What’s Behind CVS Health’s Novel Vertical Integration Strategy for Humira Biosimilars (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s Drug Channels Outlook 2024 live video webinar. Click here to see the original post from September 2023.

One update: CVS Caremark's 2024 formulary for patient-administered autoimmune products prefers:

• Humira
• Hyrimoz (the high WAC Sandoz biosimilar)
• adalimumab-adaz (the unbranded, low WAC Sandoz biosimilar)

Perhaps coincidentally, Sandoz products are marketed by Cordavis, the new business described in today's rerun.

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CVS Health has finally revealed its strategy for biosimilars of AbbVie’s Humira.

Rather than announce multiple biosimilars for its pharmacy benefit manager (PBM) formulary, the company will instead launch Cordavis, a new subsidiary that will market a private label, low-list-price version of Sandoz’ Hyrimoz. Here’s the press release: CVS Health Launches Cordavis.

Below, I highlight how CVS Health could profit from this strategy and outline crucial unanswered questions about this latest vertical integration move. Let’s see if plan sponsors, patients, and legislators will pay attention to the man behind the curtain.

Transforming Medication Access with the Next Generation of Patient Support Services

Today’s guest post comes from Kelly Martin, Vice President of Product Management at CoverMyMeds.

Kelly discusses the obstacles that patients face when attempting to access, afford, and adhere to specialty therapies. She describes how CoverMyMeds improves the patient experience by blending technology with human expertise and connection.

Click here to learn about CoverMyMed’s next-generation patient support services.

Read on for Kelly’s insights.

What CVS Pharmacy’s New Cost-Plus Reimbursement Approach Means for PBMs, Pharmacies, Plan Sponsors, and Prescription Prices

Is the world ready for new ways to price pharmacy and pharmacy benefit manager (PBM) services? CVS Health thinks so, as evidenced by two new initiatives that it announced yesterday. Below you'll find details and links to source documents.

I commend CVS Health for attempting to address key economic challenges facing the retail pharmacy industry and for tackling the hidden complexities of PBM pricing models. As I explain, a shift to cost-based pharmacy reimbursement could stabilize CVS Health’s retail business by improving its dispensing profits.

Nonetheless, CVS Pharmacy’s cost-plus model has some notable shortcomings for plan sponsors and is far less “disruptive” than the company would like us to believe. Mark Cuban should be flattered—but not fearful.

What's more, other large pharmacies will likely follow CVS with attempts to force payers and PBMs to accept some form of cost-plus reimbursement. (Et tu, Walgreens?) If that happens, expect higher prescriptions prices, less efficiency, and a slowdown in the inevitable retail pharmacy shakeout.

For more on the future of PBM and pharmacy pricing, join me on December 15 for a new live video webinar: Drug Channels Outlook 2024. I promise a a jam-packed 90 minutes filled with crucial information you need to know for the year ahead. Click here to learn more and sign up.

Drug Wholesalers and Brand-Name Drug Prices: Understanding CVS Health/McKesson and Why Pharmacies Lose Money on GLP-1s

Consider two apparently unrelated drug channel anomalies:

• In McKesson’s 2023 fiscal year, CVS bought $75 billion in pharmaceuticals from McKesson’s wholesale business—a jump of more than 35% compared with the previous year.

• Despite skyrocketing sales for anti-obesity GLP-1 drugs, many retail pharmacies are losing money on every prescription.

The common factor behind these two disparate situations: Pharmaceutical wholesalers’ unusual pricing for brand-name drugs sold to pharmacies, hospitals, and other buyers. Below, I walk through the economic fundamentals to help you understand another obscure aspect of our opaque drug pricing system.

This morning’s announcement of CVS Health’s CostVantage pharmacy reimbursement model reflects the latest attempt to fix the system’s wacky economics. Tomorrow on Drug Channels, I’ll delve into the pros and cons of this new approach.

For more on the economic forces behind healthcare industry changes, join me for my upcoming live video webinar, Drug Channels Outlook 2024, on December 15, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

How Direct-to-Consumer Rx Platforms Help Patient Support Programs Succeed

Today’s guest post comes from Josh Bliss, Head of Pharma Solutions at SingleCare.

Josh outlines manufacturers’ challenge when educating and informing patients about patient support programs. He then describes the SingleCare prescription discount card and Pharma Solutions, which provides manufacturers with a platform to reach patients.

Click here to learn how manufacturers can advertise patient support programs at the point of purchase.

Read on for Josh’s insights.

Drug Channels News Roundup, November 2023: My $0.02 on Express Scripts’ Cost-Based Pricing, Mark Cuban vs. PBMs, Dual-WAC Strategies, Pharmacy Shakeout, and Adam vs. Rocky

I hope everyone enjoyed the Thanksgiving holiday. Now that you’ve stretched your stomach, it's time to stretch your mind with some food for thought. In this issue:

• A reality check on Express Scripts’ purported “cost-based” pharmacy network

• Mark Cuban explains how and why the PBM market will change

• Why two drug prices are better than one

• Pharmacists sing the retail pharmacy shakeout blues

Plus, two Philly legends meet at a cardiology conference!

P.S. Join my more nearly 49,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter/X, where I have more than 17,000 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. I’m not posting to Threads yet.)

