Drug Channels 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. Drug Channels reaches an engaged, loyal and growing audience of more than 18,000 subscribers. Learn more...

Friday, June 23, 2017

Insider Tips to Help Meet Patient Management Standards in URAC’s Specialty Pharmacy v3.0 Accreditation

Today’s guest post comes from Russel Allinson, co-founder, Chief Executive Officer, and Chief Clinical Officer of Therigy.

Russ discusses the importance of understanding the latest URAC Specialty Pharmacy v3.0 accreditation requirements, particularly relating to patient management. To learn more, register for a free webinar co-hosted by Therigy and Cleveland Clinic. The webinar will be held on July 11, 2017, at 1:00 p.m. EDT.

Read on for Russ's insights.

Tuesday, June 20, 2017

Profits in the 2017 Fortune 500: Manufacturers vs. Wholesalers, PBMs, and Pharmacies

Time for my annual review of the Fortune 500 list. Every year, this is one of my most popular posts, because it helps us “follow the dollar” and understand how drug channel intermediaries make money.

The 2017 list contains the same seven drug channel companies that the 2016 list did: AmerisourceBergen, Cardinal Health, CVS Health, Express Scripts, McKesson, Rite Aid, and Walgreens Boots Alliance.

Using the Fortune data, I explore the profitability and shareholder returns of the largest public drug wholesalers, chain pharmacies, and pharmacy benefit managers (PBMs). I compare these companies with the Fortune 500’s ten pharmaceutical manufacturers and a separate survey of independent pharmacies.

The Fortune data remind us that many multi-billion dollar businesses profit as drugs move through the U.S. reimbursement and distribution system. We must recognize this complex system in order to tackle the price and affordability of drugs.

Monday, June 19, 2017

CBI’s Specialty Pharmacy Network Design Summit

Specialty Pharmacy Network Design Summit
August 17-18, 2017 | Philadelphia, PA
www.cbinet.com/specialtynetwork

Mark your calendar for August 17-18, 2017 and attend the Specialty Pharmacy Network Design Summit in Philadelphia!

Learn about the latest strategies to optimize specialty pharmacy networks, the role of data shaping the future of specialty pharmacy, and specialty drug pricing/contracting trends. This meeting focuses on all aspects of specialty pharmacy network design from a multi-stakeholder approach providing the ideal platform to discuss opportunities and decision-making criteria behind building and expanding your specialty drug networks.


Agenda Sneak Peek:
  • Explore the Specialty Network Design Decision-Making Process – Critical Criteria to Consider for Network Design Success
  • Patient Data Aggregation, Reporting and Interpretation Methods for Manufacturers to Better Understand the Complete Patient Journey
  • Evaluate the Emerging Trend of IDNs/ACOs Role in Specialty Pharmacy – Network Design Strategies Tailored for IDNs/ACOs Partnerships
  • Making the Connection with the Patient - Specialty Pharmacy Services Strategies, Consent Compliance and the Impact on Patient Access
  • Utilizing Innovative Health Information Technology to Transform Network Design
  • Specialty Pharmacy Oncology Case Study
  • Interactive Scenario Planning – Discover the Best Network Design to Achieve Your Goals
Sign up to receive the complete agenda here, and visit www.cbinet.com/specialtynetwork for further details and to register. Drug Channels readers will save $400 off of the standard registration rate when they use discount code MXZ956.*

 CBI will see you there!

 *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.

Thursday, June 15, 2017

Will CVS Health’s Point-of-Sale Rebates Deflate the Gross-to-Net Bubble—and Disrupt the PBM Business?

Yesterday, I examined the magnitude of 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. See New Data Show the Gross-to-Net Rebate Bubble Growing Even Bigger.

The bubble directly affects patients’ out-of-pocket costs. Many patients now have benefit plans with deductibles and are therefore required to pay the full, undiscounted cost of their prescriptions. Patients taking specialty drugs face large coinsurance computed using the undiscounted list price.

One solution replaces formulary payments made to plan sponsors with prescription discounts for patients at the point of sale (POS). Last week, CVS Health became the first pharmacy benefit manager (PBM) to publicly embrace and explain this alternative benefit design. See below for details.

Which makes me wonder: Do point-of-sale rebates solve the patients’ problems that the gross-to-net bubble causes? And will this benefit design mark the beginning of the end for the PBMs’ traditional economic model?

