Wednesday, August 25, 2021

Drug Channels News Roundup, August 2021: OptumRx’s New GPO, Pharmacy DIR Fees, State Biosimilar Laws, UM Views, and a Newspaper Delivers

Our not-quite-post-pandemic summer is coming to an end. Time to pack away the bathing suit and get serious again—with these curated curiosities combed from the now-barren Drug Channels beach:
  • OptumRx joins the PBM GPO game
  • Pharmacy DIR fees hit $11 billion
  • A terrific resource on state biosimilar laws
  • Patient views on utilization management
Plus, my social media success…from a (print) newspaper ad!

P.S. Please join the more than 12,100 consumers of my daily commentary and links to neat stuff at @DrugChannels on Twitter. You can also find me on LinkedIn, where I have more than 19,500 followers. Recent topics have included: Express Scripts’ 2022 formulary exclusion list, Amazon’s pharmacy, generics in Part D, 340B research, zero-dollar copay, pass-through rebates, PBMs’ spread pricing, Rite Aid’s Bartell deal, healthcare pricing trends, the DSCSA, John Venn, and more.

Optum Launches ‘Emisar’ Contracting Entity; Navitus Aligns with Ascent via Prime, Nephron Research

Eric Percher of Nephron Research broke the story on Emisar Pharma Services, the new, Ireland-based group purchasing organization (GPO) that OptumRx has just launched.

Eric provided this helpful timeline of PBMs’ development of purchasing groups:

[Click to Enlarge]

My $0.02: These organizations provide a novel way for PBMs (1) to extract incremental fees—on top of the usual administrative fees—from drug makers while (2) creating a non-rebate flow of funds for themselves. More air for the gross-to-net bubble, per the “Blowing Bubbles” section of Gross-to-Net Bubble Update: Net Prices Drop (Again) at Six Top Drugmakers.

(Sorry, I’m not permitted to share a link to the full Nephron report. Please contact to learn more about accessing Nephron’s research reports.)

Seniors' health care suffers due to skyrocketing fees for prescription drugs, pharmacists say, The Columbus Dispatch

Check out this excellent article from Darrel Rowland on pharmacy direct and indirect remuneration (DIR) fees in Medicare Part D.

The article includes our data on the 2020 value of pharmacy DIR, which we estimate reached $11.2 billion. (See chart below.) For more of our analyses, see Section 11.4. of our 2021 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

[Click to Enlarge]

Biosimilar Interchangeability Laws by State, Cardinal Health

Check out this fantastic and timely resource from Cardinal Health. More than 100 pages of regulatory awesomeness!

Three quarters of Americans with health insurance coverage believe too many hurdles exist between patients and doctor-prescribed medicines, Ipsos

Yikes! This Ipsos survey (funded by Novartis) examined patients’ perspectives on utilization management.

No surprise: More than 30% of insured Americans have difficulty accessing prescription medications due to PBM and insurer rules and cost-sharing burdens. Here’s a key summary chart from the survey:

[Click to Enlarge]

The survey also found that 75% of the insured perceive that there are "too many hurdles" between them and what their physician has prescribed.

This isn't how insurance should work.

Adam’s Photo, LinkedIn

And speaking of utilization management…

A few weeks ago, I snapped a photo of the full-page print ad below. The ad, which was funded by Let My Doctors Decide and the American Autoimmune Related Diseases Association, opposes PBM and insurer prior authorization tools.

Ironically, this post of a print ad became one of my most viewed social media posts of 2021, garnering more than 260 reactions and nearly 20,000 views on LinkedIn.

BTW, you read correctly: I'm so old that every morning, I still read an actual, physical paper. If you do the same, feel free to send me a telegram.

[Click to Enlarge]

No comments:

Post a Comment