Drug Channels delivers timely analysis and provocative opinions from Adam J. Fein, Ph.D., the country's foremost expert on pharmaceutical economics and the drug distribution system. Drug Channels reaches an engaged, loyal and growing audience of more than 35,000 subscribers. Learn more...

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.)

Tuesday, October 27, 2020

Battle of the Giants: CVS, Kroger, Walgreens, and Walmart Expand in 2021 Part D Preferred Networks

In Preferred Pharmacy Networks Dominate in 2021 Medicare Part D Plans, I highlighted how those networks will again rule next year’s Part D prescription drug plans (PDP).

Today, I examine the largest retail chains’ participation in the 27 major 2021 Part D preferred networks that the nine largest plan sponsors will offer. 

As you will see, most major chains increased their position as a preferred pharmacy in many 2021 networks. Only Rite Aid lost position. As usual, we provide you with a handy table for scoring each chain’s participation and all changes from 2020 to 2021.

The chains’ expanded participation may turn out to be a trick, not a treat. COVID-19 has not fundamentally altered the negative industry trends haunting retail pharmacies. Narrow networks force pharmacies to trade volume for profits. Expect another scary drop in the number of U.S. pharmacies. 

As the African proverb says: "When elephants fight, it is the grass that suffers."

Monday, October 26, 2020

GTN 2020 – Informa Connect - CBI’s Gross-to-Net Summit

GTN 2020 – Informa Connect - CBI’s Gross-to-Net Summit
November 16-18, 2020 | Virtual Event
www.informaconnect.com/gtn

Join the life sciences community next month at Informa Connect - CBI’s GTN Summit, now in the 10th year. The event is being held virtually November 16-18, 2020 and is designed to position your organization for success in the end-to-end management of GTN. Benefit from live expert panels, presentations and summits, live polling and Q&A, and a library of on-demand content for you to watch as your schedule allows. All presentations will be available for viewing for 30 days after the event concludes!

Visit www.informaconnect.com/gtn for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code GNB425 and register prior to October 30th.*

You can download the complete agenda here.

You’ll hear perspectives from companies such as ADC Therapeutics, Alkermes, Amgen, Apellis Pharmaceuticals, Bristol-Myers Squibb, Cipla Therapeutics, Deloitte & Touche LLP, Eisai US, Eli Lilly & Co, IntegriChain, Intra-Cellular Therapies, MyoKardia, Paratek Pharmaceuticals and Teva Pharmaceuticals. Our speakers are all ready to share their insights into strategic forecasting, accounting estimates, analytics and finance reporting strategies, specifically for life science companies.

Hot topics on the agenda include GTN Process and Governance, Managed Care and Payer Contracting, Market Changes and GTN Implications, Digital Finance and Robotics within GTN, Advanced Data and Analytics for Pricing and Payer Contracts, GTN Automation for Improved Forecasting, GTN Assumptions for New Product Launches, Medicare Part D and Coverage Gap, 340B and GP Programs, Managed Care and Specialty Product Rebates, Commercial and Government Chargebacks, Product Returns, Copay/Coupon Programs, and so much more!

Download the agenda to plan your sessions and wrap up your week armed with critical updates and valuable takeaways.

Visit www.informaconnect.com/gtn for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code GNB425 and register prior to October 30th.*

Informa Connect-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, October 23, 2020

New Payer Policies Introduce Copay Accumulators to Medical Benefit Products: Implications for Manufacturer Programs

Today’s guest post comes from Jason Zemcik, Senior Director, Product Management and Rick Fry, Senior Vice President, Commercial Solutions, at TrialCard.

Jason and Rick discuss the use of copay accumulators for drugs covered under a patient’s medical benefit. 

To better understand how these policies may impact your brand, join TrialCard’s Jason Zemcik on Thursday, November 5th at 1 p.m. ET for a free live webinar Implications of Copay Accumulators on Medical Benefit-Covered Products. You can also email TrialCard at sales@trialcard.com.

Read on for Jason's and Rick’s insights.

Thursday, October 22, 2020

A Primer on 340B Contract Pharmacies and Medicaid Duplicate Discounts (video)

Below is a brief video primer on a hot Drug Channels topic. I review:
  • The growth of the 340B Drug Pricing Program
  • The role and expansion of 340B contract pharmacies
  • How 340B intersects with the Medicaid drug rebate program
  • Challenges with duplicate discounts
This 10 minute video provides a quick and efficient primer on the key issues. Grab some popcorn and enjoy!

Tuesday, October 20, 2020

Preferred Pharmacy Networks Dominate in 2021 Medicare Part D Plans: The Scoop on Cigna, CVS Health, Humana, WellCare, and More

Last week, open enrollment began for the 2021 Medicare Part D plans. 

Our exclusive analysis of these data reveals that preferred cost sharing pharmacy networks will maintain their dominance as an established component of Part D benefit design. 

For 2021, 98% of Medicare Part D regional prescription drug plans (PDP) will have a preferred network. By the beard of Zeus!

Below, I provide historical data on preferred networks’ growth and then discuss the top nine companies offering the 2021 plans. None of these major plan sponsors will offer a national plan with an open network for 2021.

In upcoming articles, I’ll examine how chain and independent pharmacies will participate in these plans and what that means for pharmacy profits. As always, Drug Channels brings you the news—so you don't have to get it yourself.

Monday, October 19, 2020

16th Annual Life Sciences Trade and Channel Strategies

16th Annual Life Sciences Trade and Channel Strategies

December 1-3, 2020 | Virtual Event
www.informaconnect.com/trade-channel

Get ready to hit the ground running in 2021 by closing out the year at Trade and Channel 2020! The life science industry's foremost thought-leaders will come together virtually on December 1-3 to navigate the complex distribution and contracting landscape, and will take a deep dive into ways to optimize channel strategies to reach patients in need and provide the necessary services based on product type, site of care and reimbursement. You’ll benefit from 3 days of live content, as well as a robust library of on-demand content – with all live and on-demand sessions available for viewing for 30 days after the event concludes.

Visit www.informaconnect.com/trade-channel for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code GJE973 and register prior to October 30th.*

You can download the complete agenda here.