Wednesday, June 14, 2017

New Data Show the Gross-to-Net Rebate Bubble Growing Even Bigger

Despite a slowdown in brand-name drug list prices, the gross-to-net bubble is alive and well. The bubble reflects the growing spread between a manufacturer’s list price for a drug and the net price to a third-party payer after rebates.

According to the most recent QuintilesIMS report, the total value of pharmaceutical manufacturers’ off-invoice discounts, rebates, and other price concessions has more than doubled over the past five years, from $59 billion 2012 to an astonishing $127 billion in 2016.

Those payments offset more than half of the increase in list-price based spending. And though the gap between invoice and net prices shrank in 2016, the value of manufacturers’ discounts and rebates payments still grew last year, by $11 billion.

Below I delve into these data and share my observations. Tomorrow, I’ll examine how the bubble affects patients’ out-of-pocket costs and how CVS Health’s PBM business hopes to survive when the bubble pops.

Monday, June 12, 2017

CBI’s Annual 340B Manufacturer Summit

CBI’s Annual 340B Manufacturer Summit
August 22-23, 2017 | Alexandria, VA
www.cbinet.com/340B

With evolving regulations impacting 340B programs, pharmaceutical companies are faced with uncertainty on how to strengthen program compliance and integrity. CBI’s Annual 340B Manufacturer Summit breaks down and clarifies the impending regulations, provides strategies to develop comprehensive self-disclosure response and auditing processes, and establishes best practices to collaborate with contract pharmacies and covered entities.


Expert Perspectives Include:
  • Conference Chairperson: Sabrina Aery, Director, Medicare FFS, National 340B Strategy, Bristol-Myers Squibb
  • Compliance Spotlight: Chris Hatwig, President, Apexus
  • Covered Entity Insights: Maureen Testoni, Senior Vice President and General Counsel, 340B Health
  • Legal Spotlight: John Shakow, Partner, King & Spalding
  • Manufacturer-Only Discussion: Hae Won Min Liao, Assistant General Counsel, Gilead Sciences
  • And more!
Critical Updates, Interactive Discussions and Valuable Takeaways:
  • Develop proactive techniques to improve new policy adoption and program compliance
  • Determine impact of the Mega-Guidance withdrawal on diversion risk
  • Review manufacturer ceiling prices and civil monetary penalties
  • Reduce duplicate discount loss potential by working with intermediaries to conduct good faith dispute resolution
  • Evaluate the evolving specialty bio/pharma landscape and discuss changes in decision-making autonomy, payment methodology and delivery system structure
  • Discuss options to increase visibility into contract pharmacy operations and understand how claims adjudication has occurred
  • Uncover best practices to respond to covered entities and initiate good faith financial remediation
Download the complete agenda here and visit www.cbinet.com/340B for further details and to register. Drug Channels readers will save $400 off of the standard registration rate when they use discount code GBZ697.*

*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, June 09, 2017

Trends and Challenges in Specialty Drugs

Today’s guest post comes from Kay Morgan, V.P. of Drug Products & Industry Standards and Clinical Solutions at Elsevier.

Kay reviews specialty drug pricing and discusses strategies to manage spending on these therapies. For more, download Managing the Costs of Specialty Drugs, a free whitepaper from Elsevier.

Read on for Kay’s insights.

Thursday, June 08, 2017

Average Pharmacist Salaries Hit $120,000, but Growth Again Lags Other Healthcare Professions

Time to update our exclusive annual analysis of pharmacist salaries. As always, we rely on the latest Occupational Employment Statistics (OES) data from Bureau of Labor Statistics (BLS).

In 2016, the average gross base salary for a pharmacist at a retail, mail, and specialty pharmacy topped $120,000—up 0.6% from the 2015 figure. Retail employment expanded, with the greatest growth at drugstores.

Meanwhile, the share of pharmacists who work at hospitals grew again. Pharmacists who work at hospitals also had salary increases that exceeded those of the average pharmacist. As I explain below, the specialty boom and generic plateau continue to drive the pharmacy industry’s evolution.

Though pharmacist salaries are growing, they are not keeping pace with those of other healthcare practitioners. That disparity should be troubling to every pharmacy school dean.

Tuesday, June 06, 2017

Latest Data on Pharmacy Market’s Evolution: The Real Story Behind the Retail vs. Mail Battle

QuintilesIMS recently released Medicines Use and Spending in the U.S.: A Review of 2016 and Outlook to 2021. The report is an excellent, albeit often misinterpreted, resource for understanding the pharma market.

