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, May 22, 2019

Which PBM Best Managed Drug Spending in 2018: CVS Health, Express Scripts, MedImpact, or Prime Therapeutics?

It’s time for our annual Drug Channels’ examination of drug spending reports. For 2018, we again aim our magnifying glass at the annual trend reports from four large pharmacy benefit managers (PBMs): CVS Health, Express Scripts, MedImpact, and Prime Therapeutics. (See their report links below.) The other large PBMs—Humana and OptumRx (UnitedHealth)—provide no public transparency into their performance.

Using these data, which account for most of the commercial market, we detect the following key trends for 2018:
  • Once again, we find that drug spending is not skyrocketing—contrary to what you often hear from journalists and politicians. Spending grew by about 2% in 2018, continuing a multiyear decline in the growth rate. Total drug spending at some plan sponsors even declined.
  • Spending on traditional drugs dropped by mid-single digits, continuing a multi-year trend driven by generic drug deflation.
  • For specialty drugs, higher utilization—not drug costs—was the biggest factor driving specialty spending growth. This wasn’t true for all specialty categories, however.
Patients—in the aggregate—gain from the slower growth in drug spending. What’s missing from the PBM reports is a transparent accounting of how much patients pay out of pocket for highly rebated drugs that are sold to insurers and PBMs at deep discounts. The hidden subsidies of the gross-to-net bubble remain—for now.

Monday, May 20, 2019

Reimbursement and Access 2019

Reimbursement and Access 2019
August 13-14, 2019 | DoubleTree by Hilton Center City | Philadelphia, PA
www.cbinet.com/Reimbursement

For all companies within the life sciences arena, staying on the pulse of emerging trends, ensuring favorable reimbursement and justifying product prices are core pillars of overall product success. Whether your organization is pre-commercial or managing multiple products,
CBI’s Reimbursement and Access conference convenes stakeholders from across the life sciences community to provide insight into real-time policy briefings, impactful managed markets trends and strategies to ensure product access.

Drug Channels readers can register using discount code QEF679 to receive $500 off* the standard rate when you register by July 19, 2019.*

Gain critical insights from a distinguished speaking faculty representing AHIP, AppliedVR, Athenex Oncology, BIO, Boehringer Ingelheim, Cognoa, CSI Specialty Group, Foley Hoag LLP, Inceptua, National Hemophilia Foundation, Sobi Inc and many more!

Transform Access Strategies with Expert Insight and Compelling Discussions:
  • The Current State of Safe Harbor Protection for Rebates – Where Are We Now?
  • Realign Access Strategies to Overcome Challenges of Copay Assistance and PBM Restrictions
  • Trends in Benefit Design and the Continued Shift to High Deductible Plans
  • Medicare and Marketplace Coverage Policies Impacting Access
  • Patient Assistance Compliance and Oversight
  • The Role and Growing Use of Digital Therapeutics by Payers, IDNs and Health Systems
  • New Product Commercialization and Launch Scenario Planning
Drug Channels readers can register using discount code QEF679 to receive $500 off* the standard rate when you register by July 19, 2019.*

*Offer expires 7/19/19; 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 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.

Friday, May 17, 2019

A New Starting Point for Patient Support: Technology-Driven Hub Services

Today’s guest post comes from Erica Conroy, VP of Specialty at CoverMyMeds and Bill Nolan, VP/GM of Access and Adherence at RxCrossroads by McKesson.

Erica and Bill discuss the challenges that specialty pharmacy patients encounter when accessing and utilizing hub services. They also present evidence showing that how hub services positively affect patient outcomes.

To learn more, download CoverMyMeds’ whitepaper: Revolutionizing Patient Access and Support for Specialty Therapies: Multiple Sclerosis.

Read on for their insights.

Thursday, May 16, 2019

340B Health Gets It Wrong … Again

This week, Drug Channels published our annual update on the growth of the 340B Drug Pricing Program. See 340B Program Purchases Reach $24.3 Billion—7%+ of the Pharma Market—As Hospitals’ Charity Care Flatlines.

Right on cue, 340B Health, which lobbies for hospitals that participate in the 340B program, immediately issued its annual rebuttal of the Health Resources and Services Administration (HRSA) data that we used.

340B Health was particularly distressed that our analyses “focused on 340B sales instead of discounts.” Below, you will see that when the program is measured using 340B Health’s suggested approach, it accounted for 9% to 11% of the relevant market in 2018. That’s even higher than my computation, which showed that the 340B program constituted 7% to 8% of the total drug market that year.

We’re all entitled to our own opinions about the 340B program, but we’re not entitled to our own facts. It is indisputable that 340B contributes to a large and growing share of the market.