Gain Critical Insight from Industry Trailblazers During a Time of Transformative Change – Speakers will include:
  • Bill Roth, Founding Partner, Blue Fin Group
  • Rob Osborne, Vice President Pharma Trade Relations, Express Scripts, Accredo, CuraScript SD
  • Ray Tancredi, RPh, MBA, CSP, Divisional Vice President, Specialty Pharmacy Development &
  • Brand Rx/Vaccine Purchasing, Walgreens
  • Eric D. Hargan, Deputy Secretary, Department of Health and Human Services (HHS)
  • Natalie Bedford, Executive Director, National Channel Account Team, AstraZeneca
  • Timothy Paine, Vice President, Pharma Strategy & Relations, Fairview Pharmacy Services
  • Dave MacLeod, Head of Patient Services and Specialty Pharmacy Operations, Amylyx Pharmaceuticals
  • Brent Warner, Vice President, Gene Therapy, Novartis Pharmaceuticals
  • And more!
Live Keynotes Delivering Timely Updates and Insights on High-Impact Topics, Including:
  • Critical Update – Market Dynamics Drastically Impacting the Channel
  • Navigate the Evolving State of Regulatory Reform Driving Innovation and Access
  • Emerging and Future Trends in Channel Strategy, Distribution and 3PL
  • Pharmacy Spotlight – Innovative Models Redesigning Care in 2020 and Beyond
Insightful Strategy Sessions:
  • Discuss Reimbursement Models for Cell and Gene Therapies
  • Orphan and Rare – How Does Your First 5 Years of Channel Strategy Change for this Product Type?
  • Channel Strategy for First Medical Product – A Look at Channel Considerations for Pharmacy vs. Medical
Plus – Tailored Track Options Based on Company Size:
  • Emerging/Small Companies – Infrastructure Set-Up, License Procurement and 3PL Contracting
  • Mid-Large Companies – How Do I Think About My Portfolio Differently Based on Product Type?
Download the agenda to plan your sessions and wrap up your week armed with critical updates and valuable takeaways.

Visit www.informaconnect.com/trade-channel for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code GJE973 and register prior to October 30th.*

Informa Connect - 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 or 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, October 16, 2020

Utilizing Gini Coefficient To Anticipate Price Movement, Drug Shortages And Pricing Elasticity

Today’s guest post is sponsored by Elsevier and presented by Elsevier’s solution partner Todd Grover, Co-Founder of Glass Box Analytics.

Todd discusses how the Predictive Acquisition Cost (PAC) is utilizing the concept of a Gini coefficient to anticipate price movement, predict drug shortages, and pricing elasticity.

To learn more, read the brief: Predictive Acquisition Cost – a better standard.

Thursday, October 15, 2020

Prime Therapeutics Deepens Its Reliance on Express Scripts: Our Four Takeaways From Their New Pharmacy Relationship

Last week, news broke that Prime Therapeutics is expanding its relationship with Cigna’s Express Scripts to include mail and specialty pharmacy dispensing. So far, there's been very little written about this transaction.

Below, I share my thoughts on the following topics arising from the deal:
  • The mail and specialty pharmacy market
  • The future of AllianceRx Walgreens Prime
  • The emerging Express Scripts industry platform
  • A reminder about why the Federal Trade Commission won’t challenge the relationship
Prime is becoming increasingly dependent on outsourcing to Cigna’s Express Scripts business. This new pharmacy contract furthers the industry’s move toward vertical consolidation and the disappearance of the independent PBM industry. 

Once again, channel intermediaries continue to gain power and extract profits. More to come.

Tuesday, October 13, 2020

NEW: The 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

I am pleased to announce our new 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, available for purchase and immediate download.
We’re offering special discounted pricing if you order before October 23, 2020!

The 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors—our 11th edition—remains the most comprehensive resource for analyzing the pharmaceutical distribution industry’s economics, market structure, growth rates, forces of change, and interactions with the U.S. healthcare system.

This 2020-21 edition contains the most current financial and industry data along with detailed information about the strategies and market positions of the largest companies: AmerisourceBergen, Cardinal Health, and McKesson. It updates our annual analysis of each wholesaler’s business segments and underlying business profitability, based upon our proprietary economic models. Three new sections address COVID-19 and its impact on wholesalers, including the potential financial effects on wholesalers of widespread distribution of one or more COVID-19 vaccines.

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.

WHAT’S GOING ON

Twice a year, I spend my evenings and weekends writing two comprehensive, fact-based, and nonpartisan reports on drug channel economics. In some small way, I try to make the world a better and smarter place.

Licenses for our DCI reports are regularly purchased by nearly every company involved in the drug channel: pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospitals, buyers, benefit managers, managed care executives, policy analysts, investors, consultants, and more. So, you can find out what your customers, partners, and competitors are reading.

The 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors is the only resource of its kind available anywhere. It offers 136 proprietary charts, exhibits, and data tables.

FOUR FUN FACTS
  • The 9 chapters are self-contained and do not need to be read in order. (Really!) There are loads of internal hyperlinks to help you navigate the document and customize it to your specific interests and priorities.
  • We are offering the option to download an additional PowerPoint file with images of all 136 exhibits. This popular option helps you share the insights and data with others in your organization. (The PowerPoint file option is available only with the purchase of a corporate license.)
  • There are an astonishing 482 (!) endnotes, most of which have hyperlinks to original source materials. These source materials offer a handy way to build your knowledge base beyond what’s included in the full report.
  • As usual, I have reluctantly stripped out the corny jokes and pop culture references.
If you have any questions (before or after reading the report), please email me.

Enjoy!

Monday, October 12, 2020

Informa Connect-CBI’s 6th Edition Drug Pricing Transparency Congress

Informa Connect-CBI’s 6th Edition Drug Pricing Transparency Congress
November 16-17, 2020 | Virtual Event
www.informaconnect.com/drug-pricing-transparency

Drug Channels Readers: View the complete agenda and register today. Be sure to use your exclusive promo DRUG30 to save $300*

As the election nears and with the recent flurry of regulatory activity surrounding drug pricing transparency, bio/pharma manufacturers must continuously stay ahead of the ever-evolving changes. Join Informa Connect-CBI’s 6th Edition Drug Pricing Transparency Congress to discuss how current and future drug pricing transparency regulations will impact commercialization, reimbursement, pricing and compliance practices. Assess how companies are planning internally for these changes, hear updates post-election impacting drug pricing transparency and gain a preview of what’s to come in 2021.