Below, I analyze the latest data on how pharmacy dispensing channels have changed over the past five years. Key insights:
  • Retail chains now dispense nearly 6 out of 10 prescriptions. 
  • Mail pharmacies have experienced declining prescriptions, but have soaring purchases of specialty drugs. 
  • Contrary to popular belief, independent pharmacies continue to grow.
Just about every media story inaccurately reported the QuintilesIMS data as “drug spending.” To tickle your inner wonk, I also provide a primer on how to interpret and understand what the QuintilesIMS data really mean.

Monday, June 05, 2017

Reimbursement and Access 2017

Reimbursement and Access 2017
August 16-17, 2017 | Philadelphia, PA
www.cbinet.com/reimbursement

The market access, pricing and reimbursement landscape is rapidly evolving as stakeholders shift to a value-based healthcare system. This transition coupled with increasing drug pricing scrutiny and mounting uncertainty related to potential repeal/replacement of the Affordable Care Act creates tremendous challenges for bio/pharma manufacturers to overcome.

Join CBI in Philadelphia this August 16-17 at Reimbursement and Access 2017. Hundreds of leaders in Access, Reimbursement, Managed Markets and Commercial Operations have benefited from this highly-acclaimed event which arms attendees with best practices and practical strategies during a time of unprecedented uncertainty on complex issues.


Powerful Programming and Compelling Content on Topics Including:
  • The current state and direction of the healthcare landscape
  • Evolution and trends in drug pricing transparency
  • Value-based contracting and rebating strategies
  • Policy, trends and initiatives around Medicare benefit design
  • Updates and real-time analysis on the Healthcare Exchange Marketplace
  • Payer insights on utilization management strategies
  • Recent advancements in value-based care models in oncology
  • Emerging pathways for pricing assessment framework
  • Patient assistance and reimbursement support programs
Dynamic Dialogue Driven by a Multistakeholder Speaking Faculty Representing:
AbbVie • Apobiologix • Aralez Pharmaceuticals • AssistRx • Avalere • BIO • Boehringer Ingelheim • Celgene • Center for Medicine in the Public Interest • Chiesi USA • Churchill Pharmaceuticals • Covance • CSL Behring • Gilead • Harvard Pilgrim Health Care • Johnson & Johnson Health Care Systems • Maxor National Pharmacy Services • Magellan Health • NASP • Pacira Pharmaceuticals • Pfizer • Pharming Healthcare • PhRMA • Sunovion Pharmaceuticals • UPMC Health Plan • Walgreens • And More!


Visit www.cbinet.com/reimbursement for more information. Drug Channels readers will save $500 off the standard registration rate when they use discount code EXH946.*

*Discount expires 06/30/2017 and may not be combined with other offers, category rates, promotions, or applied towards an existing registration. Offer not valid on workshop only or academic/nonprofit registrations. 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, June 01, 2017

Patient Assistance Programs: Why Pharmaceutical Manufacturers Operate the Biggest U.S. Charities

Ronny Gal, Ph.D., a senior analyst at the investment research firm Sanford C. Bernstein & Co., recently published a fascinating report on the size of pharmaceutical manufacturers’ charitable foundations. Ronny has graciously agreed to let me share the high-level results below.

Ronny and his team found that pharmaceutical manufacturers’ patient assistance programs (PAPs) account for 10 of the largest 15 U.S. charities and provided $6.5 billion of support in 2014. (See table below.) On average, the manufacturers’ financial support accounts for 8% of their operating expenses.

PAPs are controversial and closely monitored. As I argue below, their growth is linked to pharmacy benefit designs that shift prescription costs to patients. Many insured patients face economically-debilitating coinsurance—in some cases with no limit on out-of-pocket expenses. The programs are an imperfect, but necessary, fix to our imperfect drug channel system. Ronny has provided some valuable facts that show how important these programs have become.

Wednesday, May 31, 2017

Drug Channels News Roundup, May 2017: Express Scripts, WBAD, DIR Fees, JAMA, and #Asembia17 Photos

Summer is unofficially here! Before you break out the grill, check out these officially noteworthy items:
  • My $0.02 on the new Express Scripts-Walgreens alliance
  • CMS wants more details on pharmacy-paid DIR fees
  • JAMA discovers the drug channel
Plus, revisit Asembia’s 2017 Specialty Pharmacy Summit with an awesome photo gallery. You’ll find two of my favorites lurking below.

P.S. My @DrugChannels twitter feed now has an astounding 4,100 followers. Join them and see why!

