Drug Channels 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. Drug Channels reaches an engaged, loyal and growing audience of more than 26,000 subscribers. Learn more...

Thursday, December 12, 2019

Insurers + PBMs + Specialty Pharmacies + Providers: Will Vertical Consolidation Disrupt Drug Channels in 2020?

The largest insurers, PBMs, and specialty pharmacies have now combined into vertically-integrated organizations. As I explain below, these companies have also been rapidly integrating with healthcare providers.

I also provide an updated look at these companies and highlight strategies that they are using—or could use—to control the channel. I believe that these insurer / PBM / specialty pharmacy / provider organizations are poised to restructure U.S. drug channels by exerting greater control over patient access, sites of care/dispensing, and pricing.

If they can effectively coordinate their sprawling business operations, they will pose a substantial threat of disruption to the existing commercial strategies of pharma companies.

Will they succeed by better managing care and costs, or merely by extracting higher profits from our convoluted system?

I’ll be discussing vertical consolidation and a range of other hot topics tomorrow in my exclusive live webinar: DRUG CHANNELS OUTLOOK: WHAT YOU NEED TO WATCH IN 2020. I hope you can join me. If you register but can't make it this Friday, you'll receive a link to watch a replay.

Tuesday, December 10, 2019

Latest CMS Data: Drug Spending is Not Skyrocketing; Hospitals and Physicians Dominate Healthcare Costs

Last week, the econowonks at the Centers for Medicare & Medicaid Services (CMS) released the 2018 National Health Expenditure (NHE) data, which measures all U.S. spending on healthcare. Links below.

Some drug spending highlights:
  • For 2018, spending on outpatient prescription drugs grew by 2.5%—below the spending growth rate on hospitals, physician services, and overall national healthcare costs. 
  • CMS significantly lowered its previously reported drug spending figures by billions after incorporating new data on manufacturers’ rebates. 
These latest CMS data also highlight why the policy debate over healthcare spending is so unbalanced. Too many people—including politicians, journalists, and a certain billionaire—have committed to a false narrative of “skyrocketing” drug spending. I must again note that demonizing pharmaceuticals as the prime driver of U.S. healthcare spending is simply wrong, as you will see below.

Unfortunately, the share and amount that Americans are forced to pay of prescription drug spending is much greater than that of other healthcare services. This circumstance derives from benefit designs, not drug prices. See what you think in our pretty charts below.


Drug Channels Institute will host an exclusive live webinar, Drug Channels Outlook: What You Need to Watch in 2020, on Friday, December 13, 2019, from 12 p.m. to 1:00 p.m. ET. Get ready for what will certainly be another year of change for U.S. healthcare. CLICK HERE TO LEARN MORE AND SIGN UP.

If you register but can't make it this Friday, you'll receive a link to watch the replay.

Monday, December 09, 2019

sPCMA Business Forum 2020

sPCMA Business Forum
March 16 & 17, 2020
Hilton Bonnet Creek | Orlando, FL
Register Today!

The sPCMA Business Forum will return to the Hilton Bonnet Creek in Orlando, FL on March 16 & 17, 2020.

Senior executives and decision makers from PBMs, health plans and their affiliate specialty pharmacies will come together at the sPCMA Business Forum to collaborate with drug and biotech manufacturers and other important business partners. The event offers invaluable networking and education for individuals and companies involved in the specialty pharmacy supply chain. Registration for the conference is now open online.


Speakers are among the specialty pharmacy industry’s top thought leaders, influencers, and executives. View highlights from last year or learn more about this conference on the sPCMA Business Forum website!


Contact PCMA

Please contact Kayla Firriolo (kfirriolo@pcmanet.org) with questions or to request further information.


The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

Thursday, December 05, 2019

Has Physician Specialty Dispensing Peaked—And Should They Blame PBMs?

Everyone wants to be a specialty pharmacy—but it’s getting harder to compete.

Consider the boom in pharmacies operated by physician practices. The growth in oral and patient self-injectable specialty drugs has encouraged physicians to dispense these products from their offices and clinics. For example, almost half of all oncology practices now dispense specialty drugs to their patients.