Unlike a webinar or zoom training, Drug Pricing Transparency Congress serves as a full virtual 2-day conference experience. Experts from Nestle Health Science, Sidley Austin LLP, Covington & Burling LLP, Chiesi USA, Inc., Sandoz, King & Spalding LLP, Amneal Pharmaceuticals, Novo Nordisk, ClassOne Insights, BIO, PhRMA, and more will lead robust discussions on topics, including:
  • Unpack Price Increase Transparency Requirements
  • Analyze Price Disclosure Requirements to Health Care Providers (HCPs)
  • State of The Industry — Drug Pricing Transparency Landscape Address
  • Status Report on New Drug Pricing Reporting Requirements
  • Keep a Pulse on New Legislation and Current Industry Efforts
  • Explore Developments in Pricing Investigations and Enforcement Action
  • Keys for Success and Traps for the Unwary — A Roadmap for Compliance
  • Uncover Operational Realities and Recommendations to Maximize State Transparency Reporting
  • Leverage Proactive Approaches and Resources for Operational Readiness
  • Federal Initiatives for Pricing Transparency
  • Update on the Price Increase Advance Notice Requirements
Unparalleled Virtual Capabilities:
  • Interactive presentations and panels
  • Live Q&A and polling
  • Live and on-demand sessions, all available 30-days post-event to review at your leisure
  • 1-1 meeting opportunities and peer-to-peer engagement
  • Sophisticated and seamless scheduling tools
Drug Channels Readers – View the complete agenda and register today– Be sure to use your exclusive promo DRUG30 to save $300*

Informa Connect-CBI will see you there!

*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. 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, October 09, 2020

Discriminatory Reimbursement Practices by PBMs Represent a Threat to Public Health: A Perspective from Community Health


Today’s guest post comes from Shannon Stephenson, CEO of Cempa Community Care.

I am publishing this opinion piece to share a perspective from a community health provider that is eligible for the 340B Drug Pricing Program as a Ryan White clinic and as a Federally Qualified Health Center Look-Alike. As I noted last week in my September news roundup, I generally consider federal grantees to be the good guys of 340B.

Shannon outlines her view that pharmacy benefit managers (PBMs) have reduced reimbursement to her facilities. This reduces the value of the 340B program to Cempa. It also transfers funds to PBMs and their plan sponsor clients.

Read on for Shannon’s insights on this highly controversial issue.

Tuesday, October 06, 2020

The Booming Biosimilar Market of 2020

The biosimilar market is finally beginning to fulfill its promise.

The latest data show that provider-administered biosimilar drugs are successfully displacing their reference biological products. As I predicted last year, newer biosimilars are being adopted quickly, and their prices are declining rapidly. What’s more, manufacturers of reference products are cutting drug prices to defend their market shares.

Last year, Dr. Scott Gottlieb, a former FDA commissioner, argued that we shouldn’t give up on biosimilars and prematurely regulate prices. As you will see below, Dr. Gottlieb was right.

Monday, October 05, 2020

Patient Support Services Congress

Patient Support Services Congress
October 27-29, 2020 | VIRTUAL EVENT (All-Digital Format)
www.informaconnect.com/patientsupportservicescongress

Informa Connect-CBI’s Patient Support Services Congress is a comprehensive meeting for insightful and engaging dialogue around strengthening and innovating patient-oriented programs while remaining compliant.

Exclusive Offer for Drug Channels readers — Save $300 off the standard registration rate with promo code AHC685*. Register today.

Download the agenda here and see in-depth coverage on industry trends and next-generation patient services, such as:
  • Critical Regulatory Updates and Effective Strategies for Monitoring & Oversight
  • Novel Approaches to Services, Program Architecture and Operational Management
  • The Pros and Cons of Different Support Service Models
  • Measuring the Success of Patient Support Programs
  • Transparency with Charitable Organizations
  • Adapting to a Virtual World ― Strategies for Field Team Compliance and Virtual Monitoring
Choose from Two In-Depth Tracks and Interactive Roundtables on:
  • Legal and Compliance
  • Innovation and Operations
Critical Insights on Overcoming the Challenges and Complexities Amid a Shifting Industry from:
  • Evan Panich, Assistant United States Attorney, U.S. Attorney’s Office, District of Massachusetts
  • Katherine Chaurette, Vice President Healthcare Law and Compliance, Blueprint Medicines
  • Kelley Allison, Vice President of Patient Access, Rare Disease, Horizon Therapeutics
  • Robert Britting, Director, Patient Services and Strategic Solutions, Teva Pharmaceuticals
  • Matthew Werner, Vice President, Chief Compliance & Privacy Officer, Bio-Rad Laboratories
  • John Kelly, Member, Bass, Berry & Sims PLC
  • Jenny Alonso, General Counsel and Chief Compliance Officer, Neurelis, Inc.
  • Doug Donaldson, Senior Director, Product Solutions and Patient Services, Mylan
  • And so many more!
Comprehensive Content and Dynamic Features Include:
  • 3 days of live content from industry thought-leaders
  • 10+ on-demand sessions, tailored to both access and compliance
  • Over 4 hours of live speaker Q&A
  • AI-powered virtual networking with colleagues and counterparts
  • Private meeting and chat rooms
  • Access to live and on-demand content for 30 days post-event
Exclusive Offer for Drug Channels readers — Save $300 off the standard registration rate with promo code AHC685*. Register today.

*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, October 02, 2020

Bridging Data Insights Across the Patient Journey to Inform Your Commercialization Strategy

Today’s guest post comes from Jenna Mitby-Manning, Senior Director of Commercial Strategy & Insights, Access & Adherence at RxCrossroads by McKesson.

Jenna explains how data-driven solutions accelerate time to therapy, improve patient outcomes, and allow biopharma companies to make informed strategic decisions.

Click here to learn more about RxCrossroads' therapy access and adherence solutions.

Read on for Jenna’s insights.

Wednesday, September 30, 2020

Drug Channels News Roundup, September 2020: FQHCs and 340B, Drug Prices, CVS Health’s Zinc, Telehealth, All-Time Greatest Songs, and 10K on Twitter

Autumn is here! We’ve been squirrelling away these acorns from the mighty Drug Channels oaks:
  • I agree. FQHCs are not the problem in 340B.
  • Brand-name drug prices keep on dropping
  • It’s official: CVS Health’s Zinc GPO actually exists!
  • Telehealth takes a dive
Plus, vote for your 10 favorite songs of all time!

P.S. This month, @DrugChannels exceeded 10,000 followers on Twitter. Thank you to everyone who follows my curated links to neat stuff! Click here to join the crowd.


You can also join my 12.3K followers on LinkedIn.

Tuesday, September 29, 2020

Informa Connect-CBI’s 8th Annual Coupon and Copay Forum

Informa Connect-CBI’s 8th Annual Coupon and Copay Forum
 
October 13-16, 2020 | Virtual Event
www.informaconnect.com/coupon-copay/

Exclusive Offer for Drug Channels Readers – View the complete agenda and register today – Be sure to use your exclusive promo code USAVE3 to save $300*

It’s time to talk. As managing copay programs continues to be significantly more complex, it is imperative to stay on top of current trends, emerging regulations and future legislation. Hundreds of leaders in patient access and affordability have benefited from Informa Connect- CBI’s Coupon and Copay Forum conference series. Join key stakeholders at this timely meeting and examine the design of coupon and copay programs aimed at driving the most effective and efficient patient access and affordability.

