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...

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.

Tuesday, November 12, 2019

CBI’s Medicare Pricing & Contracting Congress

CBI’s Medicare Pricing & Contracting Congress
February 25-26, 2020 | Hilton Alexandria Old Town | Alexandria, VA
www.cbinet.com/medicare2020

The current Medicare and drug pricing landscape is facing the potential for seismic changes in the year ahead. CBI’s Medicare Pricing & Contracting Congress expands in 2020 to convene stakeholders representing bio/pharma manufacturers, health plans, PBMs and leading policy advisors to provide critical updates and analysis on the impact of changing legislation.

Visit www.cbinet.com/Medicare2020 for more information. Drug Channels readers will save $500 off the standard registration rate when they use promo code RDU698*.

Benefit from In-Depth Discussions on High-Impact Issues:
  • Political and legislative trends impacting coverage & access
  • International Pricing Index Model (IPI) and Most Favored-Nations Clause updates
  • Changes to Part B and ASP reporting requirements
  • Trends and insights into Medicare Part D drug spending
  • Considerations for balancing care and quality while delivering patient-centric outcomes
  • Approaches for value-based contracting and alternative payment models
PLUS! Choose Between Two Tracks of Content:
  1. Pricing & Contracting — for manufacturers
  2. Part D Plan Strategies —for health plans and PBMs
Distinguished Speakers Driving the Dialogue:
  • Mike Anderson, Pharm.D., CEO, Part D, UnitedHealthcare Medicare & Retirement
  • Dan Wygal, Executive Director, Contract and Channel Strategy, AstraZeneca Pharmaceuticals
  • Laura Crawn, Senior Director, Government Programs Market Strategy & Support, Express Scripts
  • Steve Phillips, Senior Director, Health Policy Worldwide Government Affairs & Policy, Johnson & Johnson
  • Michelle Drozd, Executive Director Reimbursement Policy, Gilead Sciences
  • Kendra Martello, Executive Director, Public Policy & Corporate Social Responsibility, Government Affairs & Public Policy, Mallinckrodt Pharmaceuticals
  • John Gorman, Founder and Chairman, Nightingale Partners
  • And more!
Visit www.cbinet.com/Medicare2020 for more information. Drug Channels readers will save $500 off the standard registration rate when they use promo code RDU698*.

*Offer applies to standard 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.


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

Thursday, November 07, 2019

A Tale of Two Chains: Walgreens Exits Pharmacy Clinics While CVS Reinvents In-Store Care

For retail clinics, is it the best of times or the worst of times?

Walgreens  retail clinic business has been floundering. Last week, Walgreens announced that it would shut the last of its in-house retail clinics and in favor of outsourcing clinic operations to hospitals and health systems.

Other retailers are investing in more expansive healthcare services to realize the promise of store-based healthcare. That’s one reason why CVS Health is rolling out its HealthHUBs, while Walmart is phasing out its traditional retail clinics in favor of a more comprehensive Walmart Health offering.

Below, I review the retail clinic market in 2019. Many large retail chains operate clinics, but their strategies and growth rates differ. I expect the traditional retail clinic model to fade in favor of locations with broader healthcare services. This new direction will put pharmacies in more direct competition with urgent care clinics and primary care providers.

Pay close attention to how CVS Health leverages its Aetna business to manage site-of-care costs. Investors, payers, and patients will soon determine whether this has been the age of wisdom or the age of foolishness.

Tuesday, November 05, 2019

CVS Health’s Specialty Gain Is McKesson’s Pain

Last week, McKesson released its earnings for the third calendar quarter of 2019. (See the links below.) The company revealed unexpectedly high revenue growth in its distribution business—but little incremental profit from these new revenues. Its stock dropped sharply on the news.

The thief that burgled the missing profits: CVS Health, McKesson’s largest customer. McKesson’s financial results reflected the challenges of an ultra-low profit customer that unexpectedly started growing much faster than the overall industry.

Consolidation and concentration in the pharmacy and pharmacy benefit management (PBM) industries continue to pressure wholesalers’ profits. Manufacturers and smaller customers should get ready for the fryer. Robble robble!

Monday, November 04, 2019

Pharmaceutical Drug Pricing Strategies and Copay Summits

Pharmaceutical Drug Pricing Strategies and Copay Summits
December 11-12, 2019 | Alexandria, VA

World Congress invites you to the Pharmaceutical Drug Pricing Strategies and Copay Summits where experts will share their solutions for critical issues.

