Specialty Drugs Update: Trends, Controversies, and Outlook (NEW Live Video Webinar)

Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for a new video webinar:

Specialty Drugs Update: Trends, Controversies, and Outlook
This event will be broadcast live on July 29, 2022,
from 12:00 p.m. to 1:30 p.m. ET

This article describes the event and explains how to purchase a registration to participate in the event.

This event is part of The Drug Channels 2022 Video Webinar Series. Anyone who registered for the entire series will receive an email with a link to access the July event.

WHAT YOU WILL LEARN

Join Dr. Fein as he helps you and your team stay on top of the latest trends, market data, and strategies for specialty drugs. He will draw from exclusive information found in DCI’s industry economic reports.

During the event, Dr. Fein will cover a wide range of topics, including:

• Specialty drugs in pharmacy vs. medical benefits

• How plan sponsors are managing specialty benefits

• Distribution channels to providers, pharmacies, and patients

• DCI’s latest data on the specialty market position of distributors, pharmacies, and PBMs

• The latest on copay accumulators and maximizers

• Specialty carve-out and alternative funding programs

• Buy-and-bill trends

• The 340B Drug Pricing Program and specialty drugs

• Drug pricing controversies and policy debates

• And more!

PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions.

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data.

Read on for full details on pricing and registration.

Drug Channels News Roundup, June 2022: Drug Spending in 2021, PBM Exclusions, Employers vs. Rebates, GoodRx Questions, and More Prior Authorization Humor

I can’t recall any period in my life when our country has been so divided and polarized. Through the Drug Channels Institute, I strive to provide you with fact-based and balanced coverage—along with links to source materials so you can make up your own mind.

So before you launch your July 4 festivities and/or a civil war, Drug Channels humbly offers some data fireworks for our troubled nation:

• More evidence of slow growth in drug spending for 2021

• Fresh data on skyrocketing PBM formulary exclusions

• Employers still hoarding rebates

• Pharmacy pricing in the era of GoodRx

Plus, Dr. Glaucomflecken continues his humorous assault on insurance prior authorizations.

P.S. Join my nearly 29,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have nearly 14,500 followers.

Exposing the Facts About Voucher and Bridge Pricing

Today’s guest post comes from Logan Melchione, Senior Director of Account Management at Paysign.

Logan describes how some patient affordability vendors capture funds that were intended for patients. She then provides manufacturers with ideas to better manage and oversee copay, bridge, and voucher programs.

To learn more, register for Paysign’s July 13 webinar: Affording Patient Affordability Programs: The Truth About Voucher and Bridge Pricing.

Read on for Logan’s insights.

How PBMs and Discount Cards Impact Generic Drug Prices (video)

Recently, I explored the complex web of relationships and conflicts that support today’s discount card economics. See The GoodRx-Kroger Blowup: Spread Pricing, Pharmacy Margins, and the Future of Discount Cards.

In the video below, I discuss how generic drug pricing and the rise of patient-paid, discount card prescriptions pose a risk to pharmacy benefit plans and the PBM business. I also highlight the odd relationship between Prime Therapeutics, Amazon Pharmacy, Express Scripts, and five Blues plans.

The video is excerpted from my PBM Industry Update: Trends, Controversies, and Outlook video webinar. If you missed the live event, you can register to watch a replay.

Enjoy!

National Association of Specialty Pharmacy (NASP) 2022 Annual Meeting & Expo

National Association of Specialty Pharmacy (NASP) 2022 Annual Meeting & Expo
September 19-22, 2022 | Gaylord Palms Resort & Convention Center | Orlando, FL
www.naspnet.org/annualmeeting

The National Association of Specialty Pharmacy (NASP) will host the NASP 2022 Annual Meeting & Expo September 19-22. NASP will celebrate their 10th Anniversary and welcome attendees to a new conference venue – the gorgeous Gaylord Palms Resort & Convention Center, located in Orlando, Florida.

