Drug Channels News Roundup, November 2021: Specialty Pharmacy, Health Plans and Insulin, Gross-to-Net Bubble Update, CVS & 340B, and Amazon Redux

Happy Thanksgiving, everyone! Before you stretch your stomach, stretch your mind with our extra-stuffed helping of food for thought. In this issue:

• The State of Specialty Pharmacy 2021

• How health plans profit—and patients lose—from insulin

• A fantastic new analysis of the gross-to-net bubble

• CVS acknowledges how its PBM profits from 340B

• Reconsidering Amazon

P.S. Please join the nearly 13,000 consumers of my daily commentary and links to neat stuff at @DrugChannels on Twitter. You can also find my daily posts on LinkedIn, where I have more than 21,000 followers.

Recent posts have covered: outcomes-based contracts, copay accumulators, hospitals’ drug profits, biosimilar interchangeability, managed Medicaid, DSCSA, CVS Health’s networks, unintended consequences of congressional drug pricing legislation, Walmart and TRICARE, McKesson’s European retreat, and more.

Please join me for my upcoming live video webinar, Drug Channels Outlook 2022, on December 17, 2021, from 12:00 p.m. to 1:30 p.m. ET. Hundreds of people from your competitors, customers, and suppliers have already signed up. Will you be there, too?

Pathway or Perish: The Two-Pronged Hurdle to Ensuring Access in Oncology

Today’s guest post comes from Carolyn Zele, Senior Manager of Solution Enablement at MMIT.

Carolyn describes how oncology pathways were developed to help standardize treatment and ensure quality care. She argues, however, that these pathways often shut manufacturers out of the market.

Click here to learn more about MMIT's Pulse Analytics solution, which provides insight into payer- and pathway-driven barriers to access.

Read on for Carolyn’s insights.

Small Pharmacies Continue to Run Away from Medicare Part D’s Preferred Networks

In my previous post, I highlighted the largest pharmacy chains that will participate in the 2022 Medicare Part D prescription drug plans (PDP).

Today, I examine how smaller pharmacies will participate as preferred cost sharing pharmacies via the pharmacy services administrative organizations (PSAOs) that represent them in negotiations with plans.

As you will see here, the largest PSAOs are increasingly rejecting preferred networks. Below we provide details about the PSAOs owned by the three major wholesalers—AmerisourceBergen, Cardinal Health, and McKesson—along with information about AlignRx, the largest independent PSAO. There are some notable differences in strategy, as you will see from our handy scorecard below.

Smaller pharmacies’ rejection of Part D preferred networks shows that they are figuring out how to survive a highly challenging retail environment. Perhaps Part D is just a flesh wound?

Speaking of 2022, please join me for my upcoming live video webinar, Drug Channels Outlook 2022, on December 17, 2021, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

CVS, Walgreens, Walmart, and Supermarkets Keep Position in 2022 Part D Preferred Networks—With a Little Help from 340B

In Consolidation and Preferred Pharmacy Networks in 2022’s Medicare Part D Plans, I highlighted how those networks have hijacked the world of stand-alone Medicare Part D prescription drug plans (PDP) and become a major presence in Medicare Advantage prescription drug (MA-PD) plans.

Today, I examine the largest retail chains’ participation in the 21 major 2022 Part D preferred networks that the eight largest plan sponsors will offer. Below, we offer you a handy table for scoring not only each chain’s participation, but also all changes from 2021 to 2022.

Narrow networks force pharmacies to trade volume for profits, due primarily to substantial pharmacy direct and indirect remuneration (DIR) payments. One unexpected bright spot has been pharmacies’ participation in the 340B Drug Pricing Program. As you review chains’ eager participation in the 2022 Part D networks, ponder whether a material change in the 340b contract pharmacy market might tarnish the attractiveness of being preferred.

Speaking of next year, please join me for my upcoming live video webinar, Drug Channels Outlook 2022, on December 17, 2021, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Drug Channels Outlook 2022 (NEW Live Video Webinar)

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

Drug Channels Outlook 2022
Broadcast live on December 17, 2021
12:00 p.m. to 1:30 p.m. ET

This page describes the event and explains how to purchase a registration.

This event is part of The Drug Channels 2021 Quarterly Video Webinar Series. Anyone who registered for the entire series should have received an email with a link to access the December event.

WHAT YOU WILL LEARN

Join Dr. Fein as he helps you and your team get ready for the year ahead 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. The Outlook 2022 marks our third annual outlook webinar.

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

• The prescription market in 2022

• Benefit design and plan sponsor strategies

• Federal and state drug pricing policy

• The 340B Drug Pricing Program

• Consolidation and vertical integration

• Specialty pharmacy trends

• Copay accumulators, maximizers, and utilization management tools

• Biosimilars

• Drug channel evolution and disruption

• And more!

PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions.

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data.

Read on for full details on pricing and registration.

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

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.

