The State of Specialty Pharmacy 2022: Reflections, Trends, and Photos from #Asembia22

Two weeks ago, Paula and I had the pleasure of attending Asembia’s 2022 Specialty Pharmacy Summit at the wonderful Wynn Las Vegas.

Below, I violate Vegas code and tell you what happened there. I offer reflections on my keynote session with Scott Gottlieb, share my experiences during the featured session, and highlight three crucial specialty industry trends.

You’ll also find a link to my general session slides and some fun photos.

Enjoy!

Opportunities to Improve Critical Medication Access in Oncology

Today’s guest post comes from Shawn Seamans, Chief Commercial Officer at CoverMyMeds.

Shawn discusses the unique challenges cancer patients face in accessing, affording, and adhering to treatment. He explains how patient-centric technology, combined with access to caring experts, can alleviate these challenges.

Read more about access, affordability, and adherence opportunities for oncology patients in the CoverMyMeds 2022 Medication Access Report: Oncology Edition.

Read on for Shawn’s insights.

Gross-to-Net Bubble Update: 2021 Pricing Realities at 10 Top Drugmakers

Time for Drug Channels’ annual update on pricing at the largest pharmaceutical manufacturers. This year’s review includes 10 companies: Eli Lilly and Company, Genentech, GlaxoSmithKline, Janssen, Merck, Novartis, Novo Nordisk, Sanofi, Takeda, and UCB. You can find links to each company’s data below.

When rebates and discounts were factored in, brand-name drug prices declined—or grew slowly—in 2021. Consistent with our previous analyses, rebates and discounts reduced the selling prices of brand-name drugs to less than half of their list prices.

What’s more, average net drug prices have declined for the past five years—though a few companies had net price gains or slower declines in 2021.

As I have pointed out many times, pharma industry perma-critics refuse to accept that brand-name drug prices are falling—or that prescription drug spending is a small and stable portion of overall U.S. healthcare expenditures. That’s why I refer to them as drug pricing flat earthers (#DPFE).

As famous economist John Maynard Keynes reportedly said: “When the facts change, I change my mind.” What will the DPFEs do?

Informa Connect’s Hub and Specialty Pharmacy Models East

Informa Connect’s Hub and Specialty Pharmacy Models East
Delivered as a Hybrid Event
June 28-30, 2022 | Sheraton Parsippany | Parsippany, NJ
www.informaconnect.com/hub-specialty-pharmacy

Drug Channels readers will save 10% off the current registration rate when they use code 22DC10*.

This important event convenes key stakeholders including manufacturers, specialty pharmacies, hub providers and more for unrivaled collaboration to leverage innovation and optimize access. Be a part of the critical conversation at this timely meeting to explore proven strategies and cutting-edge approaches to drive an all-encompassing, state-of-the-art hub.

Live Keynotes Delivering Novel Approaches and Maximized Engagement on High-Impact Topics

• Multi-Stakeholder Panel — Elevate Hub Effectiveness Through Advancement of Stakeholder Partnerships
• Innovative Model Showcase — Emerging Manufacturer Hub Models Transforming the Patient Experience
• Specialty Pharmacy Spotlight — Enhancing Speed-to-Therapy while Increasing Patient Engagement
• Utilize Digital Engagement for End-to-End Patient Support for Specialty Products

Customize Your Experience with Tailored Content

• Choose between two streams of content focusing on:
  • Leverage Specialty Data and Analytics for Hub Efficiency and Value
  • Hub Model Optimization to Streamline and Enhance Processes
• Build your own agenda with 4 focused breakouts on critical topic areas

Featured Speakers:

• Dave MacLeod, Head of Global Patient Services and Commercial Distribution, Amylyx Pharmaceuticals
• Liam Moy, Senior Director, Patient Services, Neurology, Alexion Pharmaceuticals, Inc.
• Emily Phillips, Reimbursement, Patient Advocate, & Government Affairs Leader
• Melissa Beatty, Director, Patient Services and Reimbursement, CTI Bio Pharma
• Chad Bower, Executive Director, Field Reimbursement & Oncology Solutions, US Market Access, Daiichi Sankyo, Inc.
• Lee M. Cortes, Executive Assistant U.S. Attorney, U.S. Attorney’s Office, District of New Jersey
• Lauren Powell, MPA, PhD, Vice President, US Health Equity & Community Wellness, Takeda Pharmaceuticals

PLUS! For 2022 only, Hub and Specialty Pharmacy Models and PAP – Patient Assistance & Access Programs are under the same roof.

The two events will be co-located for shared learning, extended networking opportunities and the option to pick your favorite sessions and move between conferences if desired!

