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 nearly 100,000 subscribers and followers. Learn more...

Tuesday, July 16, 2024

PBM Power: The Gross-to-Net Bubble Reached $334 Billion in 2023—But Will Soon Start Deflating

Last week, the Federal Trade Commission (FTC) released its interim report on pharmacy benefit managers (PBMs). The report’s unsubtle subtitle revealed how the agency views PBMs: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. ICYMI, the FTC's report relied extensively on the Drug Channels Institute's (DCI's) 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

PBMs’ negotiating leverage against pharmaceutical manufacturers has been a key factor inflating the gross-to-net bubble—the ever-growing dollar gap between sales at brand-name drugs’ list prices and their sales at net prices after rebates, discounts, and other reductions.

For 2023, DCI estimates that the total value of manufacturers’ gross-to-net reductions for all brand-name drugs was $334 billion. (As we describe below, our latest estimates make a crucial change in the presentation of these figures compared with previous editions.)

Multiple forces are poised to pop the gross-to-net bubble for high-list/high-rebate products. This will force PBMs to further evolve their business models, while challenging plan sponsors and the FTC to follow the dollars.

Alas, patients remain caught in the drug channel's murky waters. I still can’t predict when SpongeBob SquarePants departs from Drug Channels—although I wish him a happy 25th birthday!

Friday, July 12, 2024

At the Breaking Point: The Unsustainable Future of Government Drug Discount Programs

Today’s guest post comes from Gavin Magaha, Senior Director of External Affairs and Policy at Kalderos.

Gavin discusses the three key reasons for duplicate discounts between the 340B Drug Pricing Program and the Medicaid Drug Rebate Program. He then explains Oregon’s novel approach to fixing the problem.

To learn more, register for Kalderos’ August 21, 2024, webinar: Revolutionizing Government Discount Programs: Why Traditional Methods Fail.

Read on for Gavin’s insights.

Tuesday, July 09, 2024

Who Will Pay for Prescription Drugs in 2032: Four Takeaways from the New Government Forecasts

The econowonks at the Centers for Medicare & Medicaid Services (CMS) recently released the latest projections for U.S. spending on healthcare. (See links below.) These data provide the latest official look at how the Inflation Reduction Act (IRA) will affect U.S. healthcare spending.

As you will see below, CMS projects that outpatient prescription drugs dispensed by retail and mail pharmacies will remain a small share of total U.S. healthcare spending. The Inflation Reduction Act’s changes to the Medicare Part D program, along with coming demographic shifts, will have a significant impact on future spending by government programs and consumers.

Nonetheless, taxpayers—primarily via Medicare and Medicaid—will continue to dominate the employer-sponsored insurance market. Like it or not, vertically integrated insurers, PBMs, specialty pharmacies, and providers will continue to prosper.

Friday, June 28, 2024

Breaking Down Medication Access and Affordability Barriers

Today’s guest post comes from Kristina Crockett, VP of Product Management at CoverMyMeds.

Kristina discusses challenges patients face accessing, affording, and adhering to prescribed medications. She goes on to describe how manufacturers can overcome these challenges to improve outcomes for both patients and brands.

Click here to learn more about CoverMyMeds’ technology solutions.

Read on for Kristina’s insights.

Tuesday, June 25, 2024

Drug Channels News Roundup, June 2024: Cordavis Humira Update, OptumRx’s New Biosim Biz, Generic Drugs' Wild Ride, IRA Predictions, and Dr. G on Med School

Happy 248th birthday, America! Before you launch your July 4 festivities, Drug Channels offers some fireworks of its own:
  • CVS Health’s Cordavis is winning the Humira biosimilar battle
  • Meet NUVAILA, OptumRx’s new biosimilar procurement business
  • The acquisition cost revolution hits a speedbump following NADAC volatility
  • Five predictions about the IRA’s impact on the drug channel
Plus, Dr. Glaucomflecken wonders why physicians don't learn about U.S. medicine’s economic realities.

P.S. Join my nearly 57,000 LinkedIn followers for daily links to neat stuff along with commentary from the Drug Channels community. Note that we will soon migrate our social media activity to the Drug Channels Institute LinkedIn page.

Top exceutives from Cencora, Eli Lilly, Optum Rx, and Walgreens will be headlining the inaugural Drug Channels Leadership Forum. Attendance will be limited, so click here to request an invite for our March 2025 event.

Monday, June 24, 2024

Meet the Four Executives Headlining the Drug Channels Leadership Forum

Good news, everyone! We have secured four outstanding fireside chat participants for our inaugural Drug Channels Leadership Forum, which will be held next March in Miami.