Register today for this premier industry event!

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:

• 40+ unique educational sessions organized into four dynamic tracks to help you focus on what is most important to you
• Continuing education credits for pharmacists, nurses, and technicians
• THREE KEYNOTE PRESENTATIONS
• Montel Williams, an Emmy Award winner, decorated former naval officer, inspirational speaker, author, entrepreneur, multiple sclerosis patient and advocate for patients worldwide
• Justin Patton, executive coach, will lead the conference in challenging attendees to Reimagine What’s Possible
• Monica Pearson, distinguished journalist and humanitarian, and the first woman and first minority to anchor the daily evening news in Atlanta, Georgia
• Six pre-conference workshops: Accreditation Workshop (1/2 day), Certified Specialty Pharmacist (CSP) Exam Preparation Course, Home Infusion Workshop (1/2 day), Hospital/Health Systems Specialty Pharmacy Workshop, Specialty Pharmacy Law Conference, and Technology Day Workshop (additional fee required for workshops)
• Dynamic Exhibit Hall featuring exhibitors representing all specialty pharmacy industry stakeholders
• The ever-popular Women in Specialty Pharmacy Luncheon, featuring motivational keynote speaker Amelia Rose Earhart (additional fee required)
• Educate to Cultivate Networking Event -- reconnect with industry colleagues and friends over lunch and learn more about Florida’s oldest industry and time-honored tradition, the authentic and skilled art of cigar rolling (additional fee required)
• CE satellite symposia
• Poster presentations and author discussions
• NASP Industry Awards presentations
• The NASP Ron Bookman Scholarship Awards
• Direct interaction with industry thought leaders and experts
• Ample networking opportunities
• 10th Anniversary Gala Celebration

Register today for this premier industry event!

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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

Technology that Supports Patients and Brands at Every Point of the Medication Access Journey

Today’s guest post comes from Shawn Seamans, Chief Commercial Officer at CoverMyMeds.

Shawn discusses how technology can be combined with human intervention to better help patients access, afford, and adhere to their therapies. He then describes how three patients benefited from support solutions.

For more information about how CoverMyMeds’ solutions can support the patient journey for your brand, visit their digital commercialization experience.

Read on for Shawn’s insights.

A New JAMA Study Misleads About Drug Prices—And Launches a New Attack on Patients with Ultra-Rare Diseases

Last week, the authors of a new JAMA study claimed that “prices for new drugs are skyrocketing.” Their research, along with a simultaneously released New York Times op-ed, received widespread media coverage. Links below.

But as I explain, the study’s headline conclusion is highly misleading. The authors obscure the real story with mathematical sleight-of-hand that misrepresents the underlying data and overlooks the true nature of today’s pharmaceutical innovations.

Most notably, the authors discount the fact that the most expensive new drugs treat ultra-rare conditions affecting extraordinarily small patient populations. Their policy recommendations would therefore have a devastating impact on these patients and their hope for treatments and cures.

As Nobel prize winner Ronald Coase observed: “If you torture the data long enough, it will confess to anything.” Read on and consider what the data are really saying.

Informa Connect’s IDN & Bio/Pharma Partnering Summit

Informa Connect’s IDN & Bio/Pharma Partnering Summit Hybrid Event
August 16-17, 2022 | Philadelphia, PA
www.informaconnect.com/IDN

Don’t miss the IDN & Bio/Pharma Partnering Summit coming up this summer in Philadelphia, where you'll be part of the important discussions on how to best optimize strategic partnerships to improve patient access and outcomes. This event showcases novel case studies and in-depth sessions that focus on innovative partnership models that will aid in delivering enhanced value, manageable costs and high-quality results.

Visit www.informaconnect.com/IDN for further details and to register. Drug Channels readers will save 10% off when they use code 22DRCH10 and register prior to June 31, 2022.*

The 2022 format includes 2 days of in-person programming, plus a virtual offering of select sessions and recorded presentations available on-demand for 12 months following the conference. Both the in-person and virtual options will include networking opportunities to connect with industry peers and colleagues.

