Drug Channels delivers timely analysis and provocative opinions from Adam J. Fein, Ph.D., the country's foremost expert on pharmaceutical economics and the drug distribution system. Drug Channels reaches an engaged, loyal and growing audience of more than 60,000 subscribers and followers. Learn more...
Today’s guest post comes from Saket Patel, Consultant, Advisory Services at MMIT.
Saket discusses market access and contracting strategies for medical benefit products when pharmacy benefit biosimilar therapies launch. He then describes how to automate formulary and medical policies to protect manufacturers from overpayment.
Now that 2023 is underway, let’s review employer-sponsored coverage for prescription drugs and speculate on what’s ahead.
Below I examine the latest data on pharmacy benefits: cost sharing tier structures, copayment vs. coinsurance, and out-of-pocket obligations. As you will see, pharmacy benefit designs again increased the use of coinsurance for specialty and fourth-tier drugs.
These designs significantly raise patients’ out-of-pocket obligations—and contribute to the controversy over copay accumulator adjustment and copay maximizers. In 2023, employers’ savings and PBMs’ profits from these programs will decline—which will trigger a coming crackdown on specialty drug benefits. Beneficiary beware!
P.S. As usual, you will also enjoy some terrible Drug Channels tiers/tears puns.
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The last thing a patient should worry about is access to care. With growing demand for patient assistance, accelerating prescription access and affordability is as crucial as ever. PAP – Patient Assistance & Access Programs is back March 20-22 and bringing together key stakeholders to collaborate and strategize on methods to meet that growing demand and navigate the access and reimbursement barriers faced daily.
Join your peers, leading experts and top solution providers for unparalleled networking opportunities and fresh perspectives on how to further access to care, understand current changes in legislation and policy and optimize PAP programs for better patient outcomes. Industry standards are evolving. Secure your spot now to ensure you and your organization are not left behind.
Do not miss this opportunity to unite with pharma, foundations, health clinics and more and benchmark on industry standards and stay on top of evolving trends to propel program performance. Can’t miss content highlights include:
State of the Industry: The Changing Landscape of Healthcare Coverage and Access
PhRMA Keynote Address
Equity Spotlight: Understanding the Importance of Equitable Healthcare, Education and Partnerships
Patient Perspective
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PAP 2023 will take place as part of Access USA, the access event bringing together three industry-leading conferences under one roof. Benefit from robust networking opportunities with all Access USA participants (that is an expected 600+ access professionals!) and expand your network and establish powerful partnerships.
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Informa Connect will see you there!
*Cannot be combined with other offers, promotions or applied to an existing registration. 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. To find out how you can promote an event on Drug Channels, please contact Paula Fein(paula@drugchannels.net).
Today’s blog post comes from Andrew Duncan, Vice President of Business Operations and Analytics at PHIL.
Andrew discusses how manufacturers can use data-driven strategy to understand utilization, increase patient access and adherence, and optimize gross-to-net.
Consolidation has brought together large, economically significant insurer/PBM/specialty pharmacy/provider organizations within U.S. drug channels. At least half of all U.S. healthcare spending flows through these seven familiar entities: Blue Cross Blue Shield, Centene, Cigna, CVS Health, Elevance Health, Humana, and United Health Group.
In the brief video clip below, I review these businesses and offer some thoughts on their positioning for 2023. As you’ll see, the vertical strategy shakeout is underway.
For 2023, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again increased the number of drugs they exclude from their standard formularies.
Each exclusion list now contains about 600 products. Growth in the number of excluded drugs slowed for the second year, due partly to the fact that so many drugs have already been dropped from PBMs’ formularies.
Below, I highlight four takeaways from this year’s lists, including a look at biosimilar insulin and the forthcoming biosimilar competition for Humira. I also note some troubling research on the patient impact of exclusions—although much remains unknown.
As always, I welcome your comments below or on social media.
Time for the Drug Channels annual reality check on drug pricing. The data once again tell a different story than you might read in your favorite politician’s Twitter feed or misleading news reports.
