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 22,000 subscribers. Learn more...

Wednesday, November 14, 2018

Express Scripts Launches a New Formulary for a World Without Rebates. Will Plan Sponsors and Drug Makers Play Along?

Express Scripts has just announced its National Preferred Flex Formulary, a new option that favors drugs with lower list prices over the high-list/high-rebate versions of these products. Click here to read the press release.

This new formulary signals that Express Scripts is trying to prepare its plan sponsor clients for a world without rebates. The formulary also provides a way for Express Scripts to prepare itself for such a world.

As I explain below, many plan sponsors embrace the warped incentives of the gross-to-net bubble—the ever-growing pile of money between a manufacturer’s list price for a drug and the net price after rebates and other reductions. I outline two crucial payer and PBM factors that make it difficult for manufacturers to cut list prices and pop the gross-to-net bubble.

Express Scripts’ new formulary challenges plan sponsors that are addicted to rebate dollars. Let’s see how many plan sponsors will prefer a low list-price over a high-list/high-rebate product—and how many more manufacturers will respond with lower list prices.

Tuesday, November 13, 2018

13th Annual Health Care Supply Chain Summit

13th Annual Health Care Supply Chain Summit
January 28-29, 2019 | New Orleans, LA

Join senior supply chain executives from top hospitals as they share strategies to improve patient outcomes by optimizing and benchmarking supply chain operations.

Key Themes in World Congress’ 13th Annual Health Care Supply Chain Summit 2019 include:
  • Cost, quality and outcomes
  • Clinical integration and physician alignment
  • Supplier relationships
  • Sustainability and standardization
  • Strategic planning
  • Value analysis and strategic sourcing
  • Data, analytics, and technology
  • Talent acquisition, supply chain leaderships, and professional development
  • Logistics and distribution
Engage in strategic discussions regarding next frontier supply chain operations with leaders from: Ochsner Health System | Mayo Clinic | AHRMM | Stanford Health Care | UPS | Mount Sinai Health System | Boston Children’s Hospital | and more!

Download the 2019 brochure.

Ready to register? Use promo code DC200 and save $200 off of current rates.


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

Friday, November 09, 2018

Enhancing Care For and Management of Hepatitis C Patients

Today’s guest post comes from Lily Duong, Chief Clinical Officer at Therigy.

Lily discusses challenges treating Hepatitis C patients and explains how a specialty patient management platform can improve outcomes.

She introduces Therigy’s latest publication series: Specialty Pharmacy Standards of Care. Download the first volume in this series here: Specialty Pharmacy Standards of Care: Hepatitis C.

Read on for Lily’s insights.

Thursday, November 08, 2018

Drug Prices After the Midterms: Five Crucial Implications of Pharmacy Benefit Design

After Tuesday's election, House minority leader Nancy Pelosi pointed to "reducing the cost of prescription drugs" as a legislative priority. But addressing patient affordability issues will require more than decrying “high drug prices.”

Today, I highlight five implications of these benefit designs on patient affordability, out-of-pocket costs, and perceptions of prescriptions prices. My observations are based on Employer Pharmacy Benefits in 2018: More Tiers, Greater Coinsurance, and Lots of High-Deductible Plans, in which I summarized companies’ 2018 prescription drug coverage for their employees.

As I explain below, many aspects of employers’ plans are unfriendly to patients with serious medical conditions and to those who face coinsurance and high-deductible plans. What’s more, most employees don’t understand their increasingly complex prescription insurance.

If politicians want to get serious about controlling how voters feel about their prescription costs, they should focus on understanding the structure of commercial and Medicare Part D benefit designs.

Tuesday, November 06, 2018

Employer Pharmacy Benefits in 2018: More Tiers, Greater Coinsurance, and Lots of High-Deductible Plans

It’s time for a deep dive into the 2018 Kaiser Family Foundation Employer Health Benefits Survey, which you can read online for free. The survey provides valuable national benchmarking for employer-sponsored health coverage in 2018.

If you’d rather not to wade through the entire report, please enjoy my highlights on prescription coverage below. I summarize employers’ 2018 pharmacy benefits by examining (1) cost sharing tier structures, (2) prevalence of copayment vs. coinsurance, and (3) average copayments and coinsurance rates, by formulary tier. I breakdown the 2018 results for plans with and without high deductibles.

For 2018, employers continue to increase cost-shifting for specialty drugs. Most plans have four or more tiers. Economically debilitating coinsurance—in some cases with no limit on out-of-pocket expenses—remains distressingly common. Many people with employer-sponsored insurance are being exposed to prescription list prices, regardless of the actual net, post-rebate costs.

In a follow-up article, I’ll provide thoughts on what employers’ benefit designs mean for patient affordability, out-of-pocket costs, and perceptions of prescriptions prices. Spoiler: Patients won’t be looking like they are having fun.