But as we show below, the share of oncology practices dispensing prescriptions has declined for the first time in at least six years. I suspect that we are at a turning point in the growth of physician practice dispensing.

As I explain below, this development reflects how PBMs and their plan sponsor clients are managing specialty channels.

PBMs offer financial carrots that entice plan sponsor to shift prescriptions into PBM-owned specialty pharmacies. This dynamic creates novel competitive conflicts between historically separate drug channel participants. Meanwhile, physicians are learning the perils of competing with vertically-integrated channel organizations.


Drug Channels Institute will host an exclusive live webinar, Drug Channels Outlook: What You Need to Watch in 2020, on Friday, December 13, 2019, from 12 p.m. to 1:00 p.m. ET. Get ready for what will certainly be another year of change for U.S. healthcare. CLICK HERE TO LEARN MORE AND SIGN UP.

Tuesday, December 03, 2019

The State of Retail Pharmacy: Independent Pharmacy Economics Stabilize—But Dropping, Owner Salaries Are

Time for Drug Channels’ exclusive look at independent pharmacy owners’ business economics. For Episode XI of our annual review, we again draw upon the latest data from the National Community Pharmacists Association (NCPA) Digest, Sponsored by Cardinal Health. Here's the press release for the recently released 2019 edition.

Below, I update our estimates of pharmacy economics and margins. Our analysis reveals that profits per prescription in 2018 were unchanged from the 2017 figures. However, the average pharmacy in the NCPA sample filled fewer prescriptions, causing the average pharmacy owner’s salary to decline for the fifth consecutive year.

Read on for our look at pharmacy profits and my comments on the competitive dynamics of retail pharmacy. How many independents will survive? Difficult to see. Always in motion is the future.


Drug Channels Institute will host an exclusive live webinar, Drug Channels Outlook: What You Need to Watch in 2020, on Friday, December 13, 2019, from 12 p.m. to 1:00 p.m. ET. Get ready for what will certainly be another year of change for U.S. healthcare. CLICK HERE TO LEARN MORE AND SIGN UP.

Monday, December 02, 2019

PAP 2020 - 21st Annual Patient Assistance & Access Programs

PAP 2020 - 21st Annual Patient Assistance & Access Programs
March 23-25, 2020 | Baltimore, MD
www.cbinet.com/pap

PAP 2020, one of the nation's largest and most impactful patient access events returns to Baltimore for the 21st year! 2020 features powerful programming and compelling content designed to navigate complexities and break through barriers to ensure prescription access and affordability. Take this opportunity to exchange techniques for successful partnering, gain key industry trends in PAPs and connect personal and professional goals to accelerate success.

Visit www.cbinet.com/pap for further details and to register. Drug Channels readers from life science manufacturers will save $400 off the standard rate when they use code MZZ849 and register prior to December 27th.*

The complete agenda and faculty list will be coming soon, and features coverage on the hottest topics that matter most:
  • Examine the intersection of patient access and shifts in healthcare legislation
  • Identify emerging best practices and industry trends in free drug programs
  • Assess the latest technology innovations to advance PAPs and drive efficiencies
  • Navigate compliance risks as greater government oversight focuses on patient support and copay programs
  • Explore advocate resources for better navigation of patient pathways and strategies to address medication access barriers
  • Foster collaboration across stakeholders to speed patient access and manage costs
  • Realize the current benefits and challenges of patient assistance from the patient perspective
KEYNOTE ANNOUNCEMENT: CBI is excited to welcome Ezekiel J. Emanuel, M.D., Ph.D., Vice Provost, Global Initiatives, the Diane v.S. Levy and Robert M. Levy University Professor, and Chair of the Department of Medical Ethics and Health Policy, University of Pennsylvania as our opening keynote speaker addressing pending health policy changes and the impact on patient affordability and access. Dr. Emanuel currently serves as a Special Advisor to the Director General of the WHO and is considered one of the leading practitioners shaping the future of healthcare, with a long record of experience at the top levels of policy including special advisor for health policy to the White House Office of Management and Budget from January 2009 to January 2011.