Tuesday, May 14, 2019

EXCLUSIVE: 340B Program Purchases Reach $24.3 Billion—7%+ of the Pharma Market—As Hospitals’ Charity Care Flatlines

The 340B Drug Pricing Program continues to expand at double-digit rates. According to our government contacts, discounted 340B purchases hit a record $24.3 billion in 2018. That figure is an astonishing 26% higher than its 2017 counterpart.

What’s more, we have found that since 2014, purchases under the program have grown at an average rate of 28% per year. By comparison, manufacturers’ net drug revenues have grown at an average rate of below 5% over the same period. Consequently, the 340B program has grown to account for at least 7% to 8% of the total U.S. drug market.

Nearly all of the billions in 340B discounts have accrued to hospitals. Yet hospitals' charity care has dropped amid the 340B program’s growth. The charts have the details.

So where did the money go? We have no idea, because hospitals and their lobbyists fight any call for them to disclose or account for how they use their 340B profits—while consistently misrepresenting the program's size and growth. Be skeptical when you read random stories about the generosity of a 340B covered entity. As always, the plural of anecdote is not data.

Read on for the latest details and ponder who really benefits from the 340B program's size—and how much longer this shocking growth can continue.

Monday, May 13, 2019

CBI’s Strategic Medicare Contracting Forum for Bio/Pharmaceutical Manufacturers

CBI’s Strategic Medicare Contracting Forum for Bio/Pharmaceutical Manufacturers
June 19-20, 2019 | Alexandria, VA
www.cbinet.com/Medicare

CBI’s Strategic Medicare Contracting Forum for Bio/Pharma Manufacturers provides a real-time analysis of newly proposed regulations, including the proposal to eliminate rebates, the use of step therapy under Medicare Part B, changes to coverage gap, influence of the International Pricing Index and much more.

Exclusive Offer for Drug Channels Readers:
Register Now and SAVE $400* using promo code MED400.

Taking place June 19-20 in Alexandria, VA, we invite you to convene with fellow stakeholders to receive an in-depth look into legislative and regulatory changes to Medicare and how it will impact manufacturers. You and your team members will benefit from this opportunity by gaining insights from industry experts on the complex changes occurring within Medicare, walking away with critical perspectives and robust knowledge on key topics.

Hear from 20+ Key Experts on High-Impact Issues, including:
  • [Keynote Address] Washington Update on Medicare Policy — The White House
  • HHS Keynote Address — U.S. Department of Health and Human Services (invited)
  • International Pricing Index Model: Evaluate the Proposed Changes for Medicare Part B Drugs — American Action Forum and Pacific Research
  • Examine the Implementation Strategies for Step Therapy Under Medicare Part B — BIO and Bristol-Myers Squibb
  • [Panel Discussion] Discover Coverage and Payment Strategies for Novel and High Cost Therapies for Rare Diseases Under Medicare Parts A and B — Health Policy Strategies, Inc., King & Spalding and Gilead Sciences
  • Impact of Value Frameworks on Access to Medications — Pfizer Inc.
  • What’s Next for Medicare? — Perspective From Capitol Hill — U.S. House of Representatives
Visit www.cbinet.com/Medicare to view the complete speaker and in-depth session lineup, then register using promo code MED400 for this exclusive savings of $400 off!

*Discount expires 6/18/19; cannot be combined or applied to existing registration. 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, May 07, 2019

The State of Specialty Pharmacy 2019: Industry Trends and Photos from #Asembia19

Last week, Paula and I had the pleasure of attending Asembia’s 2019 Specialty Pharmacy Summit at the wonderful Wynn Las Vegas.

The Specialty Pharmacy Summit remains the most important forum for learning, networking, and conducting business throughout the entire specialty marketplace.

Today marks the ninth year that I will violate Vegas code and tell you what happened there.

Below, I offer reflections on the meeting, share my experiences during the featured session, and highlight four crucial specialty industry trends. You’ll also find a link to the conference’s Featured Session slides and cool photos—including two of the many selfies for which I posed during the meeting. Enjoy!

Monday, May 06, 2019

Patient Support Services Congress


Patient Support Services Congress
June 19-20, 2019 | Sheraton University City | Philadelphia, PA
www.cbinet.com/PatientServices

Join your colleagues for CBI’s Patient Support Services Congress — an industry-driven meeting, where you can participate in a wide-ranging dialogue surrounding customized patient support, operational efficiencies and compliant program services.

Visit www.cbinet.com/PatientServices for more information. Drug Channels subscribers will save $250 off the standard registration rate when they use discount code DRC250* by March 1, 2019.


