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 24,000 subscribers. Learn more...

Wednesday, March 20, 2019

A World Without Rebates: Predictions for How the Channel Will Evolve and Why Drug Prices Will Go Down

Two years ago on Drug Channels, I wrote about a shift from rebates to discounts as a black swan event—a massively important yet unexpected break from current practice.

Given recent developments, I believe that we are moving ever closer to a world without rebates. Yet there are many unanswered questions were such a radical shift to occur.

As I see it, a world without rebates would force manufacturers to use net price as a competitive weapon. If PBMs and payers behave logically, then drug prices would drop as manufacturers are forced to compete more aggressively for prescriptions.

These conclusions are based on the predictions about market changes that I describe below. Other key implications include:
  • Winner-take-all auctions and narrow formularies for categories with therapeutically comparable products
  • Broader formularies to encourage indication-based price competition for other therapeutic categories
  • Faster patient access to new drugs with superior efficacy for certain subgroups of patients
  • Fewer pharmacy benefit benefit tiers and a greater ability for physicians and patients to make cost/value tradeoffs
  • The popping of the gross-to-net bubble and declines in brand-name list prices
  • Slower growth in drug prices
This is a longer-than-average post, but I still only scratch the surface in speculating how our world could change. If the black swan continues to spread its wings, I’ll expand in future posts on implications for drug makers, pharmacy benefit managers (PBMs), wholesalers, pharmacies, health plans, and patients. As always, I encourage you to leave your comments and ideas below.


SAVE THE DATE: Drug Channels Institute will hold a special live, interactive webinar titled Competing in a World Without Rebates on April 12, 2019, at 12 PM ET. Details and registration information will be announced in the first week of April.

Monday, March 18, 2019

CBI’s Real-Time Benefit Check & ePrior Authorization Summit

CBI’s Real-Time Benefit Check & ePrior Authorization Summit
May 14-15, 2019 | Philadelphia, PA
www.cbinet.com/eprior

CBI’s Real-Time Benefit Check & ePrior Authorization Summit is your chance to stay on the pulse of groundbreaking advancements and innovations in real-time benefit verification and prior authorizations in this evolving and complex healthcare environment. Convene with industry stakeholders from bio/pharma, PBMs, payers, health systems, prescribers and system solution providers to discuss the latest in standards, adoption and best practices to enable streamlined healthcare team workflow and quicker access to therapy to improve patient outcomes.

Visit www.cbinet.com/eprior for further details and to register. Drug Channels readers will save $300 off the standard rate when they use promo code ANS268 and register prior to April 5th. *

Download the agenda here and see in-depth coverage on critical issues, such as:
  • Real-Time Prescription Benefit and ePrior Authorization
  • New Regulations from CMS on Medicare Part D and RTBT
  • Implementing Medical Specialty Drug ePA
  • eBV and ePA Frameworks for the Future of the Medical Benefit
  • Reducing Friction in the Prescribing Process
  • Fixing ePrior from a Prescriber Perspective
  • Collaborating to Improve Patient Outcomes
  • Low Utilization of RTBC and ePA Among Stakeholders
  • Turnaround Time for Accelerated Patient Access to Therapy
  • Real-Time Benefit Data at the Point of Prescription
  • HL7 Da Vinci Project for Value-Based Care Interactions between Payers and Providers
Featured Sessions:
  • Trailblazer Talk- Hear Updates on Industry Scorecard
    • Melissa Paige, Oncology/Infusion Patient Access Principal Coordinator, University of Virginia
    • Eric Weidmann, M.D., Chief Medical Officer, eMDs
    • Evan Grossman, Vice President, Integration Services, athenahealth
  • Working Group for Specialty Pharmacy Advancements and Standard Updates in Real-Time Prescription Benefit and ePrior Authorization
    • John Klimek, R.Ph., Senior Vice President, Standards and Industry Information Technology, NCPDP
Visit www.cbinet.com/eprior for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code ANS268 and register prior to April 5th. *

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.

Tuesday, March 12, 2019

Employers Are Absorbing Even More Manufacturer Rebates from Their PBMs

The likelihood of a radical restructuring of the U.S. drug channel has never been greater. A serious effort exists to remove or decrease the role of rebates.