Unlike a webinar or zoom training, Coupon and Copay serves as a full virtual 4-day conference experience. As always, the caliber of content and peer-to-peer engagement is second to none. Experts from Diverse Biotech, Mallinckrodt Pharmaceuticals, ConnectiveRX, Orange Grove Bio, National Hemophilia Foundation, Akebia Therapeutics, Vanderbilt University Medical Center, HHS, AbbVie, PhRMA, The AIDs Institute, National Alliance of Healthcare Purchaser Coalitions, Sol-Gel Technologies, The GW School of Medicine, Apellis Pharmaceuticals, Innocoll Pharmaceuticals, Tris Pharma, kaléo and more will lead robust discussions on compelling topics, including:
  • Innovative copay program design and operations
  • Impact of COVID-19 on affordability
  • Formulary barriers, increasing patient awareness and driving adherence
  • Performance metrics to justify the cost of copay programs
  • Pharmacy surveillance of specialty brand copay programs
  • Breaking down current barriers to prescription drug access and assistance
  • PAP compliance trends and implications of copay programs
  • Copay accumulator and maximizer programs
  • Employer shifts in benefit plan design to address the growing costs of advanced therapeutics
Unparalleled Virtual Capabilities:
  • Interactive presentations and panels
  • Live Q&A and polling
  • Live and on-demand sessions, all available 30-days post-event to review at your leisure
  • 1-1 meeting opportunities and peer-to-peer engagement
  • Sophisticated and seamless scheduling tools
Exclusive Offer for Drug Channels Readers – View the complete agenda and register today – Be sure to use your exclusive promo code USAVE3 to save $300*

Informa Connect-CBI will see you there!

*Discount offer valid through 10/9/2020; 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.

Friday, September 25, 2020

Mapping the Specialty Medication Journey—Digital Patient Engagement Made Easy

Today’s guest post comes from Julia Laurin, Chief Product Officer at ConnectiveRx.

Julia discusses the medication access and adherence challenges specialty patients face. She introduces us to mobileCare Manager™ a mobile platform built specifically for the specialty patient experience.

To learn more about ConnectiveRx’s mobile engagement platform, download their one-pager or visit their website to connect with one of their experts.

Read on for Julia’s insights.

Wednesday, September 23, 2020

Specialty Pharmacy Keeps Disrupting Buy-and-Bill—and COVID-19 Will Accelerate It

Will COVID-19 trigger long-term share gains for specialty pharmacies as suppliers to hospitals and physician offices?

Before the pandemic, specialty pharmacies—via white, brown, and clear bagging—had already displaced buy-and-bill distribution channels for a substantial chunk of provider-administered specialty drugs. See below for detailed data on oncology and non-oncology products.

We estimate that in the first half of 2020, the coronavirus pandemic accelerated this shift. Some of the changes will likely be transitory, as patients return to their healthcare providers. But payers will try to retain some of these gains—especially if they also own a specialty pharmacy.

Read on and see if you agree.

Tuesday, September 22, 2020

Preorder now: The 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

On October 13, 2020, Drug Channels Institute will release The 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. This report—our eleventh edition—remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry. Notable new material in the 2020-21 edition includes three sections that address COVID-19 and its impact on wholesalers.

We are providing you with the opportunity to preorder this thoroughly updated and revised 2020-21 edition at special discounted prices. This means that you can be among the first to access our new report. Those who preorder will receive a download link before October 13.


You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to email us if you would like to pay by corporate purchase order or check.

Preorder and launch pricing discounts will be valid through October 23, 2020.

Monday, September 21, 2020

15th Hub, SPP and eServices Summit

15th Hub, SPP and eServices Summit
September 29-October 2, 2020 | Virtual Event

 This important event convenes key stakeholders including manufacturers, specialty pharmacies, hubs, payers, PBMs, physicians and more to explore strategies for developing and integrating hub programs and other patient-centric services to ensure product access and optimal reimbursement. 

Drug Channels readers will save $300 off the standard registration rate when they use code MDU494.* 

  In-Depth Discussions and Actionable Takeaways on Critical Topics: Hub Excellence
  • Innovative Affordability Strategies and Hub Models for Specialty Products
  • Examine Support Service Model Design and Strategies for Implementation
  • Training and Staff Advancement for Hub Excellence through Resource Management
  • Strategic Integration of Patient Support, Distribution, Field and Commercial Strategies for Innovative Therapies
SPP Partnering
  • Ask the Experts—Elevate Stakeholder Collaboration to Optimize Patient Access
  • Uncover Innovative Strategies to Optimize SP Networks
  • Striking the Right Balance—A Look at the Level of Integration Between Hub and Pharmacy
  • Pharmacy Perspective—Assess the Impact of Real-Time Benefit Verification on Patient Access
eRx, ePrior Auth and eServices
  • ONC Keynote Address—Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs
  • Manufacturer Insights—Assess Opportunities to Prevent Un-Due Delay of Patient Care
  • Standards Update—Navigate NCPDP Initiatives, Guidance and Future Proposals for Innovation
  • Navigate ePrior Authorization and Real-Time Benefit Verification Complexities within Medicare
Featured Speakers:
  • Alicia Dixon, MHA, Director, Patient Access and Reimbursement, Tricidia, Inc.
  • John Wiedemann, Director of Patient Support Service, Retrophin
  • Jackie Barnard, Associate Director, Field Reimbursement, Paratek Pharmaceuticals
  • Bill Goodson, Director, Patient Access and Reimbursement Services, Eisai US
  • Keith White, Vice President and Head, Global Market Access, Corbus Pharmaceuticals
  • Stephen Samuel, Chief Executive Officer, Premier Specialty Pharmacy Services
  • John Klimek, R.Ph., Senior Vice President, Standards & IT, NCPDP
  • Sarah Krug, Executive Director, Cancer 101
  • Sheila M. Arquette, R.Ph., Executive Director, National Association of Specialty Pharmacy (NASP)
  • David Kowalsky, Director, Market Access and Patient Services, EyePoint Pharmaceuticals
  • Andrew Gettinger, Chief Clinical Officer, ONC at US Department of Health & Human Services
  • And more!

Drug Channels readers will save $300 off the standard registration rate when they use code MDU494.*

*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, September 18, 2020

Three Ways to Boost Patient Access to Orphan Drugs—With an Independent Specialty Pharmacy

Today’s guest post comes from Ela Lourido, Vice President of Business Development at Biologics by Mckesson.