Tuesday, May 30, 2017

CBI’s Summit on GPO Membership Eligibility and Class of Trade Maintenance

GPO Membership Eligibility and Class of Trade Maintenance
June 20-21 2017 | Parsippany, NJ
www.cbinet.com/GPOCOT

CBI’s Summit on GPO Membership Eligibility and Class of Trade Maintenance is coming up this June 20-21 at the Hilton in Parsippany, NJ. This event convenes over 100 industry professionals representing manufacturers, GPOs, wholesalers, distributors and solution providers and arms attendees with strategies to overcome the significant operational challenges related to the proper management of customer data and GPO membership data.

Interactive Discussions and Actionable Takeaways on Topics Including:
  • Strategic Contracts in the Evolving Healthcare Delivery Landscape
  • Class of Trade Protocol Development Strategies
  • Experiences and Insights to Overcome Challenges of Membership and Class of Trade
  • Wholesaler Insight on Contract Administration Processes and Best Practices
  • Downstream Effects of Class of Trade Implications
  • Partnership Pavilion with Insight on Propelling Collaboration for Streamlined Communication
  • Plus! Benefit from 4-Focused Working Groups with attendees from CBI’s Contracts and Chargebacks conference
Multistakeholder Perspectives and Innovative Insights From:

Alliance Life Sciences • Amneal Pharmaceuticals • Arent Fox LLP • AstraZeneca • Carolinas HealthCare System • Cardinal Health • Chiesi USA Inc • Deloitte & Touche LLP • McKesson • Prometic BioTherapeutics, Inc. • Shire • Zydus 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 JSK589.*

*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.

Tuesday, May 23, 2017

A Reality Check on Amazon’s Pharmacy Ambitions

CNBC reported last week that Amazon may enter the pharmacy and/or pharmacy benefit manager (PBM) market. Here’s the story: Amazon is hiring people to break into the multibillion-dollar pharmacy market.

The news made many people freak out and then begin speculating on all of the amazing ways that Amazon would change the drug channel. USA Today breathlessly mused: Could your next prescription come from Amazon?

Amazon has been successfully attacking the front-end business of chain drugstores. But could it really disrupt the pharmacy and PBM industries?

Below, I provide a reality check on how Amazon could compete—and what it is unlikely to do.

Monday, May 22, 2017

Join me at the World Congress Pharma4 Event

World Congress Pharma4
July 24-25, 2017 | Philadelphia

Please join me at the World Congress Pharma4 event on July 24 and 25 in Philadelphia. I am pleased to be the keynote speaker for this innovative event that brings together multiple stakeholders across the channel. I'll be talking about Winning Strategies for an Integrated Drug Channel.

This 4-track event includes four interrelated conferences:


Registration to one of the four events grants you access to all of the sessions from any Summit part of Pharma4 - giving you the freedom to customize your experience!

Through high-level discussion:
  • Discover new ways to address traditional and emerging patient needs through network design and channel partners
  • Explore IT infrastructure to mitigate risk in data sharing and HUB design
  • Understand how to drive visibility through the Implementation of a serialization model and strategy for visibility to ensure regulatory compliance and traceability in the chain
  • Engage in facilitated discussions around contracting from value-based to specialty pharmacy and FMV pricing
Confirmed speakers include executives from Shire, Blue Cross Blue Shield, Pfizer, J&J, GSK, Novartis, Walgreen, Endo Pharmaceuticals, Vanderbilt University Medical Center, and Gateway Health Plan.

Click here to learn more and register for this event. Rates start at $995 for pharmaceutical manufacturers. Use discount code DC300 and save!

Please enjoy this conference introduction from Ray Tancredi of Walgreens.



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

Friday, May 19, 2017

340B Purchases Were More Than Half of the Hospital Market in 2016

Yesterday’s article on the astounding size and growth of the 340B Drug Pricing Program generated a lot of controversy. ICYMI: The 340B Program Hits $16.2 Billion in 2016; Now 5% of U.S. Drug Market

Today, I provide some context by showing how the program has taken over the hospital market.

Most 340B purchases are made by hospitals. My exclusive number-crunching below reveals that hospitals now receive discounted 340B pricing on more than 50% of their drug purchases.

Curiously, the value of hospitals' uncompensated care has been declining while 340B purchases have been soaring.

Enjoy!

Thursday, May 18, 2017

EXCLUSIVE: The 340B Program Hits $16.2 Billion in 2016; Now 5% of U.S. Drug Market

The 340B Drug Pricing Program’s explosive growth continues.

