Thursday, October 28, 2021

Drug Channels News Roundup, October 2021: PBMs’ Oncology Exclusions, Biosimilar Boom, BCBS vs. Hospitals, U.S. vs. the World, and CRISPR Comedy

Fortunately, Halloween can’t be scarier than any other day this year. So grab your pillow case and stuff it with treats from the great Drug Channels pumpkin patch:
  • Spooky! PBMs are conjuring a terrifying number of formulary exclusions for oncology drugs
  • Eerie! Brrr..did you hear that? It’s the biosimilar boom!
  • Creepy! Scream as Blue Cross Blue Shield frightfully overpays hospitals
  • Shocking! Believe it or not, U.S drug spending shambles into the middle of the herd
Plus, The Onion summons the only humorous article about CRISPR.

P.S. Please join the more than 12,700 consumers of my daily commentary and links to neat stuff at @DrugChannels on Twitter. You can also find my daily posts on LinkedIn, where I have more than 20,000 followers.

Recent posts have covered: Walgreens’ new direction; controversary over independent pharmacy counting; insurer consolidation; retail pharmacy M&A; drug pricing policy; Prime Therapeutics; 340B contract pharmacy litigation; pharmaceutical antitrust; oncology care model; and Peter Bach’s nuptials.

Controlling Cancer Care: The Emergence of Formulary Exclusions in Oncology, IQVIA

In January, I observed that the largest PBMs were starting to expand formulary exclusions into previously untouchable specialty therapy classes. See The Big Three PBMs Ramp Up Specialty Drug Exclusions for 2021 .

This new IQVIA report digs into PBM formulary exclusions for oncology drugs. As you can see from the report’s first exhibit (reproduced below), exclusions are soaring—even for oncolytics that lack a generic or biosimilar alternative.

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There is an urgent need for more research on how exclusions affect physicians’ prescribing decisions, patients’ ability to access oncology therapies, and clinical outcomes. This report provides a useful first step toward addressing these issues.

2021 Biosimilar Trends Report, Amgen

Check out this excellent—and free—report on the U.S. biosimilar market. It’s loaded with useful data and charts. Drug Channels salutes Amgen for having sponsored the research.

Consider these data from the report’s pages 13 and 14:

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As I predicted last year, the biosimilar boom is finally here. Prices are dropping while adoption accelerates.

Before the boom began, Dr. Scott Gottlieb, a former FDA commissioner, argued that we shouldn’t give up on biosimilars and prematurely regulate prices. As we can now see, Dr. Gottlieb was right. #NoTowel

Price Differences To Insurers For Infused Cancer Drugs In Hospital Outpatient Departments And Physician Offices , Health Affairs

Oh, look. It’s yet another peer-reviewed academic study documenting that provider-administered specialty drugs are much more expensive in hospital outpatient departments than they are in physician offices.

This study relied on claims information from a data warehouse with 130 million Blue Cross Blue Shield health plan enrollees. The authors note: “Had these plans excluded hospital clinics from their networks, channeling all of the infusions to physician offices, they would have saved $1.28 billion per year, or 26 percent of what they actually paid.”

Like it or not, the channel often sets a payer’s drug price—regardless of the drug’s true cost. As I noted in last month’s news roundup, this problem is not new.

The irony: Blue Cross Blue Shield plans routinely overpay hospitals...and then complain about drug prices. Once again, these insurers conveniently omit their own role in allowing powerful providers to inflate commercial drug spending.

Drug Expenditure Dynamics 1995–2020: Understanding medicine spending in context, IQVIA

Here’s another valuable IQVIA report. This one provides us with counterintuitive facts about drug spending around the world. The figures measure net spending on medicines dispensed in both retail and non-retail sectors.

Notably, drug spending accounts for 14% to 18% of total healthcare spending in most countries. Despite the political rhetoric, U.S. drug spending is—and has been—in middle of the pack as a share of total healthcare spending.

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FYI, my LinkedIn post about this report generated a spirited debate—although some of the commenters appear not to have read the actual report.

The Onion’s Guide To CRISPR, The Onion

The world’s leading news publication provides some useful FAQs about CRISPR technology. I learned something new about possums!

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