Today, we shed light on one crucial aspect of the current rebate system: how employer-sponsored health plans access the billions of dollars in manufacturer rebates that are negotiated by their pharmacy benefit managers (PBMs). For this analysis, we rely on the Pharmacy Benefit Management Institute’s (PBMI) excellent new reports.

As you will see, employers are receiving an increasing share of the rebate money collected by pharmacy benefit managers. However, employers’ rebate agreements with PBMs vary widely. Important differences also exist in rebate arrangements for traditional vs. specialty drugs.

Despite these data, we still don’t know how much of these rebates offset out-of-pocket costs for the patients whose prescriptions generated the rebate funds. As I warned last August: The focus of rebate reform will turn from PBMs to the plan sponsors that are absorbing rebate dollars.

Monday, March 11, 2019

3rd Annual Manufacturers’ 340B Summit

3rd Annual Manufacturers’ 340B Summit
May 16-17, 2019 | Philadelphia, PA
www.worldcongress.com/manufacturers340B

Join pharmaceutical manufacturers, legal experts, thought leaders, and leading regulatory strategists at World Congress’ 3rd Annual Manufacturers’ 340B Summit, May 16-17, in Philadelphia. This event is your first opportunity of 2019 to ensure you have the internal strategies in place to effectively execute 340B processes.

Register with promo code DC200 and save an additional $200 on current early bird rates.

How will you benefit from attending?
  • Review the scope of the 340B Program and possible changes to the program
  • Utilize data to identify duplicate discounts and other inconsistencies
  • Explore challenges of contract pharmacies and solutions that work for all stakeholders
  • Evaluate the implications of penny pricing, limited, distribution networks, ceiling price calculation, and civil monetary penalties
  • Survey best practices for working with the states and covered entities
Shouldn’t you be there?

Register with promo code DC200 and save an additional $200 on current early bird rates.
Can’t leave the office? Live stream this event from the convenience of your office.

This event, co-located with the 4th Annual Covered Entities’ 340B Summit, provides comprehensive coverage of the 340B program.


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

Friday, March 08, 2019

Delivering an Enhanced Patient and Prescriber Experience for Personalized Therapies

Today’s guest post comes from Rob Brown, VP/GM of Pharmacy Solutions at McKesson Life Sciences.

Rob provides insights on designing patient-centric channel strategies. He also reviews the role of centralized hub services with an integrated specialty pharmacy.

Click here to download McKesson’s case study. It describes how an emerging biotech company streamlined access for patients with an acute complex condition.

Read on for Rob’s insights.

Tuesday, March 05, 2019

NEW: The 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

I am pleased to announce our new 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, available for purchase and immediate download.
We’re offering special discounted pricing if you order before March 22, 2019!

The 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers is the only resource of its kind available anywhere. With 180 proprietary charts, exhibits, and data tables, the report provides the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system.

The 2019 edition has been significantly restructured since last year’s edition. Many sections and chapters have been expanded or reorganized to better cover the latest industry developments. Throughout the report, we have added new industry data sources, deepened our coverage of many topics, added more trending information.

Below, you can read more info and some behind-the-scenes tidbits. See page viii of the free report overview for a summary of the many significant changes and updates in this 2019 edition. Happy reading!

P.S. If you would like to pay by corporate purchase order or check, please email Tamra Feldman. If you preordered the report, you should have already received an email with download instructions. Please contact us if you did not receive the email.

Monday, March 04, 2019

Join Me for Asembia’s Specialty Pharmacy Summit 2019

Asembia’s Specialty Pharmacy Summit 2019
April 29 to May 2, 2019 | Las Vegas
www.asembiasummit.com

Please join me at Asembia's Specialty Pharmacy Summit 2019 which will take place from April 29 to May 2, 2019 in Las Vegas.

This is a must-attend event for anyone connected to specialty pharmacy. You'll meet an impressive diversity of people from pharmacies, manufacturers, health plans, wholesalers, hospital systems, pharmacy benefit managers, patient advocacy groups, and more. Click here to view the agenda.

This year, I will again lead the Featured Session, titled Specialty Pharmacy Industry Outlook: What's Next? I'll be joined by Doug Long from IQVIA and Lisa Gill from J.P. Morgan Securities. And of course, I'm looking forward to another epic selfie!