The Summit features coverage on the hottest topics impacting you today, from speakers representing Atrium Health, Bayer, Cone Health, CSL Behring, Fairview Health Services, Nebraska Medicine, NYU Langone Health System, Pfizer, Quil Health, Tempus Labs, TG Therapeutics, University of California, Davis, University of Illinois at Chicago, College of Pharmacy, University of Pennsylvania Health System, Vanderbilt Specialty Pharmacy and Vifor Pharma.

View the agenda to see the complete picture – the program, speakers, and more!

Visit www.informaconnect.com/IDN for further details and to register. Drug Channels readers will save 10% off when they use code 22DRCH10 and register prior to June 31, 2022.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates or other offers. Other restrictions may apply.

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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

Five Ways Tech Can Transform Your Program Delivery

Today’s guest post comes from Edward Hensley, Co-founder and Chief Commercial Officer at AssistRx.

Edward offers five ways life sciences companies can use technology to transform their patient support services and thus differentiate their products.

To learn more, sign up for AssistRx’s free webinar Specialty Pharma’s 2022 Patient Support Trends: Progress Check.

Read on for Edward’s insights.

Pharmacist Job Market in 2021: Retail Pharmacy Slump, Hospital Boom

Time for an update to the Drug Channels Institute (DCI) annual analysis of pharmacist salaries and employment.

The retail pharmacy shakeout affected 2021 pharmacist employment. We found that retail pharmacies and drugstores employed fewer pharmacists, while hospitals and outpatient centers continued to add positions. As a result, the share of pharmacists who work in non-retail practice settings reached a new high.

What’s more, average base salaries for retail pharmacists dropped for the second year, while salaries continued to rise for pharmacists employed by hospitals, physician offices, and other non-retail settings. Full salary data below for your enjoyment or sorrow.

As expected, the past few years have been highly challenging for retail-employed pharmacists. Expect further declines as the shakeout continues.

The Case for Data Unity, Sharing, and Usability

Today’s guest post comes from Bonnie Briggs, Associate Director of Clinical Effectiveness at Wolters Kluwer, Health.

Bonnie describes how pharmaceutical care would benefit from standard medical record identification. She then discusses the practical issues behind implementing and adopting such a system.

To learn more, download the Wolters Kluwer free ebook: Drug Data Unity: Realistic and Idealistic Futures for Information Exchange.

Read on for Bonnie’s insights.

Drug Channels News Roundup, May 2022: SaveonSP Sued, RIP Medicaid Accumulator Rule, CVS/ABC Deal, Buy-and-Bill Profits, and Aetna’s Prior Authorizations

Summer unofficially began over the weekend. Let’s turn up the heat with these sizzling news bites straight from the Drug Channels grill:

• SaveonSP gets sued

• Thoughts on the Medicaid accumulator rule opinion

• CVS buys AmerisourceBergen’s specialty pharmacy

• Fresh data on hospitals’ cancer drug profiteering

Plus, Dr. Glaucomflecken explains Aetna’s prior authorization policies.

P.S. Join my more than 27,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 14,000 followers.

The GoodRx-Kroger Blowup: Spread Pricing, Pharmacy Margins, and the Future of Discount Cards

A few weeks ago, GoodRx surprised investors with the unpleasant news that a major grocery chain had stopped accepting its discount card for an unspecified number of prescriptions. As I explain below, the unnamed chain appears to be Kroger—the sixth-largest U.S. pharmacy. What’s more, GoodRx disclosed that Kroger accounts for an unexpected one-quarter of its prescription business.

The GoodRx situation highlights crucial issues about the complex web of relationships and conflicts that support today’s discount card model. Below, I break down the economics of the discount card business to help frame the outlook for discount cards.