A DIALOGUE-DRIVEN MEETING FOR ENFORCEMENT TRENDS AND NEXT-GENERATION APPROACHES TO PATIENT SERVICES:
  • Examine the regulatory implications around copy cards and foundation relationships
  • Discuss challenges in providing compliant assistance to functionally uninsured patients under Medicare Part D
  • Assess the pros and cons of different support service models
  • Learn how hubs qualify patients based on reimbursement, insurance, and industry knowledge
  • Explore how manufacturers can tailor patient support services to individual facilities without losing the integrity of the program’s guidelines
  • Address in-house versus outsourced hub services and the role that compliance plays in those decisions
  • Review training and monitoring procedures for your field nurses to alleviate risk as operations scale up
ENHANCE YOUR LEARNING EXPERIENCE

Nurse Educator Programs takes place one day prior, on June 18th. Join your Compliance, Patient Access, and Medical Affairs counterparts to uncover leading strategies to ensure compliance throughout the design and management of Nurse Educator Programs.

Visit www.cbinet.com/PatientServices for more information. Drug Channels subscribers will save $250 off the standard registration rate when they use discount code DRC250* by March 1, 2019.


*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.

Friday, May 03, 2019

Specialty Pharmacy M&A: Our Look at 2018’s Deals (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2019 Specialty Pharmacy Summit.

Click here to see the original post and comments from January 2019.


Let’s kick off 2019 with a quick review of last year’s specialty pharmacy mergers and acquisitions (M&A). Our list (below) includes only deals that were publicly announced in 2018.

Pharmacy benefit managers (PBMs) were especially busy. CVS Health bought five specialty pharmacies. UnitedHealth’s OptumRx bought Avella Specialty Pharmacy, the largest independent specialty pharmacy.

Diplomat Pharmacy was uncharacteristically quiet during 2018, though it had been one of the most active acquirers in previous years.

The specialty pharmacy industry is rapidly maturing, so I expect many more exits in the coming years. Looking to pick up a fast-growing specialty pharmacy? Click here for your post-holiday shopping list.

Thursday, May 02, 2019

Independent Pharmacy Economics Keep Deteriorating (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2019 Specialty Pharmacy Summit.

Click here to see the original post and comments from January 2019.


Time for Drug Channels’annual look at independent pharmacy owners’ business economics, drawn from the recently released 2018 National Community Pharmacists Association (NCPA) Digest, Sponsored by Cardinal Health. Here's the press release: NCPA Releases 2017 Digest.

Below, I update our estimates on pharmacy economics and margins. Our analysis reveals that independent pharmacy owners have faced another year of deteriorating finances.

What's more, we estimate that in 2017, the average pharmacy owner’s salary fell to a level comparable to that of an employed pharmacist. Owning a pharmacy, with all of its hassles and additional obligations, now brings the same reward as being an employee. I wonder how many owners will conclude that it’s barely worth the risk and effort.

Read on for our look at pharmacy profits and some comments on the industry’s competitive dynamics, including the financial impact of direct and indirect remuneration (DIR) fees.

The pharmacy consolidation endgame is getting closer. The next time you see a pharmacy owner, offer your condolences.

Wednesday, May 01, 2019

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

This week, I’m rerunning some popular posts while I attend Asembia’s 2019 Specialty Pharmacy Summit.

This is an especially timely rerun. Believe it or not, Express Scripts' 2019 formulary prefers Eli Lilly's high-list/high-rebate Humalog insulin over the authorized generic version that is being sold at a 50% lower list price. The authorized generic will be preferred only on Express Scripts' Flex Formulary, which has very low adoption. 


Bottom line: Many plans still crave rebate dollars. Sorry, patients with deductibles and coinsurance. The gross-to-net bubble lives on! 

Click here to see the original post and comments from November 2018.


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, April 30, 2019

My Wall Street Journal Op-Ed: Don’t Blame Drug Prices on ‘Big Pharma’ (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2019 Specialty Pharmacy Summit.

Click here to see the original post and comments from February 2019.


Yesterday, The Wall Street Journal published my op-ed: Don’t Blame Drug Prices on ‘Big Pharma’. The article text is pasted below for those who don't subscribe.

I wrote this piece for a general business audience, though my arguments about rebates and patient out-of-pocket costs will be familiar to regular readers of Drug Channels. Alas, I had to omit such insider terms as gross-to-net bubble, direct and indirect remuneration, and SpongeBob SquarePants.

A personal note: I have been reading the WSJ daily since I was 18 years old. It’s a genuine thrill to see my byline on an op-ed in this newspaper. Another item off my bucket list!