I’ll be leading one-on-one conversations with each of these executives:
  • Steven H. Collis, Chairman, President, and CEO, Cencora, Inc.
  • Patrick Conway, MD, MSc, CEO, Optum Rx
  • Frank Cunningham, Group Vice President, Global Value and Access & Lilly Direct, Eli Lilly and Company
  • Tim Wentworth, CEO, Walgreens Boots Alliance, Inc.
Our fireside chats will illuminate crucial issues and key strategic concerns affecting the prescription drug market and the entire U.S. healthcare system.

The event will also include panel discussions covering a range of important topics. Participants in these panels will be announced this fall.

IMPORTANT: To maximize the value of networking and learning, the event will have a limited number of attendees. Click here to request an invitation.

We will also have a limited number of sponsors. Click here to learn more about sponsorship opportunities.

Read on for the full press release. Hope you can join us!

Friday, June 21, 2024

Mark Cuban: Five Ways that Big PBMs Hurt U.S. Healthcare–And How We Can Fix It (rerun)

This week, I’m rerunning some popular posts while I prepare for today's live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook. The webinar begins at 12:00 PM ET.

Click here to see the original post from March 2024.

Today’s guest post comes from Mark Cuban, co-founder of the Mark Cuban Cost Plus Drug Company

A few weeks ago, Mark participated in the White House Roundtable on Lowering Healthcare Costs and Bringing Transparency to Prescription Drug Middlemen. I found Mark’s comments to be intriguing and highly provocative, so I invited him to publish an edited version exclusively here on Drug Channels.

Read on for Mark’s unfiltered view of the PBM industry. Feel free to add your own thoughts below or on LinkedIn.

Thursday, June 20, 2024

Copay Accumulator and Maximizer Update: Adoption Expands as Legal Barriers Grow (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow's live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Click here to see the original post from February 2024.

It's Valentine’s Day—and commercial plan sponsors remain smitten with copay accumulators and maximizers.

Our latest update finds that as of late 2023, about half of commercial lives were in plans that utilize a copay accumulator and/or a maximizer. These programs’ growth continues to divert the value of a manufacturer’s copay support payments away from patients and toward plans and PBMs. Check out the data below.

Patient advocacy groups and some big legal wins are starting to reverse Cupid’s arrow. But given the money at stake, I suspect that plans will keep looking for love in all the wrong places.

Wednesday, June 19, 2024

Independents Outshine PBMs in Manufacturers’ Exclusive Specialty Pharmacy Networks (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Click here to see the original post from April 2024.

Last week, we documented the substantial concentration of dispensing revenues for specialty drugs. See The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents.

Today, we examine how manufacturers’ specialty networks contribute to this concentration. In DCI’s exclusive analysis below, we show that specialty pharmacies affiliated with pharmacy benefit managers (PBMs) play an outsized role in manufacturer-designated dispensing networks.

A typical network contains about five specialty pharmacies—but one in three specialty products with a manufacturer-designated network contains only a single specialty pharmacy. In those exclusive networks, independent and smaller specialty pharmacies are the big winners.

Read on for DCI’s updated profile of specialty networks—and ponder why smaller pharmacies are winning the battle for exclusive networks.

Tuesday, June 18, 2024

The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

One important update to the figures below: We (and many others) had significantly underestimated Walgreens' revenues and market share. As we discuss below, its market share is closer to 10%, compared with the 3% that we originally reported.

Click here to see the original post from April 2024.

Drug Channels Institute’s (DCI’s) latest analysis finds that participants in the specialty pharmacy market continue to get more diverse—although revenues remain highly concentrated.

We have identified nearly 1,800 dispensing sites with specialty pharmacy accreditation—about 40% of which are owned by hospitals, physician practices, and other healthcare providers.

Alas, specialty pharmacies owned by the three largest pharmacy benefit managers (PBMs) have the most brass in their pocket, as they accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs.

Read on for DCI’s latest overview of the 2023 marketplace and revenues of the biggest market participants, along with key specialty pharmacy trends.

Monday, June 17, 2024

The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.

Click here to see the original post from April 2024.

Three is still the magic number for pharmacy benefit managers (PBMs).

For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group.

Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the industry changes that will shift these shares over the next few years.

Friday, June 14, 2024

Expanding our Definitions of Out-of-Pocket Costs: Three Imperatives for Biopharmaceutical Manufacturers

Today’s guest post comes from Christine Juday, Head of Market Access at Real Chemistry.

Chris discusses new research on how patients perceive out-of-pocket costs. As she explains, many patients and unpaid caregivers consider out-of-pocket costs for medication within the context of their total spending. She then recommends three ways that manufacturers can improve patients' access and affordability.

Click here to learn more about Real Chemistry’s suite of market access consulting and payer/IDN marketing solutions. You can also sign up for its weekly Value Report, summarizing the week in drug pricing, access, and value news.

Read on for Chris' insights.