Ela discusses the important role independent specialty pharmacies play in educating payers, supporting patients, and ultimately getting potentially life-saving therapies into the hands of patients.

Click here to learn more about Biologics by McKesson's patient access services for biopharmaceutical manufacturing companies.

Read on for Ela’s insights.

Tuesday, September 15, 2020

My Wall Street Journal Op-Ed about the 340B Program

Last Friday, The Wall Street Journal published my opinion piece: The Federal Program That Keeps Insulin Prices High. The article text is pasted below for those who don't subscribe.

I summarize issues with the role of contract pharmacies in the 340B Drug Pricing Program. My arguments will be familiar to regular readers of Drug Channels. I wrote this piece for a general business audience, so it's highly readable and omits industry insider terminology. To help you get the most from the article, I have included additional links to source materials in the text.

Note that my commentary focuses primarily on hospitals, which account for the vast majority of 340B program sales. Federal grantees are more likely to pass discounted 340B prices to needy patients. However, grantees should consider my warning from 2014: The good apples—the 340B entities that require additional financial support to support needy patients—should be worried that the bad ones could rot away the program for everyone.

Please share your comments below and I'll respond where appropriate.

Monday, September 14, 2020

New for 2021: The Drug Channels Quarterly Video Webinar Series

We are proud to bring you something new for 2021!

Join Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI), for five live video webinars—one every calendar quarter, starting in the fourth quarter of 2020. These live, interactive events will be broadcast via Zoom from the Drug Channels Video studio in beautiful downtown Philadelphia.

During these quarterly updates, Dr. Fein will address the latest issues confronting the U.S. drug channel. Topics will be determined based on what’s happening—trends, policy changes, executive orders, company announcements, and more. He’ll also share DCI’s latest market data to help you stay on top of new developments. You will be able to use these events as both a capstone of your quarterly learning and a touchpoint for the future.

The 75-minute events are scheduled for 12:00 p.m. to 1:15 p.m. ET on:
  • December 18, 2020 (Drug Channels Outlook: What You Need to Watch in 2021)
  • March 26, 2021 (Drug Channels Update: 2021Q1)
  • June 25, 2021 (Drug Channels Update: 2021Q2)
  • September 24, 2021 (Drug Channels Update: 2021Q3)
  • December 17, 2021 (Drug Channels Outlook: What You Need to Watch in 2022)
PLUS: Dr. Fein will take your questions during each event. We will also offer an opportunity to submit questions in advance of each event.

Read on for full details on pricing, including substantial discounts for multiple sites.

Thursday, September 10, 2020

Why Generic Medicines Are Especially Good for the U.S. Right Now

Today’s guest post comes from George Keefe, Senior Vice President of External Affairs and Public Policy at Teva Pharmaceuticals.

George examines the economic impact of generic pharmaceuticals on the U.S. economy. He argues that the generics industry provides safe, effective, and affordable medicines for many Americans.

To learn more, download the Teva United States Economic Impact Report.

Read on for George’s insights.

Wednesday, September 09, 2020

The State of Specialty Pharmacy 2020: Market Data and Trends (video)

In May, I recorded a brief video webinar for an on-demand business education session at Asembia's 2020 Specialty Pharmacy Summit Virtual Experience.

You can watch the full video below. I review:
  • The role of specialty drugs in the pharmacy industry
  • Our latest data on specialty pharmacy accreditation
  • Commentary on PBM’s role in the specialty industry
The data are drawn from our 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Friday, September 04, 2020

Why Do CVS And Express Scripts Rely on Secretive Private Companies to Run Their Copay Maximizer Programs? (rerun)

This week, I’m rerunning some popular posts while I work on the forthcoming 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from June 2020. It was one of my most popular articles in 2020.

One minor update: PrudentRx finally has a website! It's still uninformative and misleading, but I suspect that my original article shamed them into putting up a better placeholder.




In Copay Maximizers Are Displacing Accumulators—But CMS Ignores How Payers Leverage Patient Support, I explained a new Centers for Medicare and Medicaid Services (CMS) final rule regarding health plans’ use of copay accumulator adjustment. I also highlighted why plans have responded to the negative patient impact from accumulators with copay maximizer programs.

However, maximizers are being implemented very differently from accumulators.

The two largest PBMs—CVS Health’s Caremark and Cigna’s Express Scripts—have each partnered with secretive and independent private companies to operate specialty drug maximizer programs for their plan sponsor clients. What’s more, at least one of these private companies earns fees equal to 25% of the manufacturer’s copay support program.

These arrangements are very odd. Why do multi-billion-dollar public companies rely on these private companies to administer their maximizer programs? Why do these small companies deserve such outrageous fees? Why are beneficiaries required to affirmatively sign up with the companies—or face ludicrous costs that far exceed their plan’s out-of-pocket maximums? Does any oversight exist for these arrangements?

Here’s what I managed to uncover about these businesses. See what you think.

Thursday, September 03, 2020

Copay Maximizers Are Displacing Accumulators—But CMS Ignores How Payers Leverage Patient Support (rerun)

This week, I’m rerunning some popular posts while I work on the forthcoming 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from June 2020.

I'll have an update on accumulators in September.



COVID-19 has not stopped the wheels of policy bureaucracy from grinding. Last week, the Centers for Medicare and Medicaid Services (CMS) released its final Notice of Benefit and Payment Parameters for the 2021 benefit year. You’ll find the document links below.

This final rule permits insurers to exclude the value of a pharmaceutical manufacturer’s copay support program from a patient’s annual deductible and out-of-pocket maximum obligations.

Translation: CMS has confirmed that insurers have the option to use copay accumulator adjustment for their pharmacy benefit programs.

Patients on specialty drugs lose big from accumulators, while plans profit from the lower spending that results. Consequently, copay maximizers have emerged as a more patient-friendly alternative to accumulators. Below, I remind you of the math behind these alternatives.

Plan sponsors are publicly denouncing copay support programs—while they’re privately embracing them. CMS’s final rule ignores the troubling reality behind maximizers and accumulators: They encourage plans to use pharmacy benefit deductibles as a scheme that allows payers—not patients—to reap the greatest benefits from a manufacturer’s patient support program.

Wednesday, September 02, 2020

Walgreens and CVS Top the 28,000 Pharmacies Profiting from the 340B Program. Will the Unregulated Party End? (rerun)

This week, I’m rerunning some popular posts while I work on the forthcoming 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from July 2020.

I'm rerunning this post to provide context for manufacturers' recent actions regarding 340B contract pharmacies. The "SUBREGULATORY MISCHIEF" section below explains crucial background.


