclusions to become more common. Manufacturers will face the same dilemma as our heroine Belle: Is it possible to love someone who is holding you captive?

Monday, March 27, 2017

World Congress Manufacturers’ 340B Summit

World Congress Manufacturers’ 340B Summit
May 16-17, 2017 | Philadelphia

Join pharmaceutical manufacturers, thought leaders, and leading regulatory strategists at the World Congress Manufacturers’ 340B Summit, May 16-17, in Philadelphia. This event will dive deep into the strategic, operational, legal and regulatory implications to pharma manufacturers of the evolving health care landscape around 340B.

Through high-level discussion:
  • Create strategies for managing pricing calculations and average ceiling prices
  • Overcome operational challenges to better align refund strategies
  • Improve self-disclosure reporting while building better relationships with covered entity
  • Gain legal insights and considerations around 340B to better prepare for the changing landscape
  • Review trends, findings and preparation strategies for increased HRSA audits
Confirmed speakers include executives from Pfizer, J&J, BMS, Fresenius Medical Care, Hogan Lovells, King & Spalding, Sidley, State of Oregon, University of Chicago, NACDS.

To learn more or register for this event, visit here. Rates start at $995 for pharmaceutical manufacturers. Drug Channels readers can use discount code DC200 to save $200!

This event, co-located with the 2nd Annual Covered Entities’ 340B Summit, provides comprehensive coverage of the 340B program.

CPE Credits and CLE Credits* are available.

*CLE Pending approval

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

Friday, March 24, 2017

Five Questions to Ask When Selling Your Pharmacy

Today’s guest post comes from Christian Herrington, Corporate Vice President Pharmacy Strategies for H.D. Smith.

Christian addresses five frequently asked questions for pharmacy owners who are considering selling their pharmacy. To help independent pharmacies both navigate and direct the sales process, H. D. Smith created VentureRx.

VentureRx fully supports the sale, purchase, start-up and transition strategies of pharmacies. Click here for a free, no-obligations needs assessment from VentureRx.

Read on for Christian’s insights.

Tuesday, March 21, 2017

Which PBM Best Managed Drug Spending in 2016: CVS Health, Express Scripts, MedImpact, or Prime?

Four of the largest pharmacy benefit managers (PBMs)—CVS Health, Express Scripts, MedImpact, and Prime Therapeutics—have raised their swords and released their 2016 drug trend reports. (Links below.) That means it’s time for some Drug Channels-style fun! Below, I review what the reports reveal about drug spending—and which questions remain unanswered.

Drug trend measures the year-over-year changes in a plan sponsor’s pharmacy benefit drug spending. As you will see, all four PBMs reported that their drug trend percentages for 2016 were in low single digits. The unweighted average among them was a mere 3.5%. About one-third of PBM clients experienced year-over-year declines in drug spending.

Put more simply: The U.S. doesn’t have a drug spending problem. It's fake news.

Specialty drugs have doubled as a share of plan sponsors’ benefit costs. Since these products account for only about 1% of claims, pharmacy benefit management is increasingly focused on handling these patients and their complex, hard-to-treat diseases. Unfortunately, payers seem set on discriminating against people who receive these therapies.

Keep in mind that the PBMs’ reports are primarily marketing documents, not peer-reviewed research studies. But as many PBM executives have said: What we do in life echoes in eternity!

Monday, March 20, 2017

CBI’s Real-Time Benefit Check and ePrior Authorization Summit

CBI’s Real-Time Benefit Check and ePrior Authorization Summit
May 23-24, 2017 | Philadelphia, PA
www.cbinet.com/benefit-check

CBI's Real-Time Benefit Check & ePrior Authorization Summit is headed back to the East Coast this May.

Mark your calendar and benefit from this highly focused conference that's on the pulse of groundbreaking advancements in real-time benefit verification and prior authorizations. Industry pioneers from bio/pharma, PBMs, plans, pharmacies, health systems, prescribers and system solution providers will discuss the latest in standards, adoption and best practices to ensure streamlined prescriber workflow and faster access to medication for patients.