Monday, April 29, 2019

Financial Strategies and Accounting for Bioscience Companies

Financial Strategies and Accounting for Bioscience Companies
June 11-12, 2019 | San Francisco, CA
www.cbinet.com/financialstrategies

Expectations have never been higher as more small and mid-sized life science companies prepare to launch new and innovative products in a competitive marketplace. Gross-to-Net remains a top risk, especially after a launch, and it is pivotal to achieve accuracy in GTN forecasts to avoid large adjustments.

Ensure success by gaining proven pre-revenue commercialization strategies, frameworks for managing gross-to-net estimates and mitigating risk, models to scale the business and grow a best-in-class finance function, hearing, timely updates on tax and legal matters, and industry expertise for communications and investor relations at CBI’s Financial Strategies and Accounting Summit for Bioscience Companies.

Visit www.cbinet.com/financialstrategies for further details and to register. Drug Channels readers will save $400 off the standard rate when they use discount code NHA949 and register prior to May 17th.*

Sign up for the agenda and speaker announcements here. Here’s a sneak peek into who you’ll be hearing from:
  • Alan Fuhrman, Chief Financial Officer, Amplyx Pharmaceuticals
  • Laurie Stelzer, Chief Financial Officer, Halozyme
  • Marc Belsky, Chief Financial Officer, Kezar Life Sciences
  • Robin Washington, Chief Financial Officer, Gilead Sciences
  • Mark Kaufmann, Chief Financial Officer, Ardelyx
  • Murray Kay, former Commercial Controller, Abbvie
  • Jennifer Sharpe, Executive Advisor, Life Sciences Revenue Analytics, IntegriChain
Visit www.cbinet.com/financialstrategies for further details and to register. Drug Channels readers will save $400 off the standard rate when they use discount code NHA949 and register prior to May 17th.*

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.

Friday, April 26, 2019

Help for the Patient Journey–Electronic Modernization of Medication Access

Today’s guest post comes from Ben Stormer, VP of Product Development and Strategy for Specialty at CoverMyMeds.

Ben discusses how automatic, streamlined electronic enrollment in patient hub services will improve patients' adherence to specialty medication.

To learn more, connect with CoverMyMeds at the Asembia Specialty Pharmacy Summit next week in Las Vegas.

Read on for Ben’s insights.

Thursday, April 25, 2019

Drug Channels News Roundup, April 2019: Cigna’s Insulin Program, Amazon's PillPack Moves, Magellan’s Biosimilar Success, Prime’s Formulary Exclusions, and a World Without Rebates

April is over, and now, come what May, it’s time for our monthly roundup of news stories highlighting key trends for U.S. drug channels. In this issue:
  • My $0.02 on the Cigna/Express Scripts’ $25 insulin program
  • Amazon starts marketing PillPack to Prime customers
  • Surprise! Magellan drives major biosimilar adoption.
  • Prime Therapeutics shows the power of formulary exclusion
Plus, read media coverage of our recent webinar: Preparing for a World Without Rebates.

P.S. Join the more than 7,400 people who follow my daily updates and links to neat stuff at @DrugChannels on Twitter.

Tuesday, April 23, 2019

The Specialty Pharmacy Boom: Our Exclusive Update on the U.S. Market

It’s time for Drug Channels Institute’s annual update of the number of U.S. specialty pharmacies.

As always, I had outstanding research assistance. (See photo at right.) But even we can’t count the total number of pharmacies dispensing specialty drugs, since any pharmacy can designate itself a specialty pharmacy.

We therefore counted every pharmacy location that had achieved accreditation by an independent organization.

Our exclusive findings:
  • As of the end of 2018, more than 900 unique pharmacy locations had achieved specialty pharmacy accreditation from one or more of three major independent accreditation organizations. The 2018 figure marks a 25% increase over the 729 locations in 2017 and is more than double the 2015 figure.
  • Pharmacy locations owned by healthcare providers—hospitals, health systems, physician practices, and providers’ group purchasing organizations—now account for more than one-quarter of all accredited specialty pharmacy locations.
Enjoy more of our arithmomania below. It will help explain why you’ll count more people than ever at next week’s Specialty Pharmacy Summit 2019. Drug Channels Institute will be there, so please say hello, e.g. “Greetings, it is I, a Drug Channels reader.”

Monday, April 22, 2019

CBI’s 15th Annual Commercial Contract & Chargeback Excellence

CBI’s 15th Annual Commercial Contract & Chargeback Excellence
June 25-26, 2019 | Philadelphia, PA
www.cbinet.com/chargebacks

Heading into Year 15, CBI’s Commercial Contract & Chargeback Excellence conference has become a must-attend for pricing and contracting professionals, offering interactive dialogue and best practices to guide you through a rapidly changing market.