As I explain, discount cards are really just another form of spread pricing. As the market for patient-paid prescriptions has expanded, disputes about the appropriate split of these spreads will pressure pharmacy-PBM relationships and drive change in the discount card business model.

A well-known African proverb states: “When elephants fight, it's the grass that suffers.” Will investors continue to support GoodRx—or move on to greener pastures? Read on and see what you think.

It’s Time to Put Innovative Contracts Under Warranty

Today’s guest post comes from Jane Barlow, Chief Clinical Officer, and Susan Raiola, President of Real Endpoints.

Jane and Susan discuss the mechanism and benefits of warranties in the realm of value-based contracts.

To learn more about payer-pharma warranty contracts and whether these agreements can solve issues that limit the utility of more traditional value-based contracts, sign up for Real Endpoints’ free June 9 webinar: Putting Innovative Contracts Under Warranty.

Read on for Jane’s and Susan’s insights.

The State of Specialty Pharmacy 2022: Reflections, Trends, and Photos from #Asembia22

Two weeks ago, Paula and I had the pleasure of attending Asembia’s 2022 Specialty Pharmacy Summit at the wonderful Wynn Las Vegas.

Below, I violate Vegas code and tell you what happened there. I offer reflections on my keynote session with Scott Gottlieb, share my experiences during the featured session, and highlight three crucial specialty industry trends.

You’ll also find a link to my general session slides and some fun photos.

Enjoy!

Opportunities to Improve Critical Medication Access in Oncology

Today’s guest post comes from Shawn Seamans, Chief Commercial Officer at CoverMyMeds.

Shawn discusses the unique challenges cancer patients face in accessing, affording, and adhering to treatment. He explains how patient-centric technology, combined with access to caring experts, can alleviate these challenges.

Read more about access, affordability, and adherence opportunities for oncology patients in the CoverMyMeds 2022 Medication Access Report: Oncology Edition.

Read on for Shawn’s insights.

Gross-to-Net Bubble Update: 2021 Pricing Realities at 10 Top Drugmakers

Time for Drug Channels’ annual update on pricing at the largest pharmaceutical manufacturers. This year’s review includes 10 companies: Eli Lilly and Company, Genentech, GlaxoSmithKline, Janssen, Merck, Novartis, Novo Nordisk, Sanofi, Takeda, and UCB. You can find links to each company’s data below.

When rebates and discounts were factored in, brand-name drug prices declined—or grew slowly—in 2021. Consistent with our previous analyses, rebates and discounts reduced the selling prices of brand-name drugs to less than half of their list prices.

What’s more, average net drug prices have declined for the past five years—though a few companies had net price gains or slower declines in 2021.

As I have pointed out many times, pharma industry perma-critics refuse to accept that brand-name drug prices are falling—or that prescription drug spending is a small and stable portion of overall U.S. healthcare expenditures. That’s why I refer to them as drug pricing flat earthers (#DPFE).

As famous economist John Maynard Keynes reportedly said: “When the facts change, I change my mind.” What will the DPFEs do?

Informa Connect’s Hub and Specialty Pharmacy Models East

Informa Connect’s Hub and Specialty Pharmacy Models East
Delivered as a Hybrid Event
June 28-30, 2022 | Sheraton Parsippany | Parsippany, NJ
www.informaconnect.com/hub-specialty-pharmacy

Drug Channels readers will save 10% off the current registration rate when they use code 22DC10*.

This important event convenes key stakeholders including manufacturers, specialty pharmacies, hub providers and more for unrivaled collaboration to leverage innovation and optimize access. Be a part of the critical conversation at this timely meeting to explore proven strategies and cutting-edge approaches to drive an all-encompassing, state-of-the-art hub.