The conference faculty boasts 50+ presenters from Acceleron Pharma, AIDS Institute, Anne Arundel Medical Center, Avalere Health, Bausch Health, Beacon Charitable Pharmacy, Carilion Clinic, Community Volunteers in Medicine, Cystic Fibrosis Foundation, Dermira, Eisai, GSK, Health Alliance for the Uninsured, HealthWell Foundation, J&J, LEO Pharma, Leukemia & Lymphoma Society, McKesson Pharmacy, MorphoSys US Inc, National Health Council, National Multiple Sclerosis Society, PAN Foundation, Patient Advocate Foundation, Pfizer, Rigel Pharmaceuticals, Sidley Austin LLP, SK Life Science Inc, Sobi, The National Association of Free & Charitable Clinics, Thomas Jefferson University Hospital, UC Health, UCB, UnityPoint Health, Vanderbilt University Medical Center, Virginia Health Care Foundation and many more.

Visit www.cbinet.com/pap for further details and to register. Drug Channels readers from life science manufacturers will save $400 off the standard rate when they use code MZZ849 and register prior to December 27th.*

CBI will see you there!

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates, clinic/hospital rates, non-profit rates other offers. 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.

Monday, November 25, 2019

CBI’s Patient Registries, Real World Evidence and HEOR

CBI’s Patient Registries, Real World Evidence and HEOR
January 27-28, 2020 | Miami, FL
www.cbinet.com/RWE

Kick off 2020 in Miami at the Patient Registries, Real World Evidence and HEOR Summit! Come together with colleagues from across the industry to discuss the latest innovations and best practices for collecting, analyzing and utilizing patient data.

Visit www.cbinet.com/RWE for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code ZUS222 and register prior to December 13, 2019.*

With three dedicated tracks – Patient Registries, RWE and HEOR – the conference focuses on common goals for participants centered on using data to improve treatment and outcomes. Sign up to see the agenda here.

Experts from Jazz Pharmaceuticals, AHRQ, Pfizer, Alexion Pharmaceuticals, Amicus Therapeutics, Novartis, NORD, EMD Serono, Biogen, Global Healthy Living Foundation, AstraZeneca, Stamford Health, Ferring Pharmaceuticals, Global Genes, Geisinger, BeiGene, Takeda Canada, Bridge the Gap - SYNGAP Education and Research Foundation and more will lead robust discussions on topics such as:
  • The Evolving Industry Landscape and the Role of Real World Evidence in Optimizing Market Access and Patient Outcomes
  • Getting to High-Quality Real-World Data and Applying it to RWE
  • Navigate Health Data Governance to Improve Treatments and Outcomes
  • Bringing Data Back to Patients — Empowering Patients through Data Sharing
  • Global Perspective and Outlook on Registries and RWE
  • Emerging Ethical and Compliance Issues in RWD-Driven Research
  • Harmonization of Outcomes Measures for More Patient-Centric Care
  • Leverage Machine Learning and New Technologies to Enhance RWE Generation and Outcomes Research
  • And much more!
Visit www.cbinet.com/RWE for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code ZUS222 and register prior to December 13, 2019.*

CBI will see you there!

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rate or non-profit rates. 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.

Thursday, November 21, 2019

Drug Channels News Roundup, November 2019: Amazon Pharmacy, JAMA 340B Redux, Diplomat, Hospital-Physician Integration, and the FDA

Happy Thanksgiving, everyone! Before you stretch your stomach, stretch your mind with some food for thought. In this issue:
  • Here comes Amazon Pharmacy
  • OIG Confirms it: the JAMA 340B paper is wrong
  • Diplomat gets close to the edge
  • Unfortunately unsurprising news about hospital-physician integration
Plus, a timely new campaign from the FDA.

P.S. Join the more than 8,400 people who follow @DrugChannels on Twitter. My recent tweets have highlighted biosimilars, telehealth, the Walgreens LBO, ICER, hospital consolidation, H.R.3 and biotech, reference pricing for U.S. healthcare spending, global channels overlord Stefano Pessina, and Canadians.