Informa Connect’s Trade & Channel Strategies

Informa Connect’s Trade & Channel Strategies
Delivered as a Hybrid Event
In-Person: December 13-14, 2021, Hilton Philadelphia at Penn’s Landing, Philadelphia, PA
Virtual: December 16-17, 2021
https://informaconnect.com/trade-channel/

The full agenda for this year’s Trade and Channel Strategies conference is available now! Year after year, the life science industry marks Informa Connect’s Trade and Channel Strategies as the “go-to” event for trade, channel, market access, account strategy and brand professionals. Join your industry counterparts this December to unravel the complexities of the channel, navigate high-impact topics transforming trade and benchmark winning pharmacy and distribution frameworks.

Drug Channels readers will save 10% off the current registration rate when they use promo code 10DC21*.

Meet The Expert Faculty

• Bill Roth, Founding Partner, Blue Fin Group
• Jeff Henderson, Vice President, Head of Global Market Access, Reimbursement and Distribution, VectivBio
• David Weiss, Vice President, Industry Solutions, IntegriChain
• Rena Goins, Executive Director, Global Trade, GPO & Distribution, Regeneron
• Stephen Samuel, CEO, Premier Specialty Pharmacy Services
• Shannon Wiley, Member, Bass, Berry & Sims
• Jerry Buller, DPh, MMHC, Chief Pharmacy Officer, Trellis Rx
• John Klimek, RPh, Senior Vice President, Standards and Industry Information Technology, NCPDP

Featured Sessions Include

• LANDSCAPE ADDRESS: Analyze Market Dynamics and Trends Impacting the Channel in an Ever-Changing Environment
• POLICY ADDRESS: Break Down Evolving Regulatory Reform Driving Innovation and Access Predict Novel Reimbursement Mechanisms and First Pharmacy Benefits for Biosimilars

Download your copy of the agenda today and join Informa Connect in December!

Drug Channels readers will save 10% off the current registration rate when they use promo code 10DC21*.

*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).

Risk-Based Cancer Care: A Specialty Pharmacy’s Role

Today’s guest post comes from Ashleigh Burdette, Senior Director of Clinical Innovation at Biologics by McKesson.

Ashleigh explains how biopharma companies can help patients become more adherent and achieve better health outcomes by partnering with an experienced specialty pharmacy that offers risk-based care. 

To learn more about the risk-based care approach, download the free whitepaper: Risk-Based Care Helps Cancer Treatment Adherence.

Read on for Ashleigh’s insights.

Consolidation and Preferred Pharmacy Networks in 2022’s Medicare Part D Plans: Cigna, CVS Health, Humana, UnitedHealthcare, WellCare, and More

Open enrollment is under way for the 2022 Medicare Part D plans. Our exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals that preferred cost sharing pharmacy networks will maintain their dominance as an established component of Part D benefit design.

For 2022:

• 98% of stand-alone Medicare Part D prescription drug plans (PDP) will have a preferred network.

• 66% of Medicare Advantage prescription drug (MA-PD) plans will have a preferred network.

Below, I provide historical data on preferred networks’ growth and update the top companies’ 2022 offerings. Two companies—Cigna and WellCare—have streamlined their PDP offerings by eliminating plans that had been acquired from other companies. I also provide our first analysis of the prevalence of preferred networks in three different types of MA-PD plans.

In upcoming articles, I’ll examine how chain and independent pharmacies will participate in these plans.

Sophia’s Story: Student, Daughter, Marketing Professional, Person Living with Crohn’s

Today’s guest post comes from Megan Marchal, Clinical Pharmacist at CoverMyMeds.

Megan shares the story of Sophia Garland, a young professional who is living with and learning to manage a chronic medical condition that requires specialty medication.

To learn more about technology and access to specialty medications, read the CoverMyMeds Medication Access Report: Complex Care & Specialty Edition.

Read on for Megan’s insights.

Drug Channels News Roundup, October 2021: PBMs’ Oncology Exclusions, Biosimilar Boom, BCBS vs. Hospitals, U.S. vs. the World, and CRISPR Comedy

Fortunately, Halloween can’t be scarier than any other day this year. So grab your pillow case and stuff it with treats from the great Drug Channels pumpkin patch:

• Spooky! PBMs are conjuring a terrifying number of formulary exclusions for oncology drugs

• Eerie! Brrr..did you hear that? It’s the biosimilar boom!

• Creepy! Scream as Blue Cross Blue Shield frightfully overpays hospitals

• Shocking! Believe it or not, U.S drug spending shambles into the middle of the herd

Plus, The Onion summons the only humorous article about CRISPR.

P.S. Please join the more than 12,700 consumers of my daily commentary and links to neat stuff at @DrugChannels on Twitter. You can also find my daily posts on LinkedIn, where I have more than 20,000 followers.

Recent posts have covered: Walgreens’ new direction; controversary over independent pharmacy counting; insurer consolidation; retail pharmacy M&A; drug pricing policy; Prime Therapeutics; 340B contract pharmacy litigation; pharmaceutical antitrust; oncology care model; and Peter Bach’s nuptials.

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

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.