Here's my review of last year's Summit: Reflections from #Asembia18: The State of Specialty Pharmacy 2018.

Read on for more details about this great specialty pharmacy event and register now. See you in Vegas!

A MESSAGE FROM ASEMBIA

As the nation’s largest annual healthcare conference for specialty pharmacy, Asembia’s 2019 Specialty Pharmacy Summit will welcome 6,500+ attendees from over 1,200 pharmacy providers, health systems, pharma/biotech manufacturers, payers, drug wholesalers and many other specialty pharmacy stakeholders.

Don’t miss this unique opportunity to gain in-depth understanding of specialty pharmacy from industry experts who share current information and insightful commentary on the many facets of the $150+ billion specialty pharmacy channel.

The value-packed 2019 agenda includes interactive business seminars, continuing education sessions, business workshops, extraordinary networking events and engaging exhibits.

Register and learn more at www.asembiasummit.com.

Watch the 2018 Video Highlights.


Asembia's 2018 Specialty Pharmacy Summit - Event Highlights from Asembia on Vimeo.


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

Thursday, February 28, 2019

Drug Channels News Roundup, February 2019: Diplomat’s Troubles, Sanofi’s Gross-to-Net Bubble, and the Legality of Accumulators

Winter—or at least February—is almost over! Celebrate the imminent return of spring with our selection of noteworthy news from around the drug channel. In this issue:
  • My $0.02 on Diplomat’s failures and the new realities of specialty pharmacy
  • Sanofi’s 2018 gross-to-net bubble
  • Legal issues for copay accumulators
Plus, The Onion reports a health insurance miracle!

P.S. My @DrugChannels Twitter account now has more than 7,000 followers. Join the fun for my daily commentary on the industry’s news.

Tuesday, February 26, 2019

The Top 15 U.S. Pharmacies of 2018: M&A Reshapes the Market

Next week, Drug Channels Institute will release our 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the tenth edition of our popular and comprehensive examination of the entire drug pricing, reimbursement, and dispensing system.

The exhibit below—one of 180 in our new report—provides a first look at the 15 largest pharmacies, ranked by total U.S. prescription dispensing revenues for calendar year 2018.

As you will see, vertical and horizontal mergers and acquisitions are reshaping the pharmacy and PBM industries—and enabling the big to get even bigger. I highlight some of the major transactions that affected our ranking.

For a sneak peek at the complete report, click here to download a free pre-publication draft overview (including the table of contents and a list of exhibits).

Monday, February 25, 2019

CBI’s 5th Annual Formulary, Copay and Access Summit

CBI’s 5th Annual Formulary, Copay and Access Summit
April 9-11, 2019 | San Francisco, CA
www.cbinet.com/formulary

Accumulator programs, state-level copay legislation, formulary exclusions, high-deductible plans, changes in benefit design, NDC blocks, step therapy programs - the challenges continue to arise. This April, the industry comes together to tackle these topics and more at the Formulary, Copay and Access Summit in San Francisco.

Visit www.cbinet.com/formulary for further details and to register. Drug Channels readers will save $300 off the standard rate when they use promo code KRA435 and register prior to March 22nd.*

Download the agenda here and see in-depth coverage on critical issues, such as:
  • Explore perspectives on accumulator adjustment programs and identify trends for the future
  • Demystify proposed legislations and policies for lower drug prices
  • Overcome challenges of high-deductible plans, copay caps and the evolving healthcare landscape
  • Gain insight on strategies for fast tracking prior authorization and copay assistance for specialty prescriptions
  • Gain insight on key stakeholder challenges to discover new methods for manufacturers to collaborate with payers, pharmacists and physicians to improve patient outcomes
  • Develop best practices to communicate with field reps when there are issues with co-pay cards
  • Break down rebates and reimbursements and the impact on pricing strategies
Visit www.cbinet.com/formulary for further details and to register. Drug Channels readers will save $300 off the standard rate when they use promo code KRA435 and register prior to March 22nd.*

Wait a minute – we almost forgot the most exciting part! On April 9th, benefit from a pre-conference workshop on Copay Accumulator Programs, where experts in the field will discuss navigating the complexities and impact of the emerging cost-shifting benefit design. You can tack this workshop on to your Formulary Summit registration, or just attend the workshop itself. Learn more here.