Featured Sessions Include:
  • Regulatory/Legislative Update - Gain Real-Time Updates on State and Federal Legislative Advancements
  • NCPDP Update - Advancements and Standards for Adoption
  • Transcending to Higher Efficiency and Patient Access – A Vision and Reflection on Breakthroughs in Integrated ePA Functionality and Real-Time Determinations
  • Implementation Best Practices – Showcasing Trailblazing Efforts and Pilots to Date
  • Health System Perspectives on Patient Portal Implementation
  • Integrating ePrior Authorizations and Benefit Determinations into the HUB Service Model
  • Ensuring Continuity of Care and Addressing PA Renewals
  • New Frontiers in Formulary Data Management and Prior Authorization Processes
Confirmed Speakers:
  • Lynnae M. Mahaney BSPharm, MBA, FASHP, Center for Pharmacy Practice Accreditation
  • Nicole Russell, Manager of Government Affairs, NCPDP
  • Sam Garas, RPh MSc, Director-Medical Outcomes Specialist- National Specialty Accounts, North America Medical Affairs, Pfizer, Inc.
  • John Klimek, R.Ph. Senior Vice President, Standards and Industry Information Technology, NCPDP
  • Catherine C. Graeff, R.Ph, MBA, Principal, Sonora Advisory Group; NCPDP Work Group
  • Shelly Spiro, Executive Director, Pharmacy HIT Collaborative
  • Tyler Scheid, Senior Policy Analyst, Administrative Simplification Initiatives, American Medical Association
  • Robert Sanchez, Senior Director for Enterprise Product Innovation, CVS Health
  • Michele Davidson, Senior Manager, Pharmacy Technical Standards, Development & Policy, Government Relations, Walgreen Co.
  • Joel White, Founder and President, Horizon Government Affairs
Be among the first to see the complete agenda by visiting here, or check out www.cbinet.com/benefit-check for further details and to register. Drug Channels readers will save $400 off of the standard registration rate when they use discount code HYE399.*

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

Tuesday, March 14, 2017

Scott Gottlieb’s Radical Idea for Disrupting U.S. Drug Channels: Implications for PBMs, Wholesalers, and Pharmacies

President Trump has nominated Scott Gottlieb, M.D., to be the commissioner of the Food and Drug Administration (FDA). I’ve been a big fan of Dr. Gottlieb’s for some time, and think he is an outstanding choice.

In addition to his role overseeing the FDA, Dr. Gottlieb will be a key policy advisor to the Trump administration on drug pricing. As you will see below, Dr. Gottlieb is unusually familiar with the warped incentives in the gross-to-net bubble—the growing spread between a manufacturer’s list price for a drug and the net price to a third-party payer after rebates.

His solution is to migrate brand-name pricing from today’s formulary rebates to up-front discounts. As I explain below, such a shift would radically disrupt the business models and economics of pharmacy benefit managers (PBMs), wholesalers, and pharmacies. I speculate that the change would be negative for the channel.

Right now, most people believe that we’ll continue to muddle along with our Rube Goldberg system. But if Dr. Gottlieb is confirmed as FDA commissioner, then perhaps we will see a black swan event—a massively important yet unexpected break from current practice. Hmmm…

Monday, March 13, 2017

19th Annual Medicaid and Government Pricing Congress

Medicaid and Government Pricing Congress
May 8-10, 2017
Disney’s BoardWalk Inn | Orlando, Florida

Mark your calendar for CBI's Medicaid and Government Pricing 2017 – a dynamic and power-packed program for government pricing professionals!

Between the looming prospect of Obamacare repeal or replacement, the recently released HRSA Final Rule on Calculation of 340B Ceiling Prices and much more, there is no better time to join industry at CBI’s 19th Annual Medicaid and Government Pricing Congress and gain an in-depth understanding of how to face the complexities of this rapidly evolving landscape.

Taking place May 8-10 at the BoardWalk Inn in Orlando, FL, attendees will gain best practices and practical strategies on issues including healthcare policy and politics, drug pricing enforcement, MDRP compliance, 340B, FSS solicitation, gross-to-net and much more. This all-encompassing agenda features tailored tracks, interactive working groups, political keynote address and a State Medicaid Directory panel discussion.

Convene with Leading Government Pricing Experts Representing:

Bristol-Myers Squibb | Former Head of Health and Human Services − Commonwealth of Pennsylvania and the State of Rhode Island | Department of Veterans Affairs | Magellan Rx Management | Apexus | Sunovion Pharmaceuticals | KPMG | Amneal Pharmaceuticals | Huron Consulting Group | Pfizer Inc | Sidley Austin LLP | Sandoz | BDO | Mississippi Division of Medicaid | Acorda Therapeutics, Inc. | Cumberland Consulting Group | Akara Group LLC | AbbVie | Florida Agency for Health Care Administration | Daiichi Sankyo, Inc. | West-Ward Pharmaceuticals | M. Lee Consulting, LLC | Helsinn Therapeutics (U.S.), Inc. | Fresenius Medical Care North America | Johnson & Johnson Health Care Systems Inc. | OIG, United States Department of Veterans Affairs | Oklahoma Health Care Authority | Celgene Corporation | Gilead Sciences, Inc. | Deloitte & Touche LLP | King & Spalding | PBS NewsHour | Department of Health and Human Services, OIG | Arent Fox LLP | PhRMA | Chiesi USA, Inc. | Indivior | McKesson | Plus more!


Use Discount Code DRC400 by March 24, 2017

.
*Discount expires 3/24/2017; Discount 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, March 09, 2017

Janssen Reveals and Explains Its List and Net Drug Pricing

Johnson & Johnson’s Janssen business unit recently released the 2016 Janssen U.S. Transparency Report. (Free download.)