Monday, November 05, 2018

CBI’s Specialty Therapies 2019

CBI’s Specialty Therapies 2019
January 24-25, 2019 | Las Vegas, NV
www.cbinet.com/specialtytherapies

Kick off 2019 in Las Vegas at Specialty Therapies 2019! Don’t miss the chance to come together with colleagues from across the industry to examine disruptions in specialty drug distribution and the impact on access, quality and cost. You can read all about it here.

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 BQH229 and register prior to November 30th.*

With the advent of innovative service delivery models, alternative payment models and an emphasis on data sharing and data standardization, the quest to drive better outcomes, ensure access and manage costs is more vital than ever.

Experts from Ochsner Health System, Ardon Health, Moda Health, Vanderbilt University Medical Center, Atrium Health, Indiana University Health, Fairview Specialty Pharmacy, MedImpact Health Systems, Boesen & Snow Law, Diplomat, VIVIO Health, University of Arizona Cancer Center and Blue Cross Blue Shield North Carolina lead robust discussions on topics such as:
  • Investigate how distribution channels for specialty therapies are changing and the impact on cost, access and health outcomes
  • Understand how in-house specialty pharmacies can enable health systems to accelerate a patient’s speed-to-therapy and improve quality of care through integrated clinical coordination
  • Evaluate the potential impact of the removal of safe harbor for drug rebates
  • Consider how distribution channels that accommodate 340B hospital pharmacies, PBM owned pharmacies, limited distribution drugs, any willing provider legislation and closed specialty networks affect clinical outcomes and costs
  • Unravel the complexities within Copay Accumulator Programs and how they will affect specialty therapy utilization rates and long-term medical spend
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 BQH229 and register prior to November 30th.*

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 01, 2018

Surprise Deal: Cardinal Health Sells Its Specialty Pharmacy (Again)

The evolving specialty market has just claimed another victim. Cardinal Health is selling its specialty pharmacy to BioMatrix Specialty Pharmacy LLC, a private-equity-backed company. There was no public announcement, so today's article counts as another Drug Channels exclusive. Below, I provide background about BioMatrix and the specialty pharmacies that wholesalers operate.

Cardinal’s capitulation highlights the challenges for smaller specialty pharmacies. Cardinal operates a small, sub-scale specialty pharmacy that has had difficulty attracting patients. What’s more, Cardinal’s overall size as a $137 billion business couldn’t help its pharmacy gain sufficient access to manufacturers’ and payers’ limited networks.

Each of the Big Three wholesalers—AmerisourceBergen, Cardinal Health, and McKesson—is encountering challenges to its diversification efforts. Will Cardinal’s move prompt a rethinking of wholesalers’ broad business portfolios over the next 12 to 18 months?

Tuesday, October 30, 2018

Drug Channels News Roundup, October 2018: Amgen, Walgreens, Rite Aid’s PBM, Drug Price Ads, and Buy-and-Bill Murray

Boo! Time for my Halloween bag of Drug Channels news stories. This issue’s tricks and treats:
  • Shocking! The gross-to-net bubble for Amgen’s PCSK9 product magically vanishes—and my $0.02 appears
  • Creepy! Stefano Pessina of Walgreens Boots Alliance shares startling thoughts about Amazon, ABC, and more
  • Scary! Shareholders vote today on whether Rite Aid should amputate its PBM
  • Spooky! The Wall Street Journal conjures up a frightfully funny editorial about the drug channel
Plus, the Centers for Medicare & Medicaid Services summons Buy-and-Bill Murray for its latest foray into Part B reform.

P.S. Join the zombie horde who shamble after me at @DrugChannels on Twitter. It’s a great way to haunt me between Drug Channels articles.

Monday, October 29, 2018

CBI’s 6th Annual Reimbursement & Contracting Conference

CBI’s 6th Annual Reimbursement & Contracting Conference
January 23-24, 2019 | Philadelphia, PA
cbinet.com/Contracting

CBI’s 6th Annual Reimbursement & Contracting Conference is the ideal platform for bio/pharma manufacturers to unravel complexities associated with reimbursement, pricing strategies and commercial contracting. Join industry thought-leaders and colleagues in Philadelphia on January 23-24 at this CPE accredited event, and discover the necessary insights to navigate the evolving landscapes to develop innovative and competitive pricing strategies.

