Thursday, October 29, 2020

Drug Channels News Roundup, October 2020: Accumulator Nonsense, GoodRx Fees, 340B Dollars, and Our Simulated World

Halloween is truly scary this year. Since we can’t trick-or-treat, spend some time with our spooky roundup of Drug Channels news stories:
  • Creepy! UnitedHealthcare expects physicians to enforce its copay accumulator policy
  • Vampiric! How GoodRx sucks money from the channel
  • Shocking! 340B haunts even more of the industry than you envisaged
Plus, a scary reason to be cheerful: Chances are 50/50 that we are living in a simulation!

P.S. Stretch out your arm and join the zombie horde who shamble after me at @DrugChannels on Twitter. My recent tweets have highlighted: UnitedHealth’s DivvyDose acquisition, independent analyses of Rutledge vs. PCMA, importation problems in Wyoming and Florida, Medicaid enrollment, fake news from NASHP, and unexpected public policy cameos by Drug Channels. (You can also join my followers on LinkedIn.)

Accumulator Adjustment Medical Benefit program: Provider Protocol, UnitedHealthcare

ICYMI, UnitedHealthcare has just announced a crazy new policy. The insurer will require physician and other healthcare providers to “submit specialty medication medical claims and manufacturer copay coupon reimbursement information to UnitedHealthcare.”

That’s right. Your doctor will be required to enforce an unfair benefit design—by ratting out the patients who use a copay coupon for their medical benefit specialty drugs. Yuck.

UnitedHealthcare’s Frequently Asked Questions (FAQ) document describes a protocol that will send shivers through the spines of most physicians.

Guess what? Physicians don't like this ludicrous new policy and its accompanying “Accumulator Adjustment Medical Benefit protocol.” Here are some telling comments from the American Academy of Family Physicians and the American Medical Association, courtesy of a recent Inside Health Policy article:

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To its credit, UnitedHealthcare is not (yet) working with a sketchy private company to exclude specialty drugs from insurance coverage, a la CVS Caremark and Express Scripts. (Full details in Why Do CVS And Express Scripts Rely on Secretive Private Companies to Run Their Copay Maximizer Programs?.) Perhaps that’s why it needs to be more aggressive about chasing its beneficiaries down for every last penny.

Still uncool, IMHO.

Building the Leading Digital Platform for Consumer Healthcare, GoodRx

In this GoodRx investor presentation (linked above), the company offered a useful chart to explain its business:

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The chart provides a nice visual of the GoodRx revenue recipe that I described in How GoodRx Profits from Our Broken Pharmacy Pricing System:
  1. Start with the pharmacy’s bogus cash prescription price.
  2. Save money for consumers by providing easy access to a PBM’s network rates.
  3. Collect a portion of the fee that the pharmacy pays the PBM.
I suspect that many pharmacy owners would disagree with the relative size of the “pharmacy margin” vs. the GoodRx portion of the PBM fee. It’s also easy to see why PBMs are becoming wary of GoodRx and its hypergrowth.

FYI, there’s also an entertaining and informative debate below my tweet of this chart.

The 340B Drug Discount Program: Complexity, Challenges, and Change, IQVIA

This IQVIA report contains an independent, data-based examination of the 340B Drug Pricing Program. It’s definitely worth a read.

A few highlights:
  • For 2019, the value of the 340B program at Wholesale Acquisition Cost (WAC) list prices was $67.4 billion. That equates to about 11% of the total U.S. pharmaceutical market.
  • The value of the 340B program grew by 48% from 2017 to 2019.
  • Sales through retail and mail pharmacies account for at least 25% of the 340B program.
If you’re still curious, you can read all of my articles on the 340B program here:

Do We Live in a Simulation? Chances Are about 50–50, Scientific American

Impress your nerd friends by learning about the “simulation argument”—the idea that we could be virtual beings living in a computer simulation.

Considering this year’s horrors, that trick could be the best treat of all.

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