Yesterday, Eli Lilly announced that its products can be dispensed only at covered entities and their child sites, but not via external pharmacies. However, Lilly will permit its insulin to be dispensed from 340B contract pharmacies—as long as patients receive the discounted 340B prices of $0.03 per 3 mL pen or $0.10 per 10 mL vial. Amazing.


It’s time for our annual look at the 340B Drug Pricing Program’s booming pharmacy component.

Our exclusive analysis of government data finds that 28,000 pharmacy locations—almost half of the U.S. industry—now act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. Over the past 12 months, the number of pharmacies in the program has grown by more than 3,300 locations.

As you will see below, multi-billion-dollar, for-profit, publicly traded pharmacy chains—Walgreens, CVS, Walmart, Rite Aid, Kroger, and Albertsons—continue their unchecked 340B expansion.

Despite this astonishing growth, the contract pharmacy component does not have—and has never had—a regulatory infrastructure. That’s because the subregulatory notice that created contract pharmacies wasn’t subject to any rulemaking procedures. Eli Lilly recently challenged this notice, which forced the government to concede that its own pharmacy guidance is “not legally enforceable.”

As you review our analysis, ponder why manufacturers still comply with HRSA’s non-binding guidance—and why investors remain unconcerned with the risks of public companies’ participation in the out-of-control 340B program.

Tuesday, September 01, 2020

PBMs and Drug Spending in 2019: CVS Health and Express Scripts Outperform Prime Therapeutics (rerun)

This week, I’m rerunning some popular posts while I work on the forthcoming 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from June 2020.

Since my original article below, MedImpact has released its annual drug trend report. Like Prime, MedImpact also underperformed the larger PBMs. Click here to view the updated chart that I posted on @DrugChannels.




It’s time for our annual Drug Channels examination of PBM drug spending reports. For 2019, we again aim our magnifying glass at the annual trend reports from the largest pharmacy benefit managers (PBMs): CVS Health, Express Scripts, and Prime Therapeutics. (See their report links below.)

Once again, we find that commercial drug spending did not race higher—contrary to what you keep hearing from journalists and politicians. Spending rose by less than 3% in 2019, continuing a multiyear trend of slow growth. At some plan sponsors, total drug spending even declined. For specialty drugs, higher utilization—not drug costs—was again the biggest factor driving specialty spending growth.

Notably, clients of Prime Therapeutics fared worse than those of Express Scripts and CVS Caremark. Below, I explain three factors behind Prime’s underperformance. Its third place finish highlights why the PBM industry continues to consolidate.

Monday, August 31, 2020

How GoodRx Profits from Our Broken Pharmacy Pricing System

On Friday, GoodRx filed its Form S-1 in preparation for going public. Link below.

The company is insanely profitable. Its adjusted net income—earnings before interest, taxes, depreciation, and amortization (EBITDA)—is an astonishing 40%.

Below, I provide my overview of how our crazy drug channel system enables GoodRx’s good fortune. You will admire the GoodRx management team’s business savvy in building a company that lowers out-of-pocket costs for consumers. But you will also wonder whether this business perpetuates a broken pharmacy drug pricing model.

P.S. This article updates and expands on the comments I posted to @DrugChannels on Friday evening.

Friday, August 28, 2020

The ConnectiveRx Non-Commercial Pharmacy: Maximize Your Patient Access Strategy

Today’s guest post comes from Frank Dana, Chief Commercial Officer at ConnectiveRx.

Frank discusses the access challenges that patients face at the point of prescribing. He then describes how ConnectiveRx’s non-commercial pharmacy solution streamlines workflow for healthcare providers and captures useful data for brands.

Click here to download a free information sheet about the ConnectiveRx Careform non-commercial pharmacy.

Read on for Frank’s insights.

Wednesday, August 26, 2020

Five Surprising Facts About COVID-19 Prescription Trends for Retail and Mail Pharmacies

Somehow, we are nearly two-thirds of the way through 2020. It’s time to explore what’s been happening within the U.S. prescription market and its dispensing channels.

Below, I highlight five data-based observations about the prescription trends we’ve seen so far this year. Our findings span the unexpected resilience of retail pharmacies and a troubling drop in new prescription activity.

I also offer a fresh perspective on recent mail controversies and the abundance of nonsensical statistics in recent news stories. Links to sources appear at the bottom of this article.

While reviewing the data below, please recall our Drug Channels philosophy, courtesy of the late senator Daniel Patrick Moynihan: "Everyone is entitled to his own opinion, but not his own facts."

Friday, August 21, 2020

Improve Compliance and Create Transparency with 340B Rebates (Free webinar)

As regular readers know, I believe the 340B Drug Pricing Program needs to evolve into a more transparent, properly regulated program.

That’s why I’m especially glad to share today’s guest post from Jeremy Docken, Founder and CEO at Kalderos. Jeremy explains the 340B program's use of rebates instead of the more common upfront discounts. He argues that greater adoption of the established 340B rebate process will benefit all stakeholders: covered entities, manufacturers, state Medicaid programs, and others.

To help the industry learn more about 340B rebates, Kalderos is sponsoring a live video webinar: Evolving 340B: Moving from Discounts to Rebates.

I’ll be joining Jeremy during this webinar for an interactive presentation, discussion, and Q&A. This webinar will take place on September 11, 2020 (12:00 p.m. to 1:00 p.m. ET). Registration is free and open to all.

Read on for Jeremy’s insights—and be sure to join us in three weeks!

Regards,
Adam

Tuesday, August 18, 2020

Hospitals Continue Their Startling Expansion into Specialty Pharmacy

Hospitals and health systems are building a major presence in the specialty pharmacy industry.

As we demonstrate below, nine out of ten large hospitals now operate a specialty pharmacy. Hospitals and other healthcare providers account for one-third of all U.S. accredited specialty pharmacies.

Clinical and general financial motivations are driving hospitals’ DIY specialty pharmacy growth. The enormous profit opportunities from the 340B Drug Pricing Program offer further encouragement for hospitals. In-house specialty pharmacies are also a valuable hedge against the potential loss of contract pharmacies.

Manufacturers would be wise to incorporate hospitals into channel strategy planning for their specialty drugs. At the same time, antitrust regulators should weigh the impact of hospitals’ growing clout over prescribers of specialty drugs and attempts to steer patients to in-house pharmacies.

Friday, August 14, 2020

Using Technology to Improve Medication Access and Impact More Patients

Today’s guest post comes from Julia Phillips, VP of Pharma Accounts and Enablement at CoverMyMeds.