The report, which provides new disclosures about the company’s activities, is very well done. Below, I offer some observations on Janssen’s pricing and its discussion of the drug channel system.

Notably, Janssen revealed that its average list price increases have been below 10% for at least the past five years. Its average net price increases, however, have been roughly half of the list price increases. For 2016, list-to-net reductions were 35.2%.

The report makes a meaningful contribution to the ongoing debate about the true pricing of prescription drugs and the gap between a manufacturer’s gross (list) prices and the net prices to third-party payers. Every Drug Channels reader should review it.

Tuesday, March 07, 2017

The New Health Transformation Alliance Deal: Mostly Good for PBMs, but Bad for Express Scripts

Last night, The Wall Street Journal reported that corporate members of the Health Transformation Alliance (HTA) will direct their member's pharmacy benefit management business to the Caremark business of CVS Health and the OptumRx business of UnitedHealth. See Alliance of Companies Unveil First Steps Aimed at Cutting Health-Care Costs.

HTA includes 38 of the country’s largest corporations. (See a list of the 20 founding companies here.) Many HTA members already use Caremark and OptumRx. These PBMs will retain their role in the drug channel, although with presumably lower margins, more uniform contracts, and greater transparency. Express Scripts, however, risks significant customer losses, because a number of HTA members are Express Scripts customers.

The HTA deal reinforces PBMs continued presence and role in the drug channel. By forming a giant buying group, plan sponsors are choosing to evolve their PBM relationships, not bypass the middleman. That's how markets are supposed to work. Read on for my additional observations on this novel arrangement.

Monday, March 06, 2017

The U.S. Health Care Congress 2017

The U.S. Health Care Congress 2017
April 30 – May 3, 2017 | Washington, DC

The U.S. Health Care Congress 2017 agenda has been updated and re-released.

Reserve your seat at the table with decision-makers from all walks of health care including payer, health system, policy, employer, and life sciences organizations who are committed to transforming and improving health care.

Join World Congress April 30 – May 3, 2017 in Washington, DC.

Early rates ends Friday, March 17, 2017. Use promo code DCIPEM for an additional $200 savings off the early rate.
  • Click here to download the updated agenda brochure.
The U.S. Health Care Congress 2017 will feature:
  • 4 Days of Big-Picture Keynote Addresses and Panel Discussions
    • 200+ Distinguished Speakers
  • Networking and Exhibit Hall:
    • 50+ Exhibit Booths
    • 1200+ Domestic and International Participants
  • 14 Co-Located Events
    • Health Plan and Payer Summit
    • Hospital and Health System Summit
    • Health System Integration Summit
    • Nurse Leadership Summit
    • Medicaid and Health Policy Summit
    • Bundled Payments Summit
    • Payer-Provider Behavioral Health Summit
    • Destination Health: The Medical Travel Summit USA
    • Women's Health Summit
    • Data Analytics and Technology Summit
    • Network and Contract Management Summit for Providers and Payers
    • Employer-Health System Direct Contracting, Worksite Clinics, and Value-Based Partnerships Summit
    • Prevention, Wellness, and Disease Management Summit
    • Corporate Health-Risk Innovation Summit
Who will be there? Click here to view a sample list of your colleagues who have already reserved their seat. World Congress looks forward to seeing you in DC.

Complete your registration before March 17, 2017 using promo code DCIPEM for an additional $200 savings. For an immediate reservation, call +1 781-939-2400 or reserve online.

*Discount not available on Gov't, workshop only or webcast rates. May not be combined with any other offer.


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

Friday, March 03, 2017

Watch Congress Vent About PBMs on the House Floor

ICYMI: Rep. Doug Collins (R-GA) led a 60 minute rant against pharmacy benefit managers (PBMs) in the U.S. House of Representatives. Joining him were congressmen Brian Babin (R-TX), Buddy Carter (R-GA), John J. Duncan, Jr. (R-TN), Dave Loebsack (D-IA), and Austin Scott (R-GA). It’s an enlightening tour through the usual grievances and conspiracy theories about PBMs.

Regular readers know that I have called out PBMs for the potentially warped incentives embedded in rebate practices and the gross-to-net bubble. See, for example, this article and this one.

But the overheated rhetoric on the House floor was truly jaw dropping. Example: Rep. Collins kicked things off in style by claiming that PBMs engage in “monopolistic, terrorist kind of ways that they are dealing with our community pharmacies and independent pharmacies.”

Terrorists? Really?!? I wonder how ISIS feels about this comparison.

Video, transcript, and additional observations below. Enjoy!

Thursday, March 02, 2017

New CMS Forecast: Lower Drug Spending Growth

The Centers for Medicare & Medicaid Services (CMS) recently released its updated forecasts for national health expenditures. See the Health Affairs article: National Health Expenditure Projections, 2016–25: Price Increases, Aging Push Sector To 20 Percent Of Economy. (Available for free to subscribers and to others for purchase.)