Visit www.cbinet.com/chargebacks for further details and to register. Drug Channels readers will save $400 off the standard rate when they use discount code ZKE535 and register prior to May 10th.*

Our esteemed speaking faculty, made up of companies such as Pacira Pharmaceuticals, Premier, Celgene, McKesson, Chiesi USA, Zydus Pharmaceuticals and more, will collaborate and offer perspectives on chargeback efficiency, class-of-trade, GPO membership management, contract administration, and everything in between.

Download the agenda here and see in-depth coverage on critical topics, such as:
  • Key trends and drivers of change impacting the commercial contracting landscape and market access
  • New strategies for risk-share agreements and value-based contracting
  • Optimize data exchange between trading partners from the wholesaler perspective
  • GPO Best practices for streamlined membership management and accountability
  • Valuable strategies for payer cost control approaches in the contracting space
  • Impact of HHS Proposed Rule to eliminate prescription drug rebates on contracting stakeholders
Plus! New for 2019!
  • In-Conference Workshops on the following topics: Class-of-Trade Membership Management, Value-Based Contracting Agreements, Pricing, Contracting and GTN Considerations at Launch, EDI Data Exchange, and 340B Pricing and Chargeback Reconciliation
  • Tracked programming diving into the strategies and best practices for both complex contracts management and GPO and chargeback administration
Visit www.cbinet.com/chargebacks for further details and to register. Drug Channels readers will save $400 off the standard rate when they use discount code ZKE535 and register prior to May 10th.*

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.

Thursday, April 18, 2019

TrialCard: The Role of Hub Services in an Era of Drug Price Transparency, Value-Based Care, and Consumerism

Today’s guest post comes from Scott Dulitz, Chief Strategy Officer at TrialCard.

Scott discusses the evolution of pharmaceutical manufacturer hub programs. As he explains, crucial industry trends are changing how patients and healthcare providers interact with and evaluate support services.

To learn more about TrialCard’s patient management solution, view TrialCard's recent video: Emerging Market Trends Shape Hub/Market Access Services, or email Scott at scott.dulitz@trialcard.com.

Read on for Scott’s insights.

Tuesday, April 16, 2019

The Road to 2020: Understanding the Regulatory Timeline for Part D Rebate Reform

The Department of Health & Human Services (HHS) keeps signaling that it wants to move us toward a world without rebates. Right now, it is evaluating comments on its proposal to remove rebates from federal programs. HHS wants to implement this rule in time for the January 1 start of the 2020 Medicare Part D plan year.

I would like, if I may, to take you on a journey through the 2019 regulatory timeline for both Part D and the proposed rule. As you will see, there is still a viable—but narrow—window for regulatory reform of rebates.

Despite our assessment, you should know that in the Medicare program, there are many implementation and logistical challenges in shifting rapidly toward a world without rebates. I outlined some of these issues in last Friday’s webinar: Preparing for a World Without Rebates. Don’t worry if you missed the live event. You can watch a replay and download the complete slide deck. CLICK HERE TO WATCH THE REPLAY.

In the meantime, read on for our look at the rest of 2019. I can see you shiver with antici...pation.

Monday, April 15, 2019

Rare Disease Innovation and Partnering Summit

Rare Disease Innovation and Partnering Summit
June 13-14, 2019 | Boston, MA
www.raredisease-summit.com

As genomics and advanced diagnostics expand our understanding of rare diseases, so too does the scope of impact expand. More than 30 million Americans live with a rare disease. While the industry has seen growth and heightened focus around the pursuit of orphan products and rare therapies, we’ve only scratched the surface.

CBI and EBD Group, along with support from the Alliance for Regenerative Medicine, Global Genes and MassBio, are pleased to announce the Rare Disease Innovation and Partnering Summit, a platform designed to increase chances of therapeutic success for drug developers, patient groups and investors within the rare disease marketplace. Business brings breakthroughs. Breakthroughs can transform lives.

Visit www.raredisease-summit.com for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code SFK676 and register prior to May 10th.*

Take a deep dive into the critical and evolving topics impacting you today and hear from industry thought leaders and patient advocates who have designed and led innovative approaches to complex challenges in driving curative progress.