Our exclusive sleuthing reveals that discounted sales hit $16.2 billion in 2016. That’s a 34% increase over the 2015 figure. Consequently, the 340B program accounted for 5.0% of the total U.S. drug market in 2016.

Covered entities are generating billions in untraceable profits from this fast-growing program. Hospitals, which make up the vast majority of 340B purchases, should be required to account clearly for the billions the program provides them.

This growth should make everyone—especially the manufacturers providing the discounts—pay much closer attention to what’s going on.

Tuesday, May 16, 2017

Five Fun Facts About the New Express Scripts-GoodRx Drug Discount Partnership

Last week, the pharmacy benefit manager (PBM) Express Scripts and the online discount card company GoodRx partnered on a new program called Inside Rx. The program provides point-of-sales discounts to uninsured patients on at least 40 brand-name drugs from eight manufacturers. Click here to read the press release.

This innovative partnership is the latest attempt to offer direct-to-consumer discounts that pop the gross-to-net bubble—at least for uninsured patients. Below, I delve deep inside Inside Rx. I explain:
  • How uninsured patients benefit
  • What’s in it for manufacturers, Express Scripts, and GoodRx
  • Which pharmacies are in the program’s narrow network
  • The surprises on the drug list
  • How inside Rx compares with CVS Health’s Reduced Rx program
Depending on your position in the drug channel, you will feel either joy, sadness, fear, disgust, or anger as this new program rolls out. Please feel free to emote in the comments below.

Monday, May 15, 2017

Medicaid Drug Rebate Program (MDRP) Summit 2017

Medicaid Drug Rebate Program (MDRP) Summit 2017
September 11-13, 2017 | Marriott Magnificent Mile | Chicago

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

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

Join KNect365 in Chicago this September 11-13 at MDRP Summit 2017 the essential event positioned to provide insights into the implications of these inevitable changes. It’s the longest running and the largest MDRP event where 600+ industry, state, and federal government professionals come to get questions answered, gain clarity, and remain compliant.


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

Use Discount 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
  • EXCLUSIVE! Meet Face to Face with 14+ States in One-on-One Dispute Resolution Meetings where you can recoup or save millions of dollars in rebates and reimbursements.
Stay ahead of the curve by getting the best networking, education, and technology at MDRP Summit this September. There is no other MDRP event built like it.

(and SAVE $100 off the current rates).
Be sure to use Discount Code: P2258DRUG


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

Friday, May 12, 2017

Three Misconceptions about Channel Strategy

Today’s guest post comes from AmerisourceBergen executives Donna Gilbert, Vice President Specialty and Branded Strategic Accounts, Global Sourcing and Manufacturer Relations, and Akin Odutola, Senior Vice President, Specialty and Branded Product Access, Global Sourcing and Manufacturing Relations.

Donna and Akin discuss how a manufacturer’s channel strategies affect product access and commercial success. Click here to download Changing Channels, a complimentary ebook from AmerisourceBergen.

Read on for their insights.

Thursday, May 11, 2017

What I Told HHS Secretary Tom Price About the 340B Drug Pricing Program

Last Friday, I had the privilege of meeting with Secretary of Health and Human Services (HHS) Tom Price. I was invited to meet with Secretary Price for one of his listening sessions with industry experts and stakeholders. I appreciated the opportunity to share my perspectives.

In our meeting, I highlighted four ways that the 340B Drug Pricing Program is raising drug costs. I then offered eight specific recommendations for improving the program by addressing the widespread channel distortions the program has caused.

Read on for the recommendations and a summary of my comments to Dr. Price.

I have no idea if my suggestions will have any impact. Regardless, your friendly neighborhood blogger enjoyed spending time among some Washington insiders.

Tuesday, May 09, 2017

The State of Specialty Pharmacy 2017: Reflections from #Asembia17

Last week, Paula and I had the pleasure of attending Asembia’s 2017 Specialty Pharmacy Summit in Las Vegas, itself the summit of spectacle. We even met a new friend, as you can see from the photo on the right.

The Specialty Pharmacy Summit remains the most important forum for conducting business in the specialty marketplace. More than 5,000 people learned, networked, and connected at the wonderful Wynn Las Vegas. Thanks to Larry and Robert Irene for creating an annual event that brings the entire industry together. Click here to enjoy the social media action from #Asembia17.