Live Keynotes Delivering Novel Approaches and Maximized Engagement on High-Impact Topics

• Multi-Stakeholder Panel — Elevate Hub Effectiveness Through Advancement of Stakeholder Partnerships
• Innovative Model Showcase — Emerging Manufacturer Hub Models Transforming the Patient Experience
• Specialty Pharmacy Spotlight — Enhancing Speed-to-Therapy while Increasing Patient Engagement
• Utilize Digital Engagement for End-to-End Patient Support for Specialty Products

Customize Your Experience with Tailored Content

• Choose between two streams of content focusing on:
  • Leverage Specialty Data and Analytics for Hub Efficiency and Value
  • Hub Model Optimization to Streamline and Enhance Processes
• Build your own agenda with 4 focused breakouts on critical topic areas

Featured Speakers:

• Dave MacLeod, Head of Global Patient Services and Commercial Distribution, Amylyx Pharmaceuticals
• Liam Moy, Senior Director, Patient Services, Neurology, Alexion Pharmaceuticals, Inc.
• Emily Phillips, Reimbursement, Patient Advocate, & Government Affairs Leader
• Melissa Beatty, Director, Patient Services and Reimbursement, CTI Bio Pharma
• Chad Bower, Executive Director, Field Reimbursement & Oncology Solutions, US Market Access, Daiichi Sankyo, Inc.
• Lee M. Cortes, Executive Assistant U.S. Attorney, U.S. Attorney’s Office, District of New Jersey
• Lauren Powell, MPA, PhD, Vice President, US Health Equity & Community Wellness, Takeda Pharmaceuticals

PLUS! For 2022 only, Hub and Specialty Pharmacy Models and PAP – Patient Assistance & Access Programs are under the same roof.

The two events will be co-located for shared learning, extended networking opportunities and the option to pick your favorite sessions and move between conferences if desired!

Drug Channels readers will save 10% off the current registration rate when they use code 22DC10*.

Download the full agenda and save your seat today!

*Offer applies to current 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.

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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

DCI’s Top 15 Specialty Pharmacies of 2021—And Three Factors That Will Reshape 2022

In Drug Channels Institute’s list of the top 15 pharmacies of 2021, we show that central-fill, mail pharmacies operated by large PBMs and health insurers have displaced retail chains as the largest prescription drug dispensers by revenues.

To complement that broader ranking, we present below our exclusive and updated list of the top 15 pharmacies based on specialty drug dispensing revenues in 2021. You will see that PBMs and insurers retained their dominance over specialty dispensing.

But as I explain below, 2022 will be a year of transition. Significant volume will shift to the larger players, as Centene plots its exit, Walgreens’ specialty pharmacy business collapses, and manufacturers’ 340B contract pharmacy restrictions continue.

This week, I’m attending Asembia’s Specialty Pharmacy Summit. In a future article, I’ll violate Vegas code and tell you what happened.

A Game-Changing Shift: Why Pharma Commercial Teams Are Turning to HEOR

Today’s guest post comes from Chris Harvey, Director of Solutions Engineering at Panalgo, and Carolyn Zele, Senior Manager of Solution Enablement at MMIT.

Chris and Carolyn discuss the insights that health economics and outcomes research (HEOR) professionals bring to commercial teams. They explain how that pairing benefits both manufacturers and patients.

For more on how MMIT and Panalgo help pharma manufacturers leverage HEOR and real-world data for commercial strategies, click here to learn about the Patient Access Analytics tool.

Read on for Chris’ and Carolyn’s insights.

Drug Channels News Roundup, April 2022: 340Boom, 340B Profits for Pharmacies & PBMs, Fixing Insulin, Walgreens’ Robots, and Doctors’ Day

Baseball season is in full swing! Oil up your glove, lace up your cleats, and let's run the bases around this month's news stories. Remember: Sometimes you win, sometimes you lose, and sometimes it rains.

In this issue:

• Green Monster: The 340B market hits new highs in 2021

• Not-Free Agents: Big 340B profits for CVS, Walgreens, Express Scripts, et al

• Batter Up: Fixing the insulin market

• Pinch Hitters: Walgreens bets on robots

Plus, Dr. Glaucomflecken helps UnitedHealthcare celebrate Doctors’ Day!