Drug Channels Institute will host an exclusive live webinar, Drug Channels Outlook: What You Need to Watch in 2020, on Friday, December 13, 2019, from 12 p.m. to 1:00 p.m. ET. Get ready for what will certainly be another year of change for U.S. healthcare. CLICK HERE TO LEARN MORE AND SIGN UP.

Tuesday, November 19, 2019

Part B Update: Hospitals Displacing Physicians, Amid Slow Growth in Drug Prices

The Medicare Payment Advisory Commission (MedPAC), the independent agency that advises Congress on the Medicare program, recently released its June 2019 Data Book: Health Care Spending and the Medicare Program.

This year’s report provides the latest details about the ongoing disruption of the buy-and-bill market in Medicare Part B. As you will see below:
  • Physician offices account for a diminishing share of Part B spending, though absolute spending at these sites continues to grow. 
  • Hospital outpatient settings have been crowding out physician offices. Hospital outpatient departments now account for more than 40% of Part B spending—and an even greater share for oncology products.
What's more, Part B spending has grown much faster than drug prices. The prices paid by Medicare for the top 10 Part B drugs have been growing at low- to mid-single digit rates. Spending has grown due to more beneficiaries and the adoption of newer, higher-priced therapies.

The Trump administration has signaled that it wants Medicare to pay less for Part B drugs. Its primary proposals focus on comparisons to prices paid by other countries. These analyses conveniently overlook the lower drug prices that manufacturers provide to the Medicaid program and 340B hospitals.

It looks like 2020 will not be relaxing times for the buy-and-bill channel.

Drug Channels Institute will host an exclusive live webinar, Drug Channels Outlook: What You Need to Watch in 2020, on Friday, December 13, 2019, from 12 p.m. to 1:00 p.m. ET. Get ready for what will certainly be another year of change for U.S. healthcare. CLICK HERE TO LEARN MORE AND SIGN UP.

Monday, November 18, 2019

CBI's 15th Annual Life Sciences Trade and Channel Strategies

CBI’s 15th Annual Life Sciences Trade and Channel Strategies
December 3-5, 2019 | Philadelphia, PA
www.cbinet.com/trade

Hit the ground running in 2020 by closing out the year at Trade and Channel 2019! The life science industry's foremost thought-leaders will come together on December 3-5 to unravel the complexities of the distribution channel, navigate high-impact topics transforming trade and benchmark winning pharmacy and distribution frameworks.

Visit www.cbinet.com/trade for further details and to register. Drug Channels readers will save $200 off the standard rate when they use code UTC356 and register prior to November 29th.*

You can download the complete agenda here.

Can't Miss Keynotes include:
  • Drug Channels Update - Things to Watch in 2020
    Adam J. Fein, Ph.D., CEO, Drug Channels Institute
  • Fireside Chat - Candid Conversation with an Industry Pioneer
    Bill Roth, Founding Partner, Blue Fin Group
  • Healthcare Policy Address - Current State of Regulatory Reform Driving Innovation and Access
    Eric D. Hargan, Deputy Secretary, Department of Health and Human Services (HHS)
  • How the New Wave of Algorithmic Care Will Disrupt Your Business
    Zen Chu, Investor, PillPack; Senior Lecturer in Healthcare Innovation, MIT Sloan School of Management and Harvard-MIT Health Sciences & Technology
In-Depth Summits, Interactive Workshops and Tailored Tracks focusing on:
  • New Product Launch Planning
  • Mitigate Compliance Risk in Manufacturer and Specialty Pharmacy Contracts
  • Digital and Blockchain Technology Adoption and Implementation
  • Retail and POS Contracting
  • Forward-Thinking Strategies for Specialty Generics and Biosimilars
  • 340B - Best Practices to Improve Compliance and Manage Drug Diversion
  • Specialty Channel Network Design and Contracting
  • Market Access, Patient Support and Hub Services Optimization
  • Next-Gen Specialty Product Data Strategies
Download the agenda to plan your sessions and prepare to return to the office armed with critical updates and valuable takeaways.

