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...

Friday, May 17, 2024

HCP Perspectives: Access Challenges in Treating Diabetes & Obesity

Today’s guest post is from Dr. Preeti Parikh, a practicing pediatrician and VP, Executive Medical Director at GoodRx.

At the recent Publicis Health Media HealthFront event, Preeti hosted a dialogue on the main stage with Dr. Minisha Sood. They discussed new GoodRx research and had a candid discussion about their daily challenges in caring for patients—especially those living with diabetes and obesity.

Click here to watch the full video of the conversation between Drs. Parikh and Sood.

Read on for Preeti’s insights.

Tuesday, May 14, 2024

Another IRA Surprise: Part B Coinsurance Inflation Adjustments Are Increasing Patient Costs

Contrary to what you may have heard, the Inflation Reduction Act’s (IRA) inflation rebates for Medicare Part B drugs do not always save money for seniors.

As we document below, a growing share of Part B drugs have inflation-adjusted coinsurance rates that have been increasing, not declining. In many cases, the coinsurance rate declines only briefly before rebounding back to the standard 20% rate. What’s more, these fluctuations have triggered huge jumps in patients’ out-of-pocket obligations for some drugs—even when a drug’s costs were falling.

Chalk off these coinsurance surprises to yet another unintended consequence of the IRA. Seniors who are expecting to see costs drop may find they are instead being taken for a rollercoaster ride.

Friday, May 10, 2024

Solving Access Barriers in Biomarker Testing: 5 Tips for Manufacturers

Today’s guest post comes from Hannah Baxter, Associate Partner at The Dedham Group; Jen Klarer, Partner, Head of Cell & Gene Therapy at The Dedham Group; and Carolyn Zele, Advisor, Solution Consulting at MMIT.

The authors discuss the access barriers facing patients who need biomarker testing. They discuss five ways manufacturers can prevent these barriers from affecting patients.

To learn more about navigating the complexities of market access, contact MMIT and its sister company, The Dedham Group.

Read on for their insights.

Tuesday, May 07, 2024

Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A May 2024 Update

It's time for Drug Channels’ annual update of vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels.

Below you’ll find our latest illustration of the major vertical business relationships among the largest companies along with some of the notable activity since our previous update. These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical efforts.

The companies face renewed scrutiny from the Federal Trade Commission, the Office of Inspector General, and members of Congress. But until anyone takes action, we will continue to live with the golden rule of the drug channel: Whoever has the gold gets to make the rules.

Friday, May 03, 2024

Bracing for Impact: The Future of Hub, PAP, and Affordability Programs Under the Inflation Reduction Act

Today’s guest post comes from Chris Dowd, Senior VP of Market Development at ConnectiveRx.

Chris explains how the Inflation Reduction Act of 2022 (IRA) will impact hub, patient assistance programs (PAP), and affordability programs. He discusses steps manufacturers can take to accommodate the anticipated budget reductions while maintaining access and affordability for patients.

To learn more, join Chris on June 4 at 1:00 p.m. ET for a free online panel discussion about how brands can continue to offer robust patient support despite IRA challenges.

Read on for Chris’ insights.

Tuesday, April 30, 2024

Drug Channels News Roundup, April 2024: CVS’s Humira Strategy, White Bagging “Savings,” IRA vs. Part D Plans, Walgreens Specialty Update, Pharmacies vs. GoodRx, and Oncology Fun

April is over, so it's time to hop into this month’s selection of noteworthy news:
  • CVS Health’s formulary boosts a Humira biosimilar
  • An insurer ditches buy-and-bill to save money for plans—but maybe not for patients?
  • My $0.02 on how Medicare Part D plans will react to the Inflation Reduction Act
  • Walgreens' unexpected specialty pharmacy strength
  • A video deconstruction of my infamous Drug Channels article on GoodRx
Plus, a cartoonist illustrates my recent keynote on the battle for oncology margin.

P.S. Join my nearly 55,000 LinkedIn followers for daily links to neat stuff.

Friday, April 26, 2024

Breaking Down Barriers: Helping Patients Get Therapies Quickly

Today’s guest post comes from Kevin Kettler, President of CoverMyMeds.

Kevin asks: What if there were no barriers across the therapy access and reimbursement process? In his view, eliminating barriers requires a combination of expert insight, actionable data, and simplification of the providers' experiences.

Click here to learn more about CoverMyMeds’ comprehensive technology solutions.

Meet CoverMyMeds in Booth 1305 at the Asembia AXS24 Summit. To keep up with CoverMyMeds and all the action at Asembia, click here to sign up for daily recaps from Asembia.

Read on for Kevin’s insights.

Wednesday, April 24, 2024

Independents Outshine PBMs in Manufacturers’ Exclusive Specialty Pharmacy Networks

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.

Monday, April 22, 2024

Visit Drug Channels in Booth #1801 at #Asembia24 for a Special “Ask Me Anything With Adam” (#AMAWA)

Next week, the Drug Channels Institute team will be attending Asembia’s AXS24 Summit at the wonderful Wynn Las Vegas.

And for the first time—thanks to our new friends at HMP Global—DCI will have its very own booth! (Click here for a special sneak peek.)

As you might expect, we will hit Vegas in true Drug Channels style. Stop by booth #1801 for fun and games:
  • Partake in a special in-person Ask Me Anything with Adam (#AMAWA) session with DCI president Adam J. Fein, Ph.D.! The AMAWA session will start on Monday, April 29, at 4:30 p.m. (Bring your phone if you want a selfie!)

    Adam won’t be speaking at Asembia this year, so be sure to visit booth #1801 on Monday afternoon to get his hot take on whatever topic is vexing you.
  • Spin the Drug Channels Wheel O’ Fun and win fabulous prizes!
  • Meet Bar Stern, DCI’s newest and most bearded team member!
  • Enjoy snacks, treats, and espresso!
DCI’s booth will be in the back of the hall, with all of the cool kids. Here’s a handy map:

[Click to Enlarge]

Remember: What happens in Booth #1801, stays in Booth #1801. 😉

BONUS TIP

While you’re in Vegas, be sure to visit the fantastic new exhibition about the gross-to-net bubble at Circus Circus.

10/10 would pop the gross-to-net bubble in Vegas again!

Friday, April 19, 2024

How GoodRx is Evolving Its Reimbursement Approaches to Help Pharmacies and Consumers

Today’s guest post comes from Jim Sheninger, Pharmacy Strategy Officer at GoodRx.

Jim describes GoodRx's emerging pharmacy contracting strategies. In addition to working through pharmacy benefit managers (PBMs), GoodRx now also contracts directly with Walgreens, CVS, and other national and regional pharmacies. These direct agreements are based on acqusition cost, which helps pharmacies stabilize gross margins while still providing low pricing for consumers. 

To learn more about GoodRx and its pharmacy partnerships, reach out to network@goodrx.com.

Read on for Jim’s insights.

Tuesday, April 16, 2024

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

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.

Friday, April 12, 2024

How Patient Engagement Can Reduce Brand Launch Risks

Today’s guest post comes from Jessica Lens, Chief Patient Experience Officer at CareMetx.

Jessica discusses the challenges of patient nonadherence. She then outlines how manufacturers can build adherence into their patient services program to increase patient engagement.

To learn more about enhancing patient engagement and adherence, download CareMetx's new report: Driving Brand Success: Minimize Risk and Capture Missed Value from Patient Engagement and Adherence.

Read on for Jessica’s insights.