You can download the complete agenda here. Take a look inside:

Real Life Case Examples:
  • Develop New Models for Patient-Centric Registries – Parent Project Muscular Dystrophy
  • Leverage Novel Collaborations in Orphan Drug Commercialization – Notable Labs and Cures Within Reach
  • Mapping the Patient and Caregiver Journey – An Insights-Driven Approach to Building the Foundation of Patient Identification and Services – Rhythm Pharmaceuticals
PLUS! FDA Perspectives:
  • Regulatory and Policy Update – Legislative Updates and New Initiatives within the FDA’s Orphan Drug Program
    Featuring: Janet Maynard, MD, MHS, Director, Office of Orphan Products Development, FDA, Samir Shaikh, Deputy Director of Patient Affairs Staff, Office of Medical Products and Tobacco, FDA, Martine Zimmerman, Global Head, Regulatory Affairs, Alexion and John Hallinan, Chief Business Officer, Massachusetts Biotechnology Council
And! Benefit from Four Impactful Tracks:
  • Patient-Driven Progress
  • Reimbursement & Access
  • New Launch & Commercialization
  • Partnering & Investment
Additional perspectives and insight from 50+ leaders at companies such as Aegerion Pharmaceuticals, Alliance for Regenerative Medicine, Asklepios BioPharmaceuticals, Athersys, Bexion Pharmaceuticals, BioMarin, bluebird bio, Blueprint Medicines, Boston Children’s Hospital, Cotinga Pharmaceuticals, Cure CMT4J, Cydan II Inc., EveryLife Foundation for Rare Diseases, Geisinger, Global Genes, Horizon Pharma, Intercept Pharmaceuticals, Jackson Lab, Massachusetts General Hospital, MDA, Pfizer, Rare Access Action Project, Recordati Rare Diseases, Recursion Pharmaceutical, Sobi, Syros Pharmaceuticals, Tufts University School of Medicine, Xontogeny and more. Mark this as a must-attend event in 2019. Don’t miss it!

Visit www.raredisease-summit.com for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code SFK676 and register prior to May 10th.*

CBI and EBD Group will see you there!

Produced by: CBI and EBD Group
Supported by: Alliance for Regenerative Medicine, Global Genes and MassBio

*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.

Friday, April 12, 2019

Drug Price Transparency and Rebate Reform Take Center Stage

Today’s guest post comes from Kay Morgan, Vice President of Drug Information Excellence at Elsevier.

Kay discusses her thoughts on the latest developments on rebate reform and drug price transparency reform. Learn more by downloading Elsevier’s white paper: Prescription Drug Transparency Reform: While You Wait.

Read on for Kay’s insights.

Tuesday, April 09, 2019

The Top 15 Specialty Pharmacies of 2018: PBMs Keep Winning

In Drug Channel Institute's list of the top 15 pharmacies of 2018, we show that many of the largest U.S. pharmacies are now central-fill mail and specialty pharmacies operated by PBMs and insurers. To complement that broader list, below you’ll find the Drug Channels Institute list of the top 15 pharmacies based on specialty drug dispensing revenues.

As you will see, PBMs and insurers dominate specialty drug dispensing channels. The top four companies—all of which are fully or partly owned by a PBM—accounted for more than 70% of prescription revenues from pharmacy-dispensed specialty drugs. Payer- and PBM-owned specialty pharmacies’ market shares grew in 2018, due largely to merger and acquisition transactions.

PBMs are earning an increasing share of their profits from specialty dispensing activities. Don’t be surprised if drug channel reform starts examining the connection between specialty pharmacies’ profits and brand-name list prices.


Drug Channels Institute will host an exclusive new webinar, Preparing for a World Without Rebates, on Friday, April 12, 2019, from 12 p.m. to 1:00 p.m. ET. Get informed about the hottest topic facing our industry. Registration closes at midnight on Thursday. CLICK HERE TO LEARN MORE AND SIGN UP.

Monday, April 08, 2019

World Congress’ Integrate 2019

World Congress’ Integrate 2019
July 22-23, 2019 | Philadelphia, PA
www.worldcongress.com/integrate

Integrate is a three-track event featuring:
  • 6th Annual Specialty Network Design and Channel Optimization Summit
  • 6th Annual Patient Support Services and Hub Design Summit
  • 3rd Annual Patient Services Compliance Summit
Register with promo code DC200 and save an additional $200 on current early bird rate.

Join your peers across specialty distribution, patient support services and hub design, and patient services compliance to break down silos and strategize best practices for improving support and access from manufacturer to patient, provider and networks.

Our mission is to break down silos between internal colleagues and key stakeholders to help streamline business practices and provide better support and access to patients.