These new data don’t account for any changes in policy or the law, such a repeal of the Affordable Care Act (ACA). They do, however, show drug spending growth below that of CMS’s July 2016 projections. The updated forecasts predict that through 2025, drug spending will grow at roughly the same rate as will total U.S. healthcare spending.

By 2025, the U.S. is expected to have spent about $597 billion annually on outpatient prescription drugs. Just seven months ago, the 2025 figure was projected to $615 billion. Below, I also review drug spending projections by payer. CMS expects that drug spending will account for a stable share of private insurance, but a bigger part of Medicare spending.

Note that these projections will be revised when the law changes. For now, we have only CMS’s vision. Reality will render its own opinion soon.

Tuesday, February 28, 2017

Drug Channels News Roundup, February 2017: Specialty Pharmacy (x2), PBMs in Medicare, and Health Insurance Hilarity

Our mild winter is almost over! Celebrate the imminent return of spring with our selection of noteworthy news stories. In this issue:
  • Business trends for specialty pharmacy owners
  • The new Specialty Pharmacy Patient Choice Award
  • Pharmacy benefit managers find a powerful friend
Plus, some droll health insurance humor! (Is there any other kind?)

P.S. Remember to follow me on Twitter @DrugChannels for daily tweets on cool and intriguing stuff.

Monday, February 27, 2017

eyeforpharma Oncology Market Access & Pricing 2017

eyeforpharma Oncology Market Access & Pricing 2017
June 15-16, 2017
Le Meridien | Philadelphia, PA

In an increasingly complex and fragmented healthcare space, isn’t it time for true innovators to take control?

Against the back drop of increased pricing pressure, the next few years in Oncology will be volatile. But with volatility comes great opportunity- especially for Pharmaceutical companies ready to step from the periphery to the centre of the healthcare stage. Pharma can- and should lead stakeholders towards mutually beneficial outcomes and drive the decision making processes that will both outline oncology’s future and redefine the healthcare system.

The shift from volume to value has brought the adoption of alternative payment models, increased payer involvement, increased spending on oncology therapeutics, a shift in drug distribution, integrated delivery systems… the list is endless. Meeting the needs of cancer patients is now down to successful navigation of a complex, fast-evolving market place.

The answer to this existential crisis is multi-stakeholder buy-in, but with pharma firmly at the helm. We need to embrace more collaboration, transparency and payer/patient engagement. eyeforpharma’s Oncology Market Access & Pricing Summit will show you how. Download the full agenda here.

In June, after the dust from ASCO has settled, with expert insights from Julie Locklear, VP, EMD Serono; Kevin Fitzpatrick, CEO, CancerLinQ; Bryon Wornson, VP, Pfizer; Ariella Evenzahav, Head, Takeda; Lou Sanquini, VP, Healthagen Aetna and many more…eyeforpharma will be addressing the key strategic points in more detail, including:
  • Expert insights on how to move value from theory to reality
  • Ways to change market place dynamics and develop stronger patient, payer and HCP partnerships
  • Guidance on how to connect reimbursement with value and win over your stakeholders
Join eyeforpharma at a provocative and complete gathering for commercialization, market access and pricing leaders in Oncology to find out how Pharma can deliver leadership-based value, satisfy payers and drive better outcomes across the board.

Access the full agenda here.


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

Wednesday, February 22, 2017

The Top 15 Specialty Pharmacies of 2016

In 2016, specialty drugs became an even bigger part of the pharmacy industry. We estimate that in 2016, retail, mail, long-term care, and specialty pharmacies dispensed about $115 billion in specialty pharmaceuticals. Specialty drugs accounted for 28% of the pharmacy industry’s prescription dispensing revenues.

Below is our exclusive list of the 15 largest pharmacies, ranked by estimated revenues from dispensing specialty pharmaceuticals. This year’s expanded list includes specialty pharmacies owned by pharmacy benefit managers (PBMs), health plans, retail chains, and wholesalers. A further five pharmacies are independent companies—for now.

Lace up and get ready to slug it out with our latest update on the booming specialty market.

Tuesday, February 21, 2017

Join me at Asembia's Specialty Pharmacy Summit 2017

Specialty Pharmacy Summit 2017
April 30 – May 3, 2017
Wynn & Encore | Las Vegas

Please join me at Asembia's  Specialty Pharmacy Summit 2017, which will take place from April 30 to May 3, 2017, at the wonderful Wynn & Encore Las Vegas.

This year, I will help kick things off with an opening Featured Session titled Specialty Pharmaceuticals and Pharmacy: Today, Tomorrow and Beyond. I'll be joined by Doug Long from QuintilesIMS and Eric Percher from Barclays Capital.

The Summit attracts an impressive diversity of pharmacies, manufacturers, health plans, wholesalers, hospital systems, pharmacy benefit managers, patient advocacy groups, and more. View the agenda and check out the list of speakers.