Visit www.cbinet.com/trade for further details and to register. Drug Channels readers will save $200 off the standard rate when they use code UTC356 and register prior to November 29th.*

CBI will see you there!

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates, clinic/hospital rates, non-profit rates other offers. 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.

Friday, November 15, 2019

Drug Channels Outlook: What You Need to Watch in 2020 (A Drug Channels Institute Live Webinar)

On December 13 at 12:00 p.m to 1:00 p.m. ET, Drug Channels Institute (DCI) will host an exclusive new webinar: Drug Channels Outlook: What You Need to Watch in 2020. Join Dr. Adam J. Fein, CEO of DCI and the author of Drug Channels, for this one hour, live event as he helps you understand and get ready for what will certainly be another year of change for U.S. healthcare.


The webinar’s benefits include:
  • An unlimited number of people may listen at one location! Invite your whole team for an hour of intensive learning and strategic insight. The presentation is sure to spark important internal discussion about the coming year’s implications for your business.
  • The opportunity to ask Dr. Fein questions during the event
  • Dr. Fein’s slides and analysis of the marketplace. You’ll also receive a downloadable PDF with the webinar slides.
  • Access via any device with a web browser (computer, iPad, iPhone/Android, etc.)
WHAT YOU WILL LEARN

We will help you and your team get ready for the year ahead by outlining key issues and uncertainties that will surely affect your planning.

Dr. Fein will share his latest thinking on:
  • The crucial market trends that will drive the strategies of pharmacies, wholesalers, PBMs, and payers
  • What’s next for drug pricing and the gross-to-net bubble
  • The prospects for vertical integration, consolidations, and novel channel alliances
  • How health plans and payers will manage drug channels
  • The likely changes to government regulations and policy
  • An update on prospects for disruption by Amazon and other new entrants
PLUS: Dr. Fein will take your questions.

HOW TO SIGN UP

The webinar will take place on December 13, 2019, at 12:00 p.m. ET.

Sign up now for only $250 per site.
  • After you register, you will receive an email with the information you will need to access our webinar and add it to your calendar. We will also send you reminder emails one day and one hour before the event.
  • Invite your entire field team to listen at multiple sites around the country. Contact Paula Fein (paula@drugchannelsinstitute.com) to get special pricing for 10 or more locations. If you purchase access for multiple sites, we will contact you for the name and email address of a contact person at each location.
  • If your plans change and you can’t make it on December 13, we will provide an opportunity to watch a replay of the webinar. Unfortunately, we are unable to offer refunds.
  • Pembroke Consulting clients receive free access to the webinar. Contact Tamra Feldman (admin@drugchannels.net) for details. Note that we will automatically refund purchases from Pembroke’s corporate clients.

Wednesday, November 13, 2019

Employer Pharmacy Benefits in 2019: High Deductibles and Greater Coinsurance Expose Even More Patients to Prescription List Prices

It’s time for our annual deep dive into employer-sponsored health coverage via the 2019 Kaiser Family Foundation Employer Health Benefits Survey. This report provides valuable national benchmarking data. You can read it online for free.

Below, you’ll find my highlights of the report’s findings on prescription coverage. I summarize employers’ 2019 pharmacy benefits by examining (1) cost sharing tier structures, (2) the prevalence of copayment vs. coinsurance, and (3) average copayments and coinsurance rates, by formulary tier. I break down the 2019 results for plans with and without high deductibles.

Employer benefit designs increasingly expose patients to the list price of their prescriptions. This is due largely to the benefit designs described below, which have shifted out-of-pocket spending for prescription drugs from copayments toward deductible and coinsurance spending. As you will see, cost sharing for prescription drugs in high-deductible plans differs significantly from that of plans that lack high deductibles. Plans with no limit on out-of-pocket expenses remain distressingly common.

Patients are finding their benefits to be increasingly mysterious, with more tiers, more coinsurance, and greater use of deductibles. When people complain about “drug prices,” they are actually complaining about the share of costs that they pay—and how those costs are computed. Put another way, the plan details won’t give employees a glad expression.

Read on for my analysis along with our annual Drug Channels tiers/tears puns.