P.S. For my daily pitches on the industry’s hits and misses, join my nearly 27,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 13,800 followers.

Next week, I'll be live and in-person at Asembia's Specialty Pharmacy Summit. During Tuesday's general session, I'll be joining Dr. Scott Gottlieb for a fireside chat at 8:00 AM and will then present my "State of Specialty Pharmacy 2022" at 9:30 AM. Hope to see you there!

Informa Connect’s Patient Support Services Congress

Informa Connect’s Patient Support Services Congress
Hybrid Event | June 14-16 in Philadelphia, PA
www.informaconnect.com/patientsupport

Exclusive Offer – Be sure to use your exclusive promo PSS22DC to save 10% off* of your registration.

A proven industry staple, Patient Support Services Congress is back June 14-16, 2022 and ready to arm industry with next-generation approaches to patient services for optimal program performance. Taking place in a hybrid format in Philadelphia, PA, prepare to join leaders from across industry as they come together for innovative discussions on access strategy, patient interactions, case management, compliance practices and more.

This event unites both compliance and operations teams. You will benefit from collaboration and next-level benchmarking to drive program success. Take advantage of tailored, tracked content featuring detailed case studies on control enhancement and operational excellence to further advance your programming.

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code PSS22DC to save 10% off* of your registration.

In two-and-a-half days, walk away with critical insights on industry standards, forward-thinking strategies to propel program performance, and so much more.

Can’t miss content highlights:

• Industry Address – Dive into Market Trends Impacting Access, Adherence and the Patient Journey
• Enforcement Update – Explore Rising Oversight and High Priority Risk Areas for Patient Services Compliance
• Engage, Educate, Exchange — Optimize Relationship Management between Manufacturers and Patients for Enhanced Outcomes
• The Rise of Technology – Accelerate Enrollment Through AI-Driven Approaches
• Address Disparities in Access Through Patient Support Program Design to Improve Outcomes
• And more!

PLUS! Customize Your Experience with Two Tailored Tracks:

Compliance and Legal

• Implement Internal Controls to Reduce Compliance Risks with Nurse Educators and HCP/Patient Interactions
• Manage Third-Party Compliance to Optimize Patient Interactions
• Enhance Patient Data Monitoring for Greater Strategic Outcomes
• Monitor Virtual Programs and Field Team Compliance for Successful Adaptation
• Create Compliant Bridge and Quick Start Programs for Rare Disease
• And more!

Innovation and Operations

• Discover Hybrid and Alternative Patient Solutions Models to Best Support Patients and HCPs

Build and Maintain Patient Engagement for Rare Disease

Utilize Predictive Analytics to Build a Better Patient Services Program

Streamline Patient Education to Create Meaningful Communication

Enhance Access, Reimbursement and Benefit Support Through Programming

And more!

How Does Hybrid Work?

• ALL ACCESS PASS includes the in-person event June 14-16 AND all benefits of the virtual experience pass
• VIRTUAL EXPERIENCE PASS includes live streaming of select sessions June 14-16 as well as recorded presentations from the in-person events available for 10 business days beginning June 21

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code PSS22DC to save 10% off* of your registration.

Informa Connect will see you there!

*Cannot be combined with other offers, promotions or applied to an existing registration. Other restrictions may apply.

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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

Four Reasons Why PBMs Gain As Maximizers Overtake Copay Accumulators (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from February 2022.

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More than four years ago, I warned about the emerging trend of copay accumulators and outlined the costly consequences for patients.

The latest data reveal that copay accumulator adjustment programs are now in the word list for a growing share of pharmacy benefit designs. What’s more, adoption of copay maximizers now exceeds that of copay accumulators. Maximizers avoid the brutal patient adherence problems of accumulators, while allowing plan sponsors to extract even more patient support funds.