Drug Channels readers will save 10% off the current registration rate when they use code 22DC10*.

Download the full agenda and save your seat today!

*Offer applies to current rates only and may not be combined with other offers, category rates, promotions or applied to an existing registration. Offer not valid on workshop only or academic/non-profit registrations.

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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

DCI’s Top 15 Specialty Pharmacies of 2021—And Three Factors That Will Reshape 2022

In Drug Channels Institute’s list of the top 15 pharmacies of 2021, we show that central-fill, mail pharmacies operated by large PBMs and health insurers have displaced retail chains as the largest prescription drug dispensers by revenues.

To complement that broader ranking, we present below our exclusive and updated list of the top 15 pharmacies based on specialty drug dispensing revenues in 2021. You will see that PBMs and insurers retained their dominance over specialty dispensing.

But as I explain below, 2022 will be a year of transition. Significant volume will shift to the larger players, as Centene plots its exit, Walgreens’ specialty pharmacy business collapses, and manufacturers’ 340B contract pharmacy restrictions continue.

This week, I’m attending Asembia’s Specialty Pharmacy Summit. In a future article, I’ll violate Vegas code and tell you what happened.

A Game-Changing Shift: Why Pharma Commercial Teams Are Turning to HEOR

Today’s guest post comes from Chris Harvey, Director of Solutions Engineering at Panalgo, and Carolyn Zele, Senior Manager of Solution Enablement at MMIT.

Chris and Carolyn discuss the insights that health economics and outcomes research (HEOR) professionals bring to commercial teams. They explain how that pairing benefits both manufacturers and patients.

For more on how MMIT and Panalgo help pharma manufacturers leverage HEOR and real-world data for commercial strategies, click here to learn about the Patient Access Analytics tool.

Read on for Chris’ and Carolyn’s insights.

Drug Channels News Roundup, April 2022: 340Boom, 340B Profits for Pharmacies & PBMs, Fixing Insulin, Walgreens’ Robots, and Doctors’ Day

Baseball season is in full swing! Oil up your glove, lace up your cleats, and let's run the bases around this month's news stories. Remember: Sometimes you win, sometimes you lose, and sometimes it rains.

In this issue:

• Green Monster: The 340B market hits new highs in 2021

• Not-Free Agents: Big 340B profits for CVS, Walgreens, Express Scripts, et al

• Batter Up: Fixing the insulin market

• Pinch Hitters: Walgreens bets on robots

Plus, Dr. Glaucomflecken helps UnitedHealthcare celebrate Doctors’ Day!

P.S. For my daily pitches on the industry’s hits and misses, join my nearly 27,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 13,800 followers.

Next week, I'll be live and in-person at Asembia's Specialty Pharmacy Summit. During Tuesday's general session, I'll be joining Dr. Scott Gottlieb for a fireside chat at 8:00 AM and will then present my "State of Specialty Pharmacy 2022" at 9:30 AM. Hope to see you there!

Informa Connect’s Patient Support Services Congress

Informa Connect’s Patient Support Services Congress
Hybrid Event | June 14-16 in Philadelphia, PA
www.informaconnect.com/patientsupport

Exclusive Offer – Be sure to use your exclusive promo PSS22DC to save 10% off* of your registration.

A proven industry staple, Patient Support Services Congress is back June 14-16, 2022 and ready to arm industry with next-generation approaches to patient services for optimal program performance. Taking place in a hybrid format in Philadelphia, PA, prepare to join leaders from across industry as they come together for innovative discussions on access strategy, patient interactions, case management, compliance practices and more.

This event unites both compliance and operations teams. You will benefit from collaboration and next-level benchmarking to drive program success. Take advantage of tailored, tracked content featuring detailed case studies on control enhancement and operational excellence to further advance your programming.

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code PSS22DC to save 10% off* of your registration.

In two-and-a-half days, walk away with critical insights on industry standards, forward-thinking strategies to propel program performance, and so much more.

Can’t miss content highlights:

• Industry Address – Dive into Market Trends Impacting Access, Adherence and the Patient Journey
• Enforcement Update – Explore Rising Oversight and High Priority Risk Areas for Patient Services Compliance
• Engage, Educate, Exchange — Optimize Relationship Management between Manufacturers and Patients for Enhanced Outcomes
• The Rise of Technology – Accelerate Enrollment Through AI-Driven Approaches
• Address Disparities in Access Through Patient Support Program Design to Improve Outcomes
• And more!