Join your peers to learn from 35 speakers and enjoy 5 hours of networking at The Westin, Alexandria, VA. Drug Channels readers save $200 off the standard rate when you use promo code DC200 and register by November 8th.* To register your team, contact World Congress at 800-767-9499.

The price of prescription drugs and affordability of treatments is at the center of the health care debate. These Summits address the critical juncture of price and affordability, by showcasing strategies, innovations, and best practices across the bio/pharmaceutical industry to share how to be a part of the solution.

Given the recent news headlines, Senate finance hearings, and the introduction of drug pricing transparency laws, drug pricing is under the national spotlight. Hear both perspectives at the Pharmaceutical Drug Pricing Strategies Summit which brings pricing and reimbursement leaders together to discuss the future of federal and state pricing requirements, transparency regulations, and strategic drug pricing models.

The 2nd Annual Copay Summit convenes multiple stakeholders together, from manufacturers, payers, states, government, advocacy, and foundational groups, to examine regulations and innovations around the use of Copay and Coupon programs, and Copay Accumulator and Maximizers in an evolving health care landscape.

The Summits’ in-depth sessions will help you attain solutions for issues your organization faces in drug pricing and copay strategies.
  • Develop strategic drug pricing models to meet federal and state pricing requirements and ensure transparency
  • Examine the changes regarding copay accumulator adjustments, state copay legislation, and compliant assistance programs
  • Explore multi-stakeholder insights from manufacturers, and insurers, on the future of drug price transparency and patient affordability
Our distinguished speaking faculty will share their insights:
  • Mike Mason, Vice President, Lilly Diabetes, Senior Vice President, Connected Care and Insulins Eli Lilly and Company; he recently testified before the U.S. House of Representatives
  • Robert Popovian, Vice President, US Government Relations, Pfizer; he has published and presented extensively on the impact of biopharmaceuticals and health policies on health care costs and clinical outcomes
  • Peter Pitts, President of the Center for Medicine in the Public Interest; he is a former member of the United States Senior Executive Service and was FDA’s Associate Commissioner for External Relations
Join your peers to learn from 35 speakers and enjoy 5 hours of networking at The Westin, Alexandria, VA. Drug Channels readers save $200 off the standard rate when you use promo code DC200 and register by November 8th.* To register your team, contact World Congress at 800-767-9499.

*Cannot be combined with other offers or prior registrations.


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

Friday, November 01, 2019

Connecting Providers and Technology: Improving the Patient Journey Through Actionable Insights

Today’s guest post comes from Ben Stormer, Vice President of Specialty Product Development and Strategy at CoverMyMeds and Regina Murphy, Vice President of Product Strategy, Access and Adherence at RxCrossroads by McKesson.

Ben and Regina describe AMP: Access for More Patients™, a new technology-based hub service solution from CoverMyMeds and RxCrossroads by McKesson. To learn more about AMP, visit go.covermymeds.com/specialty.

Read on for Ben’s and Regina’s insights.

Thursday, October 31, 2019

Drug Channels News Roundup, October 2019: Express Scripts + 340B, Government Negotiation, Compounding Pharmacies, and Red Meat (with Onion)

Eeek! Time for my Halloween roundup of Drug Channels news stories.

In this issue:
  • Creepy! Express Scripts invests in 340B
  • Shocking! What Americans really think about government drug price negotiations
  • Scary! A terrifying tale of compounding pharmacies and the Cats movie
Plus, the best take on nutrition research I have ever read.

P.S. Join the more than 8,300 people who follow @DrugChannels on Twitter. My recent tweets have highlighted biosimilars, Part D in 2020, generic drug approvals, H.R.3 and its effects, 340B hypocrisy, ICER, Jamaican monetary policy, billionaires, and more.

Tuesday, October 29, 2019

Even More Independents Avoid 2020 Part D Preferred Pharmacy Networks

Last week, I highlighted the largest pharmacy chains that will participate in next year’s Medicare Part D prescription drug plans (PDP).

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

For most independent pharmacies and their PSAOs, the profit sacrifices of Medicare Part D preferred networks are apparently no longer worth the incremental volume. As I predicted last year, they are starting to reject preferred networks:
  • McKesson’s Health Mart Atlas will be the only PSAO whose members’ level of participation in preferred Part D networks will be comparable to that of the big chains.
  • Pharmacy members of AmerisourceBergen’s Elevate network will again skip preferred status in the major Part D networks.
  • Members of Cardinal Health’s PSAOs and the independent Arete Pharmacy Network will be preferred in many fewer 2020 networks compared with 2019.
You’ll find details and a handy scorecard below.