Despite this impressive growth, you may not yet have considered PBMs’ business model for these tools. Below, I outline why PBMs have incentives to prefer maximizer programs over accumulators and alternatives such as specialty carve-out programs.

I look forward to hearing your thoughts on these developments in the comments below or on social media: LinkedIn (preferred) or Twitter.

Follow the Vial: The Buy-and-Bill System for Distributing and Reimbursing Provider-Administered Outpatient Drugs (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from October 2021.

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By reader request, we present below a channel flow chart illustrating the buy-and-bill process for provider-administered drugs. This chart complements Follow the Dollar: The U.S. Pharmacy Distribution and Reimbursement System for Patient-Administered, Outpatient Brand-name Drugs.

To further help you understand this channel, I have also included a brief video to explain the buy-and-bill system. The video is excerpted from my recent Drug Channels Update: Buy-and-Bill Trends video webinar.

This post is adapted from Chapter 3 of our new 2021–22 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Five Takeaways from the Big Three PBMs’ 2022 Formulary Exclusions (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from January 2022.

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For 2022, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)— increased the number of drugs they excluded from their standard formularies.

Each exclusion list contains 400 to 500 products. Growth in the number of excluded drugs slowed, due partly to the fact that so many drugs have already been dropped from PBMs’ formularies.

Below, I highlight five observations about this year’s lists, including unexplainable differences in how PBMs handle specialty drugs, biosimilars, and insulin.

I also offer some thoughts on non-medical switching and what we still don’t know about how exclusions affect patients.

Let me know what you think by commenting below or on social media.

Why PBMs and Payers Are Embracing Insulin Biosimilars with Higher Prices—And What That Means for Humira (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from November 2021.

An ironic postcript: Less than two months after my article was published, Cigna CEO David Cordani bragged about the cost savings from "aggressive adoption" of biosimilars. Anyone want to tell him about the Express Scripts formulary for insulin biosimilars?

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The Food & Drug Administration (FDA) recently approved the first interchangeable biosimilar insulin product: the insulin glargine-yfgn injection from Viatris. Read the FDA’s press release.

Alas, I’m sad to report that the warped incentives baked into the U.S. drug channel will limit the impact of this impressive breakthrough.

Viatris is being forced to launch both a high-priced and a low-priced version of the biosimilar. However, only the high-list/high-rebate, branded version will be available on Express Scripts’ largest commercial formulary. Express Scripts will block both the branded reference product and the lower-priced, unbranded—but also interchangeable—version. Meanwhile, Prime Therapeutics will place both versions on its formularies, leaving the choice up to its plan sponsor clients.

Consequently, many commercial payers will adopt the more expensive product instead of the identical—but cheaper—version. As usual, patients will be the ultimate victims of our current drug pricing system.

Below, I explain the weird economics behind this decision, highlight the negative impact on patients, and speculate on what this all could mean for biosimilars’ future. Until plan sponsors break their addiction to rebates, today’s U.S. drug channel problems will remain.

Informa Connect’s PAP – Patient Assistance & Access Programs

Informa Connect’s PAP – Patient Assistance & Access Programs
Hybrid Event | June 28-30 in Parsippany, NJ
www.informaconnect.com/pap

Exclusive Offer – Be sure to use your exclusive promo code 22DCPAP10 to save 10% off* of your registration.

Informa Connect is pleased to announce that PAP – Patient Assistance & Access Programs will return as a hybrid event June 28-30 in Parsippany, NJ and virtually through the ConnectMe platform. As the barriers for medication assistance become increasingly significant and out-of-pocket costs and the number of uninsured and functionally uninsured patients increase, it is essential for stakeholders to collaborate on how to further access to care, understand current changes in legislation and policy, and optimize PAPs for better patient outcomes. This event unites pharma, foundations, health clinics and more. Do not miss this opportunity to benchmark on industry standards and stay on top of evolving trends to propel program performance.