Here's my review of last year's Summit: The State of Specialty Pharmacy in 2016: Reflections from #Asembia16.

Read on for more details about this great specialty pharmacy event and register now. See you in Vegas!

Thursday, February 16, 2017

Retail Clinic Check Up: CVS Retrenches, Walgreens Outsources, Kroger Expands

Retail clinics focus on convenient care for simple acute conditions. They exemplify how drugstores and other retail outlets are broadening their services to emphasize non-dispensing revenues.

As I predicted last year, clinic growth stalled in 2016. From 2010 to 2015, the number of retail clinics grew by nearly 70%, to more than 2,000 locations. As of January 2017, the number of retail clinics was unchanged compared from the 2016 figure.

Below, I update our analysis of the chains with the biggest clinic market share: CVS Health, HEB, Kroger, Rite Aid, Walgreens, and Walmart. As you will see, strategies and growth rates differ.

FYI, this post is adapted from Section 1.4.1. of our 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. Friendly reminder: Discounted pricing for the report ends tomorrow!

Tuesday, February 14, 2017

Express Scripts Reveals What Really Drives Drug Spending—And Why the Government May Do No Better

Last week, Express Scripts released its 2016 Drug Trend Report for the commercial market. (Free download. Download the two separate documents titled “Executive Summary” and “Commercially Insured” for the full story.)

Kudos to Express Scripts for continuing to publish these insightful data. Too bad that its PBM peers have stopped releasing comparable data or devolved into publishing only the briefest of marketing pamphlets.

For 2016, drug trend—the year-over-year change in spending—was a mere 3.8% for Express Scripts’ commercial plan sponsor customers. The Express Scripts data also highlight how drug prices were only part of the reason behind moderating drug spend. Contrary to the public rhetoric, increased utilization was a bigger influence than higher prices for both specialty and traditional drugs.

Tough benefit management enabled one-third of plan sponsors to lower spending from 2015 to 2016. Will Medicare and Medicaid really be willing to limit access to medicines and pharmacies? I wonder how many Americans would say “Be Mine” to aggressive utilization management tactics.

Monday, February 13, 2017

CBI’s Formulary, Co-Pay and Access Summit

CBI’s Formulary, Co-Pay and Access Summit
April 11-12, 2017 | San Francisco, CA
www.cbinet.com/formulary

CBI’s Formulary, Co-Pay and Access Summit is coming up April 11-12 at the Hyatt Centric Fisherman’s Wharf in San Francisco. For 2017, this annual meeting focuses on overcoming patient affordability barriers and navigating increased efforts from health plans to limit reimbursement of high cost therapeutics. There’s also a focus on the hot button issues impacting the pharma/bio industry today, including formulary exclusions, high deductible plans, changes in benefit design, NDC blocks and step therapy programs.

Interactive Discussions on Critical Topics Affecting Patient Access and Discount Programs:
  • Formulary Breakthroughs – Moving Beyond Co-Pay Programs to Encourage Collaboration and Improve Patient Outcomes
  • Survey Data Review - Explore Physician Perspectives on Prior Authorization and Formulary Issues
  • Buy and Bill, Physician Administered Specialty Drugs – Managing Complexities while Ensuring Compliance
  • May the Field Force Be With You – Managing Field Representatives to Execute Co-Pay Programs
New for 2017!
  • Tech Talk – SEO Optimization to Promote Co-Pay Cards
  • Stefani Klaskow, Head of Industry, Healthcare, Google
For more information, please download the complete agenda or visit www.cbinet.com/formulary. Drug Channels readers will save $400 off of the standard registration rate when they use discount code MPD934.*

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



Tuesday, February 07, 2017

NEW: The 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

I am pleased to announce our new The 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, available for purchase and immediate download.
We’re offering special discounted pricing if you order before February 17, 2017!

With more than 140 proprietary charts, exhibits, and data tables, it offers the only complete examination of the pharmacy and PBM industries’ prescription economics, reimbursement models, market structure, growth rates, forces of change, and interactions within the U.S. healthcare system.

See below for more info and some behind-the-scenes tidbits. Happy reading!

Monday, February 06, 2017

sPCMA Business Forum 2017

sPCMA Business Forum 2017
March 8 & 9, 2017
Hilton Bonnet Creek | Orlando, FL

The sPCMA Business Forum offers invaluable networking and education for individuals and companies involved in specialty drug benefit management including specialty pharmacies, PBMs, drug manufacturers and others.