For 2022, brand-name drugs’ net prices dropped for an unprecedented fifth consecutive year. What’s more, after adjusting for overall inflation, brand-name drug net prices plunged by almost 9%.
The factors behind declining drug prices will remain in the coming years—and become even stronger due to forthcoming changes in Medicare and Medicaid. Employers, health plans, and PBMs will determine whether patients will share in this ongoing deflation.
Thank you, dear readers, for welcoming me into your inboxes and browsers each week. I’ve had a blast writing Drug Channels and hope that you had fun reading it.
Wishing you and your family health and happiness,
Adam
Ring in 2023 with our final news roundup of the year:
A vertical integration update
Walgreens backs away from prescriptions
Meet a cash-pay pharmacy that’s not owned by a billionaire
Time to cure or kill 340B?
Plus, Dr. Glaucomflecken helps you celebrate “I met my deductible” season!
As healthcare stakeholders continue to prioritize the move to value-based care and aim to provide equitable access to care for all, leaders must develop novel approaches to empower the patient and ensure effective risk-sharing strategies.
The Value-Based Care Summit, produced by The Healthcare Innovation Company (thINc), brings together stakeholders across all healthcare sectors, including payers, providers, and manufacturers to discuss novel approaches, innovative models, and mutually beneficial partnerships to accelerate the journey to value-based care.
Can't miss content highlights including:
Risk-Sharing and Value-Based Contracting: Examine outcomes-based strategies and innovation in payment arrangements tailored to health plan, provider, and pharma strategies
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Cross-Stakeholder Partnerships: Foster collaborations to provide patient support, improve health outcomes, and lower total cost of care
Population Health and Value-Based Care: Leverage real world data and understand social determinants of health to build predictive value-based care solutions for populations
Care Delivery Transformation: Explore remote care solutions and understand patient needs to implement a value-based care delivery model
Data and Evidence: Explore data sharing, integration, and infrastructure best practices to support risk-sharing agreements and support data-driven healthcare
Two Dedicated Tracks for Your Focus Area:
For Payers & Providers
For Pharmaceutical, Biotech, and Other Manufacturers
*All registrations subject to review by the thINc team. Cannot be combined with other offers, promotions or applied to an existing registration. 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. To find out how you can promote an event on Drug Channels, please contact Paula Fein(paula@drugchannels.net).
This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: Drug Channels Outlook 2023.
ICYMI, the Health Resources and Services Administration (HRSA) finally got tired of my Freedom of Information Act (FOIA) requests. Shortly after I published the article below, HRSA posted public data about 340B covered entity purchases on its website. Alas, HRSA neglected to post any historical data. Fortunately, my 2022 FOIA efforts (described below) extracted purchases by 340B covered entity type for 2015 through 2021.
Here’s a summer surprise for fans of the 340B Drug Pricing Program: Drug Channels has just obtained the 2021 figures from the Health Resources and Services Administration (HRSA)! Even better, my Freedom of Information Act (FOIA) request was able to pry out detailed purchases by covered entity type.
The data tell a familiar story. For 2021, discounted purchases under the 340B program reached a record $43.9 billion—an astonishing $5.9 billion (+15.6%) higher than its 2020 counterpart. Hospitals accounted for 87% of these skyrocketing 340B purchases.
What’s more, the difference between list prices and discounted 340B purchases also grew, to $49.7 billion (+$7.0 billion). This figure approximates the money collected by 340B covered entities.
340B advocates have been screaming that “drug companies are cutting 340B,” but the data tell a very different story. Only in the U.S. healthcare system can billions more in payments and spreads be considered a cut.
Read on for full details and analysis, including the opportunity to download your very own copy of the raw data from HRSA.
Last month, IQVIA quietly released a fascinating new report on discount cards. (Link below.) The research was sponsored by the Association for Accessible Medicines (AAM).
Below, I highlight three unexpected findings from the data regarding GoodRx’s market position, when people use discount cards, how much they save, and why PBMs should still be worried about this market.
There’s a lot to unpack about the growing discount card market. As you’ll see, this report provides valuable insights about a market that seems stacked against patients.
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This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: 
This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: 