Today marks the seventh year that I will violate Vegas code and tell you what happened there. Below, I offer reflections on key specialty industry trends, DIR fees, patient satisfaction controversies, and a link to the Featured Session slides. You’ll also find a few incriminating photos! Please add your own observations and photos to the comments section below.

Monday, May 08, 2017

Partnering with IDNs BioPharma Strategy Summit

Partnering with IDNs BioPharma Strategy Summit
August 16-17, 2017 | Philadelphia, PA

As health systems continue to grow and consolidate to form major Integrated Delivery Networks (IDNs), manufacturers are tasked with learning how to best contract with, and sell to, these evolving systems to ensure product success. With conflict of interest policies in place and restricted access to physicians, manufacturers are changing their sales approach to better reach and engage these new customers.

CBI’s Partnering with IDNs Strategy Summit convenes manufacturers and IDNs to discuss how to create a mutually beneficial partnership that contributes to continual care coordination, strategic product management and enhanced access.

Drug Channels readers will save $400 off the standard registration rate
when they use discount code QJF259.*

Key Explorations Include:
  • The IDN model of patient care coordination and what it can do to improve the patient experience on behalf of the provider, manufacturer, payer and other stakeholders
  • Changes in the hospital reimbursement model, focused on quality tied to outcomes measures
  • Effective ways manufacturers can partner with health systems
  • Understand the size and scope of the current US hospital marketplace and the GPO’s contracting relationships with those providers
  • Explore implications of value-based RWE on the healthcare manufacturing community in terms of contracting, distribution, and consumer engagement with payers and providers
  • Gain perspective on how IDN SPs are gaining manufacturer network access
Confirmed Speakers Include:
  • Jeff Prewett, Sr. National Account Director – Oncology GPO & IDN, Lilly USA, LLC
  • Anindita Sinha, Director, Business Insights – Market Intelligence, Bayer
  • William T. Lee, D.Ph, MPA, FASCP, Pharmacy System Director, Carilion Clinic Healthcare System
  • Thomas Felix, M.D., R&D Policy, Intercontinental Region, Amgen
  • Jerry Buller, Director, Specialty Pharmacy Services, Vanderbilt University Medical Center
  • Michelle Templin, Vice President, Government Affairs and Business Development, MHA ACO Network

Visit www.cbinet.com/IDNStrategy for more information. Drug Channels readers will save $400 off the standard registration rate when they use discount code QJF259.*

*Discount may not be combined with other offers, category rates, promotions, or applied towards an existing registration. Offer not valid on workshop only or academic/nonprofit registrations. 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, May 05, 2017

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

This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from January 2017.



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?

Thursday, May 04, 2017

Five Industry Trends for U.S. Drug Wholesalers in 2017 (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from December 2016. FYI: I updated a few links with our more current market data.



Modern Distribution Management recently published my article 2016 MDM Market Leaders | Top Pharmaceuticals Distributors. It is an excerpt from the 2016-17 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Below, I republish the section highlighting five significant industry trends affecting the U.S. drug wholesaling industry. I think Drug Channels readers will enjoy this summary as we look toward an eventful 2017.

Wednesday, May 03, 2017

Plan Sponsors Like More Transparent PBMs—Yet Not All Choose Transparency (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from December 2016.



Pharmacy benefit managers (PBMs) are facing unprecedented criticism about their business practices and levels of transparency. Which got me wondering: What do plan sponsors—the PBMs’ customers—think about their PBMs?

For the answer, I turned to Pharmacy Benefit Management Institute (PBMI) 2016 Pharmacy Benefit Manager Customer Satisfaction Report (available for purchase.) It rates 11 PBMs based on feedback from more than 500 plan sponsor customers.

The data show a strong association between a PBM’s perceived transparency and a plan sponsor’s satisfaction. As you will see in the charts below, plan sponsors are more satisfied with PBMs that are more transparent.

Yet the causality of this relationship isn’t entirely clear. Smaller plan sponsors tend to work with smaller PBMs, which are rated more highly on transparency and alignment of goals. Are more transparent PBMs truly better? Or, are we observing a selection effect, whereby plan sponsors with fewer internal resources choose PBMs with different business and profit models? And if PBM transparency is so wonderful, why don’t all plan sponsors insist on it?

Tuesday, May 02, 2017

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

DIR Fees, Rebates, Pharmacy Economics, and the Future of Medicare Part D
This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from February 2017.



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.

Monday, May 01, 2017

The Top 15 U.S. Pharmacies of 2016 (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from February 2017.



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!

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…