Conference sessions will cover critical industry issues including:
  • The high price drug debate
  • Net price
  • Legislative landscape under a new Administration
  • The shifting landscape of specialty pharmacy business models
  • Medical formulary and driving preferred utilization in the medical benefit
  • The latest developments in oncology value-based care
  • America’s opioid abuse epidemic
  • Digital technologies and medication adherence
  • Specialty drug trend and management implications
  • Limited specialty networks for rare and orphan diseases
  • Exclusion lists
  • And more!
Industry thought leaders confirmed to speak include:
  • Tom Barker, Partner, Co-Chair, Healthcare Practice, Foley Hoag, Formerly General Counsel, HHS, and Formerly General Counsel, CMS
  • Jeffrey Berkowitz, Executive Vice President, Optum
  • Chris Bradbury, Senior Vice President, Integrated Clinical Solutions and Specialty Pharmacy, Cigna
  • William Fleming, President, Humana Pharmacy Solutions, Humana Inc.
  • Mark Merritt, President & Chief Executive Officer, PCMA
  • Steve Miller, Senior Vice President & Chief Medical Officer, Express Scripts
  • Dave Moules, Vice President, U.S. Payer and Channel Access, Pfizer
  • Len Schleifer, Founder, President & CEO, Regeneron
  • And many more!

Contact PCMA
Please contact Jenny Dawson with questions or to request information about the Affiliate Program or conference sponsorships.


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


Thursday, February 02, 2017

The Top 15 U.S. Pharmacies of 2016

Next week, Drug Channels Institute will release our updated 2017 Economic Report on Pharmacies and Pharmacy Benefit Managers (known in our previous editions as The Economic Report on Retail, Mail, and Specialty Pharmacies)

The exhibit below—one of 143 in our new report—provides a first look at the largest pharmacies, ranked by total U.S. prescription dispensing revenues for calendar year 2016. As you will see, the growth of specialty drugs is reshaping the pharmacy and PBM industries.

For a sneak peek at the complete report, download the free overview. Enjoy!

Wednesday, February 01, 2017

DIR Fees, Rebates, Pharmacy Economics, and the Future of Medicare Part D

The Centers for Medicare & Medicaid Services (CMS) just released a controversial and important new report: Medicare Part D – Direct and Indirect Remuneration (DIR).

The report shows mixed consequences of DIRs in the Medicare Part D program. For example, manufacturer rebates (the biggest part of DIRs) reduce plan costs and Part D premiums. However, beneficiaries pay higher out-of-pockets costs because coinsurance amounts are based on the undiscounted, pre-rebate retail price. Meanwhile, the government is paying a growing share of drug costs due to catastrophic coverage.

The CMS report has important implications for how we think about rebates, gross-to-net discounts, plan premiums, and patients’ out-of-pocket expenses. That’s why industry reactions have ranged from outrage to defensiveness. I encourage you to read the report and think about how it lays the groundwork for changing the Medicare Part D program.

Tuesday, January 31, 2017

Drug Channels News Roundup, January 2017: Gross-to-Net Details, Part B, Diplomat, CVS Health, and…This Site!

The weather may be chilly, but our monthly news update will keep you purring. Here are important new developments that will ignite your curiosity:
  • A great new report that quantifies manufacturers’ gross-to-net discounts
  • MedPAC targets Part B reimbursement
  • Diplomat and CVS Health offer competing looks at the specialty drug pipeline
Plus, we here at Drug Channels have just released our 2017 media kit. Check it out and let us know how we can help you appear on the site!

P.S. I've been pretty active on the @DrugChannels Twitter  account. Follow along for my daily tweets on cool and intriguing stuff.

Monday, January 30, 2017

CBI’s 4th Annual e-Rx and EHR Forum — ePrescribing and Electronic Health Records

CBI’s 4th Annual e-Rx and EHR Forum — ePrescribing and Electronic Health Records
March 15-16, 2017 | Philadelphia, PA

Exclusive Offer – Register by 2/24/2017 and save $400* (mention promo code ERXDC4)

CBI's flagship e-Rx and EHR conference returns to Philadelphia in March for unparalleled learning and benchmarking opportunities. Benefit from the life sciences industry’s foremost event dedicated to the forward thinking strategies and tactics to streamline HCP workflow, drive customer education and facilitate access via e-Prescribing and EHR technologies.

Why e-Rx and EHR 2017? Here are just a few of the many exciting features of this year's transformative program:
  • A four-physician panel delivering first-hand accounts of HCP experiences with EHR systems
  • An eye-opening Keynote from IBM Watson Health, providing a unique glimpse into the future of healthcare IT
  • Industry insights and expertise from, among others: AstraZeneca, Celgene, Boehringer Ingelheim, NCPDP, Maine Coast Memorial Hospital, Intercept Pharmaceuticals
  • Coverage of the hottest topics and key challenges keeping you up at night, including population health, innovations at the point of prescribe, ePrior authorizations, preventing opioid abuse and so much more

*Discount offer valid through 2/24/2017; 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.

Thursday, January 26, 2017

McKesson’s Profit Shortfall: How Wholesalers Benefit From Rising Drug List Prices

Yesterday, McKesson reported another quarter of disappointing financial results. Click here to read the press release.

CEO John Hammergren complained that the company was “unfavorably impacted in the third quarter by weaker branded pharmaceutical pricing than anticipated.”

