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...
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.
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.
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.
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.
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.
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.
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
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!
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
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
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
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.
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.