How will you benefit from attending?
  • Three Master Classes: Choose from three master classes focused on specialty data strategies, Nurse Educator Programs, and Compliance and Auditing strategies for Patient Support Services
  • Legal Roundtable: Hear from the DOJ and industry C-Suite Compliance executives on current and future trends in litigation and regulations around patient support services and foundational partnerships
  • Multi-Stakeholder Insights: Hear directly from specialty pharmacies, payers, PBMs, Hubs, government agencies, health systems, and industry leaders to ensure specialty product success
  • Access to Three Tracks: Customize your learning experience through free movement between sessions- All for 1 ticket price!
Shouldn’t you be there?

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


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

Friday, April 05, 2019

Addressing the Rising Impact of Co-Pay Accumulators on Patients

Today’s guest post comes from Bill Nolan, VP/GM of Access and Adherence at RxCrossroads by McKesson.

Bill discusses the proliferation of co-pay accumulators and the negative effects they can have on patients, particularly those with high-deductible health plans. He offers solutions that biopharma companies can embrace to mitigate the impact, including the adoption of patient-centric support.

To learn more, download McKesson’s white paper: The Impact of Accumulators on Co-pay Programs.

Read on for Bill’s insights.

Wednesday, April 03, 2019

The Gross-to-Net Bubble Reached a Record $166 Billion in 2018

The gross-to-net bubble—the ever-growing pile of money that sits between a manufacturer’s list price for a drug and the net price after rebates and other reductions—reached another high last year.

Drug Channels Institute developed the term gross-to-net bubble to describe the speed and size of growth in the total value of manufacturers’ gross-to-net reductions.

We estimate that in 2018, the total value of gross-to-net reductions for brand-name drugs was $166 billion. As you will see below, that figure doubled over the preceding six years. Below, I also highlight the various elements that fill the bubble. About two-thirds of total gross-to-net reductions come from rebates paid to third-party payers.

The gross-to-net bubble reflects—and drives—many of the problems with U.S. drug pricing. However, recent movement toward a world without rebates suggests that we may soon hear this bubble pop…


Drug Channels Institute will host an exclusive new webinar, Preparing for a World Without Rebates, on April 12, 2019, from 12 p.m. to 1:00 p.m. ET. CLICK HERE TO LEARN MORE AND SIGN UP.

Monday, April 01, 2019

Preparing for a World Without Rebates: A Drug Channels Institute Webinar

On April 12 at 12:00 p.m. ET, Drug Channels Institute (DCI) will host an exclusive new webinar: Preparing for a World Without Rebates.

Join Dr. Adam J. Fein, CEO of DCI and author of Drug Channels, for this hour long, live event as he helps you understand and get ready for what would be a momentous change to our industry.

If you need access for 10 or more lines, contact Paula Fein (paula@drugchannelsinstitute.com) for special pricing

NOTE: A replay of this event is available. Click here for more information.

The webinar’s benefits include:
  • An unlimited number of people may listen on a single phone line. Invite your whole team for an hour of intensive learning and strategic insight. The presentation is sure to spark important internal discussion about the implications for your business.
  • Dr. Fein’s slides with marketplace data and analysis. You’ll also receive a downloadable PDF with all of the slides from the webinar.
  • An opportunity to ask Dr. Fein questions during the event
  • Access via any device with a web browser (computer, iPad, phone)

WHAT YOU WILL LEARN

A serious effort exists to remove or decrease the role of rebates in the drug channel. We will help you and your team master one of the hottest topics in our industry.

Dr. Fein will share his latest thinking on:
  • What’s driving the effort to reform the rebate system
  • The pros and cons of such alternatives as point-of-sale rebates and negotiated discount models
  • The Department of Health & Human Services (HHS) proposed rule to alter the rebate system in federal programs—its timing, implementation, and risks
  • Key uncertainties that could affect your scenario planning—including the likelihood of change in commercial markets
  • The roles that PBMs, pharmacies, and wholesalers could play in operationalizing a shift to discounts
  • What a world without rebates could mean for patients, benefit designs, competition, drug prices, and more
  • PLUS: Dr. Fein will take your questions.

HOW TO SIGN UP

The webinar will take place on April 12, 2019, from 12:00 p.m. to 1:00 p.m. ET.

  • At least 48 hours before the event, you will receive an email with a toll-free dial-in number and a unique PIN for your location. You will also receive an email on the morning of the event.
  • If you purchase access for multiple sites, we will contact you for the names and email addresses of a contact person at each location.
P.S. No, this is not an April Fool's joke. The webinar will really happen on April 12. No foolin'!