PLUS! Customize Your Experience with Two Tailored Tracks:

Compliance and Legal

• Implement Internal Controls to Reduce Compliance Risks with Nurse Educators and HCP/Patient Interactions
• Manage Third-Party Compliance to Optimize Patient Interactions
• Enhance Patient Data Monitoring for Greater Strategic Outcomes
• Monitor Virtual Programs and Field Team Compliance for Successful Adaptation
• Create Compliant Bridge and Quick Start Programs for Rare Disease
• And more!

Innovation and Operations

• Discover Hybrid and Alternative Patient Solutions Models to Best Support Patients and HCPs

Build and Maintain Patient Engagement for Rare Disease

Utilize Predictive Analytics to Build a Better Patient Services Program

Streamline Patient Education to Create Meaningful Communication

Enhance Access, Reimbursement and Benefit Support Through Programming

And more!

How Does Hybrid Work?

• ALL ACCESS PASS includes the in-person event June 14-16 AND all benefits of the virtual experience pass
• VIRTUAL EXPERIENCE PASS includes live streaming of select sessions June 14-16 as well as recorded presentations from the in-person events available for 10 business days beginning June 21

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code PSS22DC to save 10% off* of your registration.

Informa Connect will see you there!

*Cannot be combined with other offers, promotions or applied to an existing registration. Other restrictions may apply.

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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

Four Reasons Why PBMs Gain As Maximizers Overtake Copay Accumulators (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from February 2022.

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More than four years ago, I warned about the emerging trend of copay accumulators and outlined the costly consequences for patients.

The latest data reveal that copay accumulator adjustment programs are now in the word list for a growing share of pharmacy benefit designs. What’s more, adoption of copay maximizers now exceeds that of copay accumulators. Maximizers avoid the brutal patient adherence problems of accumulators, while allowing plan sponsors to extract even more patient support funds.

Despite this impressive growth, you may not yet have considered PBMs’ business model for these tools. Below, I outline why PBMs have incentives to prefer maximizer programs over accumulators and alternatives such as specialty carve-out programs.

I look forward to hearing your thoughts on these developments in the comments below or on social media: LinkedIn (preferred) or Twitter.

Follow the Vial: The Buy-and-Bill System for Distributing and Reimbursing Provider-Administered Outpatient Drugs (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from October 2021.

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By reader request, we present below a channel flow chart illustrating the buy-and-bill process for provider-administered drugs. This chart complements Follow the Dollar: The U.S. Pharmacy Distribution and Reimbursement System for Patient-Administered, Outpatient Brand-name Drugs.

To further help you understand this channel, I have also included a brief video to explain the buy-and-bill system. The video is excerpted from my recent Drug Channels Update: Buy-and-Bill Trends video webinar.

This post is adapted from Chapter 3 of our new 2021–22 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Five Takeaways from the Big Three PBMs’ 2022 Formulary Exclusions (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from January 2022.

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For 2022, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)— increased the number of drugs they excluded from their standard formularies.

Each exclusion list contains 400 to 500 products. Growth in the number of excluded drugs slowed, due partly to the fact that so many drugs have already been dropped from PBMs’ formularies.

Below, I highlight five observations about this year’s lists, including unexplainable differences in how PBMs handle specialty drugs, biosimilars, and insulin.

I also offer some thoughts on non-medical switching and what we still don’t know about how exclusions affect patients.

Let me know what you think by commenting below or on social media.

Why PBMs and Payers Are Embracing Insulin Biosimilars with Higher Prices—And What That Means for Humira (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from November 2021.

An ironic postcript: Less than two months after my article was published, Cigna CEO David Cordani bragged about the cost savings from "aggressive adoption" of biosimilars. Anyone want to tell him about the Express Scripts formulary for insulin biosimilars?

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The Food & Drug Administration (FDA) recently approved the first interchangeable biosimilar insulin product: the insulin glargine-yfgn injection from Viatris. Read the FDA’s press release.

Alas, I’m sad to report that the warped incentives baked into the U.S. drug channel will limit the impact of this impressive breakthrough.

Viatris is being forced to launch both a high-priced and a low-priced version of the biosimilar. However, only the high-list/high-rebate, branded version will be available on Express Scripts’ largest commercial formulary. Express Scripts will block both the branded reference product and the lower-priced, unbranded—but also interchangeable—version. Meanwhile, Prime Therapeutics will place both versions on its formularies, leaving the choice up to its plan sponsor clients.

Consequently, many commercial payers will adopt the more expensive product instead of the identical—but cheaper—version. As usual, patients will be the ultimate victims of our current drug pricing system.

Below, I explain the weird economics behind this decision, highlight the negative impact on patients, and speculate on what this all could mean for biosimilars’ future. Until plan sponsors break their addiction to rebates, today’s U.S. drug channel problems will remain.