With independents fleeing preferred networks, will the Centers for Medicare & Medicaid Services (CMS) take a closer look at the market? And are independents really ready to say that they are never ever, ever, ever getting back together with preferred networks?

Monday, October 28, 2019

CBI’s Specialty Therapies and Biosimilars Congress

CBI’s Specialty Therapies and Biosimilars Congress
January 22-24, 2020 | Miami, FL
www.cbinet.com/specialtytherapies

Kick off 2020 in Miami at the Specialty Therapies and Biosimilars Congress! Come together with colleagues from across the industry to tackle the challenges involved in managing the cost and quality of innovative therapies that are controlling or conquering diseases that were once considered untreatable.

Visit www.cbinet.com/specialtytherapies for further details and to register. Drug Channels readers will save $400 off the standard rate when they use promo code SPT400 and register prior to November 22nd.*

The quest to drive better outcomes, ensure access and manage costs is more vital than ever. Don’t miss the chance to be part of the conversation. Sign up to see the agenda here.

Experts from Blue Cross Blue Shield of Michigan, MedImpact Healthcare System, Fairview Specialty Pharmacy, Ochsner Health System, Boehringer Ingelheim, AHIP, Hemophilia Alliance, BBCIC, Mayo Clinic, Sunovion Pharmaceuticals and more will lead robust discussions on topics such as:
  • Biosimilar Litigation and Patent Law
  • Cell and Gene Therapy Reimbursement and Funding Strategy
  • Medicare Report 2020
  • Barriers to Entry – Challenges and Solutions for Entering the Marketplace
  • Collaboration in a Complicated Landscape – The Role of Specialty Pharmacies in Controlling Cost
  • Managing the Patient’s Journey – Payer Contracts, Points of Care and Formulary
  • Real World Data and Demonstrated Value – The Care for Biosimilars and Expensive Therapies
  • The Evolving Role of the Specialty Pharmacy in Oncology Management
Visit www.cbinet.com/specialtytherapies for further details and to register. Drug Channels readers will save $400 off the standard rate when they use promo code SPT400 and register prior to November 22nd.*

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, October 24, 2019

Winning? CVS, Kroger, and Walmart Expand in 2020 Part D Preferred Pharmacy Networks

In Preferred Pharmacy Networks Rebound in 2020 Medicare Part D Plans, I highlighted how those networks will again dominate next year’s Medicare Part D prescription drug plans (PDP).

Today, I examine chain pharmacies’ participation in the major 2020 Part D preferred networks that the nine largest plan sponsors offers. Some highlights:
  • CVS will retain its position as a preferred pharmacy in many 2020 networks, while Walgreens will pull back on its preferred pharmacy participation. 
  • For the first time in years, Rite Aid will expand its participation in plans that are independent of its EnvisionRx subsidiary.
  • Walmart will regain its position as the chain most committed to preferred networks. Kroger and Albertsons will maintain the strong positions that they have established over the past few years.
Below, we provide you with a handy table for scoring each chain’s participation and all changes from 2019 to 2020.

The winners will gain and/or retain Part D prescription volume, but profits will suffer due to direct and indirect remuneration (DIR) price concessions, a.k.a., DIR fees. The retail chains have never clearly disclosed how they tradeoff prescription volume for profits. Remember: you can’t spell “pyrrhic victory” without victory.

Tuesday, October 22, 2019

Preferred Pharmacy Networks Rebound in 2020 Medicare Part D Plans: Details on WellCare, CVS Health, Humana, Cigna, and More

The Centers for Medicare & Medicaid Services (CMS) has released its data on the 2020 Medicare Part D plans.

Our exclusive analysis of these data reveals that preferred cost sharing pharmacy networks will maintain their dominance as an established component of Part D benefit design. For 2020, 95% of Medicare Part D regional prescription drug plans (PDP) will have a preferred network. In 2019, 92% of plans had such a network.

Below, I provide historical data on preferred networks’ growth and then discuss the top nine companies offering the 2020 plans. Humana is the only major plan sponsor to offer a national plan with an open network for 2020.

The prominence of preferred networks will again pressure pharmacy profits. That’s because pharmacies must pay direct and indirect remuneration (DIR) price concessions, a.k.a., DIR fees. In my next post, I’ll examine chain pharmacies’ participation in these plans and what it means for pharmacy profits.

P.S. Today’s post is brought to you by the letter D.