Exclusive Offer for Drug Channels Readers:
Register Now to SAVE $400* using promo code MGS852

Featured Sessions from Our Distinguished Faculty Include:
  • Best Practices and Implications of Contracting with Digital Therapeutics – Pear Therapeutics
  • Unmet Medical Need – Can the Stakeholder Align? – Chiesi USA, Inc.
  • 340B Summit – Case Studies and Provider Perspective – Boone County Hospital and ProMedica
  • HEOR and RWE Around the World – Roles in Reimbursement and Contracting – BeiGene, Ltd.
  • And more!
  • Plus, Choose Between Two In-Conference Summits:
    1. Foundational Summit: Principles of Reimbursement and Contracting – The Robinson Research Group, Inc.
    2. Strategic Summit: Network Contracting Strategies — The Janssen Pharmaceutical Companies of Johnson & Johnson and Johnson & Johnson Health Care Services
Visit cbinet.com/contracting to view the complete agenda and speaker lineup, then register using the Drug Channels promo code MGS852 to save $400 off* the standard rate.

 *Expires 1/22/18; applies to standard rate only and may not be combined with other offers or applied to existing registration.


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

Thursday, October 25, 2018

PBM Pricing Overhaul: Express Scripts Prepares for a World Without Rebates—But Employers May Not Change

This week, Express Scripts announced an innovative pharmacy benefit contracting model for members of the National Drug Purchasing Coalition (NDPC), a group of 18 large employers. Click here to read the fully-titled press release.

You should pay close attention to this b.i.g. news. It is structured so that Express Scripts will not profit from the flow of funds from a brand-name manufacturer to a plan sponsor. What’s more, the PBM’s compensation will be fully delinked from drug list prices. Instead, Express Scripts will earn only fixed management fees plus additional at-risk compensation tied to clinical outcomes.

I spoke to Express Scripts and the NDPC’s consultant to clarify how the new model will differ from more conventional structures. As I see it, this PBM compensation approach could be an important step in our industry’s journey toward a world without rebates.

For now, it only applies to a sliver of Express Scripts’ revenues. But if the new pricing model is widely adopted, Express Scripts (Cigna) will be able to escape drug channel disruption unscathed.

The biggest unknown is how employers will behave as they select pharmacy benefits. Will the funds flowing transparently through the PBM be put toward solving the reverse insurance issue the gross-to-net bubble? Will this lower out-of-pocket costs for patients? As they say: Mo money, mo problems.

Tuesday, October 23, 2018

The Law of Holes: Some Independents Skip 2019 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 independent pharmacies’ participation via the pharmacy services administrative organizations (PSAOs) that represent these pharmacies in negotiations with plans.

This year’s results show a major divergence in strategies. Three of the four biggest PSAOs will participate in a comparable number of Part D networks, as the big chains do. AmerisourceBergen’s Elevate network, however, continues to go its own way and will skip preferred status in the major Part D networks. You will find its reasoning below.

Are we at a turning point for preferred pharmacy networks? Remember that Humana will trigger a small pullback by switching two of its plans from preferred to open networks for 2019. Have pharmacies decided to stop digging holes in their income statements?

Monday, October 22, 2018

CBI’s Specialty Product Data Strategies Summit

CBI’s Specialty Product Data Strategies Summit
December 12, 2018 | Philadelphia, PA
www.cbinet.com/specialtydata

Specialty Product Data Strategies 2018 is your next step towards leveraging internal and third-party data to drive product access, uptake, adherence and outcomes. This unique and cutting-edge forum provides you with breakthrough data discussions and key industry perspectives on how to strategically contract, analyze and utilize specialty data to measure outcomes and illustrate value. You can read all about it here.

Drug Channels readers will save $200 off the standard rate when they use
discount code HXF785 and register prior to November 2nd.*

Innovative Discussions and Compelling Case Studies:
  • Leverage Artificial Intelligence (AI) to Drive Specialty Channel Insights and Examine Emerging Pharmacy Models Driving New Data Sets for Specialty Drugs
  • Transform Specialty Product Data Sets into Cutting-Edge Dashboards to Gain Actionable Insights
  • Update on NCPDP’s New Specialty Pharmacy Work Group and Task Group Activities
  • Partnership Pavilion— Collaborating with the Right Complex Patient Data Providers to Drive Value
  • I Know What I Want, but How Do I Get There? Building an Effective, Innovative Commercial Operations Organization
  • Value-Based Therapy Management Driven by Data Collection throughout the Patient and Product Journey
  • Revamp and Restructure Contracting Agreements for Specialty Data to Create Operational Efficiencies
  • Strategies to Foster High Quality Data for Advanced Analytics
  • Opportunities for Data-Driven Patient Services
Visit www.cbinet.com/specialtydata for further details and to register. Drug Channels readers will save $200 off the standard rate when they use discount code HXF785 and register prior to November 2nd.*

CBI will see you there!

REMINDER: Upgrade your registration and come in a day early to attend CBI’s Trade and Channel Strategies meeting. To register for both events, please visit this site, sign up for the Trade and Channel event and chose the Specialty Data track.

*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.