Julia discusses the challenges of both access to therapy and patient adherence, specifically during the COVID-19 pandemic. CoverMyMeds’ technology solutions mitigate these issues and ultimately improve patient outcomes.

To learn more, download the CoverMyMeds case study, Overcoming Medication Access Barriers Caused by Prior Authorization.

Read on for Julia's insights.

Tuesday, August 11, 2020

Five Top Drugmakers Reveal List vs. Net Price Gaps (Plus: The Trouble With Insulin Prices)

Time for our annual update on pricing at five of the largest pharmaceutical manufacturers—Eli Lilly, Janssen, Merck, Novartis, and Sanofi. You can find links to each company’s data below.

When rebates and discounts were factored in, drug prices declined—or grew slowly—in 2019. Consistent with our previous analyses, rebates and discounts reduced the selling price of brand-name drugs to about half of their list prices.

This growing disparity between list and net prices continues to inflate the gross-to-net bubble. As the companies’ insulin data illustrate below, the bubble raises costs for patients who are not always benefiting from lower net selling prices.

These data also highlight the lunacy of inflationary rebates that are based on a government pricing metric that approximates a brand-name drug's list price. This is what Senator Charles Grassley (R-IA) has proposed in the Prescription Drug Pricing Reduction Act of 2020. Legislation should shield patients from the excesses of the gross-to-net bubble while enhancing the competitive pressures that are reducing drug prices. Is that too much to ask?

Friday, August 07, 2020

Patient Assistance Programs–Weathering COVID-19 and the Unknown

Today’s guest post comes from Rob Brown, VP/GM of RxCrossroads by McKesson Program Pharmacy.

Rob reviews how COVID-19 is changing patient access and adherence to specialty therapies. He then describes specific RxCrossroads’ program changes that are helping patients and providers remain on therapy and navigate this challenging environment.

To learn more, visit www.McKesson.com/RxCrossroads.

Read on for Rob’s insights.

Tuesday, August 04, 2020

The Gross-to-Net Bubble Hit $175 Billion in 2019: Why Patients Need Rebate Reform

Last Friday’s Executive Orders revived the government’s effort to reform rebates in federal programs. Whether that effort succeeds, today's update reminds us what's still at stake in reforming rebates within the U.S. drug channel.

For 2019, Drug Channels Institute estimates that the gross-to-net bubble—the dollar gap between sales at brand-name drugs' list prices and their sales at net prices after rebates and other reductions—reached $175 billion.

The bubble reflects—and drives—many of patients’ problems and misunderstandings of U.S. drug prices.

However, the political and practical challenges to rebate reform remain daunting. Few people grasp the complex economic interplay of patient out-of-pocket spending, cost-shifting, premiums, and payer incentives.

Despite the pandemic, I remain hopeful that we can help this bubble pop.

Monday, August 03, 2020

NASP 2020 Annual Meeting & Expo Virtual Experience

NASP 2020 Annual Meeting & Expo Virtual Experience
September 14-18, 2020 | Virtual Experience
www.naspmeeting.com/registration

Utilizing innovation and cutting-edge technology, the National Association of Specialty Pharmacy (NASP) is hosting its 2020 Annual Meeting & Expo, September 14-18, as a full-scale virtual conference experience that includes all that attendees have come to expect and love from the live event. The NASP 2020 Annual Meeting & Expo Virtual Experience promises to be the next best thing to being there!

The conference agenda is jam packed and offers something for everyone, whether you are new to the industry or a seasoned expert. Conference highlights include:
  • 26 unique educational sessions and panel discussions, organized into four dynamic CORE tracks – Clinical, Operational, Regulatory, and Patient Experience – to help you focus on what is most important to you
  • Earn CPE and CLE credits through in-line programming, satellite symposia and pre-conference workshops
  • Encore presentations of the popular sessions
  • THREE KEYNOTE PRESENTATIONS
    • Jim Kelly, former NFL quarterback and Pro Football Hall of Fame member, will share what it means to be “Kelly Tough”
    • Former interim chair of the Democratic National Committee (DNC) Donna Brazile and former chairman of the Republican National Committee (RNC) Michael Steele will give a joint keynote presentation on the political landscape and the 2020 election
    • Allan Lichtman, a distinguished professor at American University, scholar, and author will share his predictions for the 2020 election
  • Five pre-conference workshops: the CSP Exam Preparation Course, Legal Day, Home Infusion Workshop (1/2 day) and our two newest workshops, Technology Day and Hospital/Health Systems Workshop (1/2 day) (additional fee required for workshops)
  • The interactive Virtual Exhibit Hall will feature 50+ exhibitors, representing stakeholders from across the specialty pharmacy industry
  • The ever-popular Women in Specialty Pharmacy event, featuring motivational keynote speaker Courtney Clark
  • CE satellite symposia
  • Poster presentations and author discussions
  • NASP Annual Meeting Award presentations – including two new awards – the Specialty Pharmacy Service Excellence award and the Strategic Partner of the Year award
  • The NASP Ron Bookman Scholarship Awards
  • Direct interaction with industry thought leaders and experts through live Q&A and private chats
  • Ample networking opportunities
  • Virtual wellness initiatives on Tuesday and Wednesday mornings to help you get up and going
  • Personalized avatars and MUCH More!
Register today for this must-see virtual experience!


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

Wednesday, July 29, 2020

Drug Channels News Roundup, July 2020: Diabetes Costs, Regeneron’s Copay Support, MA Rethinks Coupons, My Favorite Chart Updated, and ABC’s Steve Collis

The steamy, socially distanced days of summer are here. Cool off by getting up close and personal with our refreshing selection of articles and insights. In this issue:
  • Pricing problems for diabetes treatments
  • Controversy over Regeneron’s copay support
  • Massachusetts concedes that coupons help some patients (but accumulators hurt)
  • A 2020 update to my all-time favorite chart
Plus, thoughtful perspectives on diversity from AmerisourceBergen CEO Steve Collis

P.S. Join the more than 9,700 followers of my curated links published on @DrugChannels on Twitter. My recent tweets have highlighted: VC’s pharmacy love, physicians’ biosimilar concerns, drug trend in workers’ comp, copay accumulator news, the outlook for insurance costs, remdesivir pricing, Philly pharmacies, how paid parking boosts telemedicine, and more.

ON SALE! We are offering our 2019–20 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors at discounts up to 35% off. Sale prices valid thru September 8, 2020. The updated 2020-21 edition will be available in October 2020.