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code 22DCPAP10 to save 10% off* of your registration.

Whether you choose to attend in-person or virtually, PAP will deliver unparalleled strategies to drive patient assistance and affordability. Ensure you are at the table with leaders from across industry as they collaborate on and discuss the most timely and crucial topics, including industry standards for patient assistance, changing legal trends, tools and technologies to empower patients to better manage OOP costs, next-generation models for assistance, and so much more.

Can’t miss content highlights:

• State of the Industry: Policy Updates and Regulatory Advancements Driving Affordability and Access
• Panel: Current Trends and Industry Benchmarks for PAPs
• Navigate the Legal Underpinnings of Patient Assistance and Gain Insight on OIG Oversight
• Foundation and Advocate Insights: Collaborating to Evolve PAPs and Accelerate Patient Access
• Ensuring the Continuity of Care Across the Patient Journey
• Patient Perspective Fireside Chat
• Three Customizable Tracks by Company Classification
• Bio/Pharma Manufacturers
• Patient Advocates
• Hospitals/Clinics/Health Systems
• Diversity, Equity and Inclusion Summit: Advance Advocacy and Innovation to Achieve Health Equity
• Part One: Racial and Income Disparities in Healthcare
• Part Two: Explore Proactive Approaches to Increase Access to Healthcare
• Emerging Best Practices and Industry Trends in Free Drug Programs
• And more!

PLUS, 2022 EXCLUSIVE:

PAP will be co-located with Hub & Specialty Pharmacy Models! That’s right – Benefit from shared learning, extended networking opportunities and the option to pick your favorite sessions and move between conferences if desired at no additional cost (and that includes access to the Hub & Specialty Pharmacy Models virtual platform as well)!

How Does Hybrid Work?

• ALL ACCESS PASS includes the in-person event June 28-30 AND all benefits of the virtual experience for PAP AND Hub & Specialty Pharmacy Models East
• VIRTUAL EXPERIENCE PASS includes live streaming of all general sessions June 28-30 as well as recorded presentations from the in-person events available for 10 business days beginning July 5

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code 22DCPAP10 to save 10% off* of your registration.

Informa Connect will see you there!

*Cannot be combined with other offers, promotions or applied to an existing registration. Other restrictions may apply.

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The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

Kristy’s Story: Navigating Specialty Medication Challenges

Today’s guest post comes from Megan Marchal, Director of Specialty Pharmacy Strategy at CoverMyMeds.

Megan discusses the access and affordability challenges faced by specialty therapy patients. She describes how CoverMyMeds’ centralized technology solutions—paired with experts familiar with each therapy—help patients navigate these challenges. And, she shares one patient’s personal journey.

To learn more about CoverMyMeds’ technology solutions, visit Booth 229 at the Asembia Specialty Pharmacy Summit in Las Vegas, May 2-5, 2022.

Click here to sign up for CoverMyMeds’ Asembia Specialty Pharmacy Summit recaps.

Read on for Megan’s insights.

Who Will Pay for Prescription Drugs in 2030? (Hint: It’s Us)

The econowonks at the Centers for Medicare & Medicaid Services (CMS) recently released the latest projections for U.S. spending on healthcare. (See links below.) These data provide our first official look at post-pandemic U.S. healthcare spending.

As you will see below, outpatient prescription drugs dispensed by retail and mail pharmacies are projected to remain a small share (8.4%) of total U.S. healthcare spending. What’s more, taxpayers—via Medicare and Medicaid—will continue to crowd out the private insurance market. One bright spot: consumers will account for an ever-smaller share of drug spending.

Thus, the government actuaries expect that pharmaceuticals will not be the key driver of U.S. healthcare spending growth. Will someone tell our elected officials?

Speaking of prescription drug payment, be sure to sign up for my new live video webinar, PBM Industry Update: Trends, Controversies, and Outlook, on April 22, 2022, from 12:00 p.m. to 1:30 p.m. ET.