Thursday, March 28, 2019

Drug Channels News Roundup, March 2019: The Insulin Gross-to-Net Bubble, HHS Blasts Rebates, a New 340B Report, and Theranos

Spring has finally reached our worldwide headquarters here in lovely downtown Philadelphia. (See photo at right.) Before your allergies kick in, please inhale this month’s selection of noteworthy news stories:
  • Eli Lilly discloses the bonkers gross-to-net economics for Humalog insulin
  • John O’Brien of HHS blasts the current drug pricing system
  • The Community Access National Network’s 340B Commission releases an excellent new report—and you can read my testimony, too!
Plus, a compelling new HBO documentary delves further into the sordid tale of Elizabeth Holmes and Theranos.

P.S. Join the more than 7,200 people who follow my comments and links at @DrugChannels on Twitter.


SAVE THE DATE: Drug Channels Institute will hold a special live, interactive webinar titled Preparing for a World Without Rebates on April 12, 2019, at 12 PM ET. Details and registration information will be announced on Monday.

Tuesday, March 26, 2019

Latest CMS Forecast: Hospitals and Physicians Will Grab Most of the $1.3 Trillion Increase in U.S. Healthcare Spending

The econowonks at the Centers for Medicare & Medicaid Services (CMS) have recently published new projections for U.S. National Health Expenditures (NHE). You’ll find links and my data analysis below.

As you will see, total U.S. spending on healthcare is projected to grow, from $3.5 trillion in 2017 to $4.8 trillion in 2023. Spending on hospitals and professional services is expected to grow by a combined $750 billion—about 59% of CMS’s projected $1.3 trillion increase in U.S. healthcare spending.

CMS also projects that spending on outpatient prescription drugs will account for only 9% of the total increase in U.S. healthcare spending. What’s more, total growth in spending on healthcare administration by the government and insurance companies is roughly equivalent to the growth in total spending on outpatient prescription drugs. Guess which of these categories will contribute more to patients’ well-being!

These sobering figures put the debate about drug spending in context. To say that slashing drug spending would solve the healthcare spending problem is like saying you can afford a New York City penthouse by making fewer trips to Starbucks.

Monday, March 25, 2019

CBI’s 21st Annual Medicaid and Government Pricing Congress

CBI’s 21st Annual Medicaid and Government Pricing Congress
May 20-22, 2019 | Orlando, FL
www.cbinet.com/medicaid

Exclusive Offer – Register by April 5th
and save $500* with promo code MDCDC5.

As our healthcare system proves to be more turbulent than ever, with a slew of regulatory and political announcements, hearings, the never-ending drug pricing debate, and most recently, FDA Commissioner Scott Gottlieb announcing his resignation and talks of doing away with rebates and/or PBMs, the time has never been more opportune to convene with industry colleagues at the 21st Annual Medicaid and GP Congress this Spring in Orlando.

The 2019 agenda boasts 55+ speakers, 30+ customizable sessions and 7 hours of dedicated networking time. Bio/pharma, regulatory and government experts representing Johnson & Johnson, OIG, Sunovion, Pfizer, Ingenus, Chiesi, AstraZeneca, Amneal, Hikma, CMS, Bristol-Myers Squibb, Apotex, Fresenius Medical Care, UCB, Alvogen, PhRMA, Jazz Pharmaceuticals, Insmed, Arbor Pharmaceuticals, Eisai, Goldwater Institute, Amicus Therapeutics and many others are set to drive the dialogue.

Stay on the pulse with timely, up-to-the-minute insights on the political and regulatory landscape, industry hot topics and best practices:
  • Political and Legislative Trends
  • 340B Guidance
  • State and Federal Transparency Regulations
  • Civil Monetary Penalties
  • Value-Based Frameworks
  • State Invoicing and Disputes
  • Contracting with PBMs
  • Changes to Medicare
  • Bona Fide Service Fees
  • GTN and Accruals
  • And many other critical topics. Download the complete agenda.
Drug Channels Readers – Register today with promo code MDCDC5 and save $500.*

*Discount offer valid through 4/5/2019; applies to standard rates only and may not be combined with other offers, categories, promotions or applied to an existing registration. Offer not valid on workshop-only or 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.

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 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 Preparing for 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.

Friday, February 15, 2019

Pharmacy Fraud Within Pharmaceutical Co-Pay Programs: What You Need To Know

Today’s guest post comes from Tim Ogren, Senior Vice President, Products at TrialCard.

Tim discusses the rise in pharmacies making fraudulent claims and the costs of these claims. Learn more in Trialcard’s white paper: Detecting Pharmacy Fraud: Is Your Brand’s Co-Pay Program Protected?

TrialCard developed Spotlight®, a pharmacy fraud detection product for manufacturers. To learn more, contact Tim Ogren, TrialCard’s Senior Vice President of Products, at tim.ogren@trialcard.com.

Read on for Tim’s insights.