Sunday, July 26, 2020

Trump’s Executive Orders on Drug Pricing: The Drug Channels Guide to Industry Implications

Surprise! President Trump signed four executive orders (EO) last Friday afternoon. They cover:
  • Pass-through of 340B discounts for insulin and EpiPens
  • Rebate reform (!)
  • Importation
  • Most Favored Nation (MFN) pricing for drugs
The fourth order on MFN has not been publicly released, so I will reserve comment for now.

I see significant challenges in implementing these far-reaching orders. Below, you’ll find the text of the first three along with my commentary and links to Drug Channels articles that will help you make sense of them.

Read on and see if you agree with me.

Friday, July 24, 2020

Clarity in the Face of COVID-19: Building an Effective Patient Savings Strategy

Today’s guest post comes from Frank Dana, Chief Commercial Officer at ConnectiveRx.

Frank discusses how the loss of commercial insurance coverage will affect the newly unemployed. He describes how ConnectiveRx's affordability tools can help pharmaceutical manufacturers and patients.

To learn more, download ConnectiveRx’s free reference: Five Keys to Building a Successful Copay Strategy in the COVID-19 Era.

Read on for Frank’s insights.

Thursday, July 23, 2020

How Hospitals and PBMs Profit—and Patients Lose—From 340B Contract Pharmacies

The stunning growth of specialty pharmacies in the 340B Drug Pricing Program has accelerated a troubling trend: Patients covered by commercial insurance and Medicare Part D are footing the bill for 340B savings.

That's the uncomfortable reality of the 340B program’s hidden prescription economics.

Whenever a prescription is eligible for 340B pricing, an insured patient could pay thousands of dollars out of pocket—even as the 340B hospital and its contract pharmacy generate substantial profits. Meanwhile, private health plans and Medicare pay full price for drugs that are sold to 340B covered entities at deep discounts, further subsidizing hospitals and PBM-owned specialty pharmacies.

Below, to show you how this occurs, I follow the dollar for a brand-name specialty drug used by a consumer with commercial insurance. Our indisputable math exposes the little-understood economics behind specialty pharmacies in the 340B program.

I hope that the program’s participants take an honest look at who is actually paying for their 340B savings. As always, I welcome your feedback via email or in the comments below.

Tuesday, July 21, 2020

PBM-Owned Specialty Pharmacies Expand Their Role In—and Profits From—the 340B Program

Last week, I documented that nearly half of U.S. pharmacies now participate in the 340B Drug Pricing Program. Below, we update our exclusive analysis of the biggest specialty pharmacies within 340B.

The four largest specialty pharmacies are owned by CVS Health, Cigna’s Express Scripts business, UnitedHealth Group’s OptumRx business, and Walgreens Boots Alliance/Prime Therapeutics.

As you will see below, these specialty pharmacies have dramatically increased their participation in the 340B program. Hospitals are the primary 340B covered entities that engage with these specialty pharmacies.

We estimate that specialty pharmacy dispensing accounted for nearly one-third of PBMs’ total gross profits in 2019. Consequently, the 340B program is a significant and growing component of profitability for these large, for-profit, publicly traded companies.

Later this week, I’ll examine how patients with commercial and Medicare Part D insurance are subsidizing the super-sized 340B profits of these companies.

Tuesday, July 14, 2020

Walgreens and CVS Top the 28,000 Pharmacies Profiting from the 340B Program. Will the Unregulated Party End?

It’s time for our annual look at the 340B Drug Pricing Program’s booming pharmacy component.

Our exclusive analysis of government data finds that 28,000 pharmacy locations—almost half of the U.S. industry—now act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. Over the past 12 months, the number of pharmacies in the program has grown by more than 3,300 locations.

As you will see below, multi-billion-dollar, for-profit, publicly traded pharmacy chains—Walgreens, CVS, Walmart, Rite Aid, Kroger, and Albertsons—continue their unchecked 340B expansion.

Despite this astonishing growth, the contract pharmacy component does not have—and has never had—a regulatory infrastructure. That’s because the subregulatory notice that created contract pharmacies wasn’t subject to any rulemaking procedures. Eli Lilly recently challenged this notice, which forced the government to concede that its own pharmacy guidance is “not legally enforceable.”

As you review our analysis, ponder why manufacturers still comply with HRSA’s non-binding guidance—and why investors remain unconcerned with the risks of public companies’ participation in the out-of-control 340B program.

Friday, July 10, 2020

CMS Best Price Proposal and Copay Assistance: How New Rule Could Change the Access Landscape

Today’s guest post comes from Rick Fry, Senior Vice President of Commercial Solutions and Jason Zemcik, Senior Director of Product Management at TrialCard.

Rick and Jason outline their view of the crucial issues in the new proposed rule from Centers for Medicare and Medicaid Services (CMS) regarding copay accumulator adjustment programs. They preview the public comments that TrialCard expects to submit to CMS.

Please visit TrialCard’s copay accumulator program resources to learn more about mitigating copay accumulator programs. Contact sales@trialcard.com to discuss solutions for your organisation.

Read on for Rick’s and Jason’s insights.

Thursday, July 09, 2020

The Top 15 Specialty Pharmacies of 2019: PBMs Stay On Top (rerun)

This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from April 2020.


In Drug Channels Institute's list of the top 15 pharmacies of 2019, 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 ranking, we present below our exclusive list of the top 15 pharmacies based on specialty drug dispensing revenues. Consistent with our previous analyses, PBMs and insurers have retained their dominance over specialty drug channels, while smaller pharmacies are facing increased competition and profit pressures.

I see upside for specialty pharmacies in the aftermath of the pandemic. This growth will come at the expense of provider-administered drug channels. I expect the top companies’ share will increase in 2020, due to mergers and business transitions among the largest PBMs. However, the increasing role of government payers may create opportunities for smaller pharmacies.

This Friday, I’ll discuss how COVID-19 will affect the specialty pharmacy market during the first of my two live video webinars.

Wednesday, July 08, 2020

Four Unexpected Ways that the COVID-19 Medicaid Boom Will Affect PBM and Pharmacy Profits (rerun)

This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from April 2020.


The U.S. economy is in a medically-induced coma. Unemployment is soaring. Companies are teetering on the brink of bankruptcy. It is unclear when our lives will return to their pre-pandemic state.

One thing seems apparent: As people lose jobs and health insurance, Medicaid enrollment will jump, perhaps by as much as 20% to 30%. This will have profound implications for the drug channel.

Today, I focus on how this increase will affect retail pharmacies and pharmacy benefit managers (PBMs). Below, I review Medicaid enrollment trends, how states manage prescriptions, and the factors driving the coming boom in Medicaid enrollment.

As I explain, many (but not all) retail pharmacies will benefit from Medicaid growth. PBMs, however, will not fare as well. Read on and see if you agree.