On last night’s earnings call, the company echoed its threat to renegotiate agreements with manufacturers that don’t increase drug list prices at a rate that's acceptable to McKesson.

In What McKesson’s Profit Warning Means for Manufacturers and Pharmacies, I explained that McKesson and other drug wholesalers want drug list prices to rise. To help you interpret what’s going on, below is a brief excerpt from our 2016-17 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors that outlines precisely how wholesalers benefit from drug price inflation—even when they have fee-based agreements with manufacturers. File this post under “warped channel incentives.”

Tuesday, January 24, 2017

The Weird and Wild Gross-to-Net Adventures of EpiPen and Its Alternatives

Last week delivered significant announcements that will shake up the market for epinephrine auto-injector pens. CVS began promoting a lower-cost EpiPen alternative. Small pharma company Kaléo relaunched the AUVI-Q. Meanwhile, Mylan’s new generic EpiPen continued to gain traction.

It’s a good time to revisit the EpiPen situation and see what it tells us about U.S. pharmaceutical industry pricing. After last week’s announcements, there are now four key products, each with its own list price and rebate arrangements:
  • An EpiPen with a $608 list price and rebates to pharmacy benefit manages (PBMs)
  • An EpiPen with a $300 list price, but no rebates
  • Adrenaclick, an alternative product with a $110 cash price at CVS pharmacies
  • Auvi-Q, another alternative, with a $4,500 (!) list price
As I explain below, these variations wonderfully illustrate the warped incentives embedded in our crazy drug channel. Will we make progress in popping the gross-to-net bubble?

Monday, January 23, 2017

PAP 2017 – CBI’s 18th Annual Patient Assistance & Access Programs

PAP 2017 – CBI’s 18th Annual Patient Assistance & Access Programs
March 16-17, 2017 | Baltimore, MD

CBI’s PAP Summit continues the tradition of uniting manufacturers, co-pay foundations, non-profits, free clinics, advocacy organizations, hospitals and more to analyze the legalities, intricacies and best practices for these vital programs at a time of unprecedented need. As pricing pressures, politics, regulatory scrutiny and "under insurance" converge, now is the time to gather, discuss and plan the path forward.

2017 Program Highlights Include:
  • Marketplace trends impacting patient access, affordability and adherence
  • The prospect of Obamacare reversal and what it means for patient access
  • Emerging market-based and political initiatives to control drug utilization
  • New waves of patients and evolving models of assistance
  • Trends and insights in co-pay program assistance and utilization
  • Program best practices to optimize the patient journey
  • Advocate and manufacturer relations to enhance patient access
Plus – Choose from Three Content Streams:
  • Technology and Innovation – Paving a Path to Improve Outcomes
  • Affordability and Access – Streamlining Financial Support and Access to Care
  • Legal and Compliance – Oversight and Frameworks for Compliance
For more information, please download the complete agenda or visit www.cbinet.com/pap. Drug Channels readers will save $400 off of the standard registration rate when they use discount code FDH399.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rate or non-profit 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 18, 2017

New 2017 Part D Enrollment Data: Walgreens and Walmart Trounce CVS in Preferred Networks

Just-released data from the Centers for Medicare & Medicaid Services (CMS) confirms that preferred cost sharing networks will continue to dominate Medicare Part D. Our exclusive analysis finds that for 2017, 73% of seniors are enrolled in Prescription Drug Plans (PDPs) with preferred pharmacy networks. The three biggest companies—Humana, UnitedHealthcare, and CVS Health's SilverScript—now account for 69% of enrollment in stand-alone Part D plans.

Below, we use the enrollment data to analyze the major pharmacy chains’ position within the 17 major multi-regional Part D plans with preferred networks. As you will see, Walgreens and Walmart are the big winners, while CVS and Rite Aid lag far behind.

As long as pharmacies are willing to accept lower reimbursements in exchange for increased store traffic, preferred networks will continue to grow. For 2017, Walgreens’ aggressive partnering strategy looks likely to result in significant prescription market share gains.

Tuesday, January 17, 2017

PBMI 22nd Annual Drug Benefit Conference

PBMI 22nd Annual Drug Benefit Conference
March 6 – March 8, 2017 | Orlando, Florida
Location: Loews Portofino Bay Hotel at Universal Orlando

The conference will kick off with an opening speech by Scott Gottlieb, M.D. Dr. Gottlieb is a practicing physician and Resident Fellow at the American Enterprise Institute. A leading expert in health policy, Dr. Gottlieb’s work focuses on providing insights into the economic and technological forces driving the transformation of healthcare.

Attendees will benefit from hearing from thought leaders and innovators who will provide insight into practical and proven strategies for effectively managing the drug benefit. The conference includes three educational tracks and continuing education credit (CE) for pharmacists, is available. Check out the conference program to see who will be there.