Do you want to know even more about key healthcare trends? Then join me for my upcoming live video webinar, Drug Channels Outlook 2024, on December 15, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Simplify and Accelerate Benefits Verification with a Fully Integrated, Adaptable Platform

Today’s guest post comes from Maria Kirsch, President of Patient Services at EVERSANA.

Maria discusses the challenges patients and healthcare providers face accessing specialty therapies. She introduces us to ACTICS^® eAccess, EVERSANA’s technology platform for electronic prior authorization and benefits verification that can be used for both the pharmacy benefit and the medical benefit.

To learn more about EVERSANA’s technology solution, schedule a live demo here.

Read on for Maria’s insights.

Medicare Part D in 2024: Mapping Large Chains' Position in 2024’s Preferred Pharmacy Networks

In Medicare Part D in 2024: The Seven Largest Companies' Preferred Pharmacy Networks and the Coming Collapse of the PDP Market, I documented how those networks now dominate stand-alone Medicare Part D prescription drug plans (PDPs) and have become a major presence in Medicare Advantage prescription drug (MA-PD) plans.

Today, I examine the seven largest retail chains’ participation in the 20 major 2024 Part D networks that the eight largest plan sponsors will offer. As always, I offer you a handy table for scoring each chain’s participation and changes from 2023 to 2024.

As you’ll see, these companies all maintained strong positions in the major PDP’s preferred networks. Walmart has the highest participation, while Rite Aid has the lowest. In an upcoming post, I’ll delve into how smaller pharmacies will participate in the 2024 Part D plans, by examining the pharmacy services administrative organizations (PSAOs).

Speaking of 2024, please join me for my upcoming live video webinar, Drug Channels Outlook 2024, on December 15, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Drug Channels Outlook 2024 (NEW Live Video Webinar)

It’s time for our most popular event of the year!

Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for DCI’s new live video webinar:

Drug Channels Outlook 2024
This event will be broadcast live on
Friday, December 15, 2023
12:00 p.m. to 1:30 p.m. ET.

This post describes the event, outlines the pricing options, and explains how to purchase a registration. (Or, just click here to order.) The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

This event is part of The Drug Channels 2023 Video Webinar Series. (Please note that our December 2023 webinar is *not* included with next year’s 2024 Video Webinar Series.)

WHAT YOU WILL LEARN

Join Dr. Fein as he helps you and your team get ready for 2024 by outlining key issues and uncertainties that will surely affect your planning. This event can be both a capstone of your annual learning and a touchpoint for the future. DCI’s Outlook webinars have proven to be reliable and informative guides to crucial aspects of the ever-evolving healthcare industry.

During the event, Dr. Fein will share his latest thinking and projections on a wide range of topics, including:

• Commercial implications of the Inflation Reduction Act

• Vertical integration and consolidation trends

• Update on Humira biosimilars

• PBM strategies and the outlook for state and federal legislation

• What’s next for discount cards and cash-pay pharmacies

• Impact of anti-obesity GLP-1 agonist medications

• 340B Drug Pricing Program update and outlook

• Specialty drug costs and accumulators, maximizers, and alternative funding

• The retail pharmacy shakeout

• Gross-to-net bubble predictions

• The evolving oncology market

• Coming controversies and threats

• And much more!

PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last 90 minutes to accommodate audience questions.

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data. He will draw from exclusive information found in DCI's economic reports.

Read on for full details on pricing and registration.

Four Trends That Are Shaping the Future of Market Access

Today’s guest post comes from James Pisano, Partner, Market Access at The Dedham Group and Dinesh Kabaleeswaran, SVP of Insights & Advisory Teams at MMIT.

James and Dinesh offer four trends that they predict will shape medication access in the coming years. Click here to learn about consulting services from MMIT and its sister company The Dedham Group.

Read on for James’ and Dinesh’s insights.

Vertical Integration Lessons: The Economics and Strategies of Hospital-Owned Specialty Pharmacies

As many of you know, hospitals and health systems have emerged as significant participants in the specialty pharmacy industry. A new American Society of Hospital Pharmacists (ASHP) survey provides fresh insights into these specialty pharmacies.

Below, I review key findings on the economics and operations of these specialty pharmacies. I then highlight how hospitals steer prescriptions to their internal specialty pharmacies.

As you’ll see, hospitals use network strategies that would make any pharmacy benefit manager (PBM) proud—especially when combined with the prescribing activities of hospital-employed physicians.

Vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels gets most of the attention. But a parallel vertical integration has been occurring among hospitals, specialty pharmacies, and physicians. Manufacturers and payers must adapt to the growing power and market tactics of hospital-owned specialty pharmacies.

Is Your Hub Partner Missing the Therapeutic Area Expertise You Need?

Today’s guest post comes from Greg Morris, Chief Strategy Officer at CareMetx.

Greg highlights the value of therapeutic area expertise in enhancing the performance of hub services. He explains how CareMetx's hub used its experience in the retina space to improve a new brand-name product’s launch.

To learn more about the impact of hub service on brand launch success, download CareMetx’s latest report: Patient Service Trends Point the Way to Better Hub/ Provider Partnerships.

Read on for Greg’s insights.