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.

Wednesday, February 20, 2019

How Health Plans Profit—and Patients Lose—From Highly-Rebated Brand-Name Drugs

My Wall Street Journal op-ed (Don’t Blame Drug Prices on ‘Big Pharma’) has received a lot of attention.

Especially notable was a letter to the editor from American Health Insurance Plans (AHIP). It claims that “the savings that insurance providers negotiate are returned directly to consumers through lower premiums and out-of-pocket costs."

Don’t believe this misleading half-truth. It distorts the primary argument of my WSJ op-ed: Patients often pay full price for drugs that are sold to insurers at deep discounts.

Below, to show you why, I follow the dollar for an expensive, highly rebated brand-name drug used by a consumer with a high-deductible health plan. As you will see, the consumer pays more than twice the true discounted price of the drug. Meanwhile, the health plan pockets a large rebate.

That's the uncomfortable reality of the gross-to-net bubble that AHIP wants to hide. Insurers may not use rebates to lower the out-of-pocket costs for the patient whose prescription generated the rebate. And at the same time, AHIP indignantly blames "the prices drugmakers set." We all deserve better.

Tuesday, February 19, 2019

CBI’s 4th Edition Drug Pricing Transparency Congress

CBI’s 4th Edition Drug Pricing Transparency Congress
March 25-26, 2019 | Philadelphia, PA
www.cbinet.com/drugpricing

From implementation and changes made across the country in states like Oregon, California and Nevada to the release of the long-awaited HHS proposed rebate rule, complexities continue to arise for industry. According to HHS Secretary Alex Azar, this proposal “has the potential to be the most significant change in how Americans’ drugs are priced at the pharmacy counter, ever.”

With all that is going on with drug pricing within state and federal laws, uncertainty arises for stakeholders with responsibilities in commercialization, reimbursement, pricing and compliance practices. Is your organization prepared to act? And fast?

Join CBI’s 4th Edition Drug Pricing Transparency Congress to strategize and gain best practices regarding drug pricing transparency to overcome challenges and remain compliant.

Register by Friday, March 15 and save $300* off the standard rate with promo code DCB300.

Key Topics Addressed:
  • Pre-Conference Workshop (March 25): Medicare Drug Pricing and Reimbursement – Deep Dive into the Emerging International Pricing Model
  • Review drug pricing transparency legislation and litigation — Including a deep-dive, state-by-state analysis of laws in Oregon, California and Nevada
  • Explore how the future of drug pricing transparency regulation and the proposal to exclude rebates will impact commercialization, reimbursement and drug pricing models
  • Deliver comprehensive legal interpretations of drug pricing transparency and reporting laws currently on the books and the policy outlook for 2019
  • Benchmark overall state compliance practices related to drug pricing reporting
  • Discuss organizational shifts within legal and compliance departments to handle drug pricing obligations and reporting
Hear from Industry Experts, Including:
  • Debbie A. Walters-Francique, Vice President, Assistant General Counsel, Pfizer Inc.
  • John A. Murphy III, Deputy General Counsel, BIO
  • Amie Phillips Pablo, Associate Director, Compliance Government Reporting, Novo Nordisk
  • Brian A. Bohnenkamp, Partner, FDA & Life Sciences Practice, King & Spalding LLP
  • William Harris, Assistant General Counsel, US Market Access, Sanofi
  • Susan Hibbard, Senior Manager, Transparency and Disclosure, Ethics and Compliance, Boehringer Ingelheim
  • David Gibbons, Associate, Hyman, Phelps & McNamara, P.C.
  • Joanne Chan, Assistant General Counsel, PhRMA
  • Kendra Martello, Senior Director, Public Policy, Government Affairs and Public Policy, Mallinckrodt Pharmaceuticals
  • James Kim, Attorney, McDermott Will & Emery LLP
  • Sarah diFrancesca, Partner, Cooley LLP
  • Trevor L. Wear, Partner, Sidley Austin LLP
Don't miss this critical dialogue. Register by Friday, March 15 and save $300* off the standard rate with promo code DCB300.

*Offer expires 3/15/19; applies to standard rates only and may not be combined with other offers, category rates, and promotions or applied to an existing registration.


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