Conference attendees can get a head start on their conference learning experience by selecting one of two FREE pre-conference workshops to attend. Workshops will be held Monday, March 6th from 10:30 am to 12:45 pm.
  • Workshop A: Trust But Verify: A Case Study on the Value of Auditing Your PBM Sponsored by Pharmaceutical Strategies Group
  • Workshop B: Improving Patient’s Safety and Outcomes with Innovative Solutions Sponsored by Surescripts, LLC
Note: Conference registration is required to attend a workshop.

Drug Channels readers will save $255 off conference rates when they register online and use discount code PEM17.

If you have questions or need information about exhibiting or sponsorship at the conference, please contact Linda DeChant at ldechant@pbmi.com.


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

Wednesday, January 11, 2017

Yes, Commercial Payers Are Adopting Narrow Retail Pharmacy Networks

ICYMI: CVS drugstores were booted from the pharmacy networks of Blue Cross and Blue Shield of Alabama. It's more evidence for preferred and limited pharmacy networks in commercial plans. But how many payers are adopting these new narrow network models?

As far as I know, the only public answer comes from the Pharmacy Benefit Management Institute’s (PBMI) new 2016 Trends in Drug Benefit Design report. (Free download with registration.) Drug Channels again thanks Takeda Pharmaceuticals U.S.A. for having sponsored the research.

According to the PBMI’s survey data, almost half of all employers have a narrow pharmacy network. The chart below tracks the growth in different network designs. Many interrelated factors support the continued adoption of narrow networks. The savings to payers from narrow networks come primarily from pharmacies, which offer or must accept lower per-prescription margins. That’s what makes narrow networks so controversial—but also highly pro-competitive. Caveat venditor!

Monday, January 09, 2017

14th Annual World Health Care Congress

14th Annual World Health Care Congress
April 30 – May 3, 2017 | Washington, DC

Don't forget to reserve your seat at the table with Health Plan and Payer decision makers at the 14th Annual World Health Care Congress taking place April 30-May 3, 2017 in Washington, DC.

Early rates end January 12, 2017. Use promo code PC200 for an additional $200 savings off the early rates.*

The updated agenda is now available to download.

DON’T MISS THESE FEATURED SESSIONS!
  • KEYNOTE: A Productive Conversation: Cross-Sector Initiatives to Find Affordability in Drug Pricing
  • Discuss Innovative Business Strategies Essential to Excel in a Volatile Marketplace
  • Pragmatic Approaches to Succeed at Value-Based Payment and Care
  • Develop Internal Competencies, Best Practices, and Infrastructure to Improve Population Health and Manage High-Cost Areas
  • Measure the Impact of Ambulatory Nursing in a Value-Oriented Health Care System
  • Streamline Data Sharing and Use Predictive Modeling to Prevent Complex Issues and Improve Behavioral Care Delivery
  • Assume Higher Risks for Greater Rewards in a Next Generation ACO
  • Assess Opportunities and Challenges in MACRA to Determine the Most Suitable Models for Involvement
  • Case Study: Develop a Bundle and Define an Episode of Care for Oncology
Who will be there? Click here to view a sample list of your colleagues who have already reserved their seat.

Complete your registration before January 12, 2017 using promo code PC200 for an additional $200 savings.* For an immediate reservation, call +1 781-939-2400 or reserve online.

World Congress looks forward to seeing you in DC.

*Discount not available on Government, workshop only or webcast rates. May not be combined with any other offer.

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


Wednesday, January 04, 2017

Specialty Pharmacy M&A: Our Look at 2016’s Deals

For 2016, we estimate that total prescription dispensing revenues from specialty drugs at retail, mail, long-term care, and specialty pharmacies hit a record $115 billion. Specialty dispensing revenues continue to grow at double-digit rates, which is one reason specialty drugs make up a growing share of pharmacy industry revenues.

So it’s no surprise that there is a vigorous market for the buying and selling of specialty pharmacy companies. Let’s kick off 2017 with a quick review of last year’s 14 significant specialty pharmacy mergers a & acquisition (M&A) transactions. Our list below includes only deals that were publicly announced in 2016.

I expect many more transactions in 2017. If you’re looking to pick up a fast-growing specialty pharmacy, click here for your shopping list.

Tuesday, January 03, 2017

sPCMA Business Forum 2017

sPCMA Business Forum
March 8 & 9, 2017
Hilton Bonnet Creek | Orlando, FL

The sPCMA Business Forum attracts many executives and decision makers from PBMs and the nation's largest specialty pharmacies. The two-day event offers unparalleled networking and education for individuals and companies involved in specialty drug benefit management including specialty pharmacies, PBMs, pharma/biotech manufacturers, and others.


Conference features include:
  • Receive CPE while participating in sessions led by senior industry thought leaders and decision makers
  • Timely and insightful CPE sessions
  • Dedicated time and extensive facilities for private meetings
  • Scheduled networking events with other attendees
The new PCMA conference app allows users to access the attendee list, send messages to other attendees, create a personalized schedule, and access hotel maps--all in advance of the conference!

Contact PCMA

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


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