Five Takeaways from the Big Three PBMs’ 2022 Formulary Exclusions

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.

NEW: The Drug Channels 2022 Video Webinar Series

Join Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI), for three live video webinars during 2022. These live, interactive events will be broadcast via Zoom from the Drug Channels Video studio in beautiful downtown Philadelphia.

Click here to order the Drug Channels 2022 Video Webinar Series

During these events, 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, company announcements, and more. He’ll 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 current learning and a touchpoint for the future.

The three events are scheduled for 12:00 p.m. to 1:30 p.m. ET on:

• April 22, 2022

• July 29, 2022

• December 16, 2022 (Drug Channels Outlook 2023)

PLUS: During each webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. And after each event, each registrant will receive an email with links to register to view a replay of the event and to download the full slide deck.

Read on for a video invite and full details on pricing, including substantial discounts for multiple sites.

The 340B Rebate Model: A Solution to the Contract Pharmacy Controversy

Today’s guest post comes from Jeremy Docken, Founder and Chief Strategy Officer at Kalderos.

Jeremy describes Kalderos’ 340B rebate model. He discusses an independent research organization’s study of the 340B rebate model’s impact on covered entities’ cash flow.

To learn more, download the whitepaper: The Kalderos 340B Rebate Model In Action: Ensuring a Thriving and Sustainable 340B Program.

Read on for Jeremy’s insights.

The Retail Pharmacy Outlook for 2022

As I have highlighted in previous posts, retail pharmacies are experiencing a period of intense competition that continues to pressure prescription profits. What's more, the pharmacy shakeout is accelerating, as smaller competitors exit and larger companies reduce store count. 

In the video below, I provide a brief overview of key challenges facing retail pharmacy this year.

The video is excerpted from my Drug Channels Outlook 2022 video webinar. If you missed the live event, you can register to watch a replay.

Enjoy!

PCMA Business Forum

PCMA Business Forum
February 28 – March 1, 2022
JW Marriott Grande Lakes | Orlando, FL
Register Today!
www.pcma.com/businessforum

The PCMA Business Forum is PCMA's largest business networking and educational conference. PCMA’s PBM Members send a large number of executives from relevant business units including pharma and trade relations, specialty pharmacy, clinical and patient care services, and the c-suite. Dynamic conference activities for this two-day event include:

• 20+ timely and thought-provoking educational sessions featuring industry thought leaders. New for 2022, sessions will be broken out into three tracks:
• Strategic Insights – Our industries’ senior most thought leaders and decision makers (main stage sessions)
• Specialty Pharmacy insights and trends (breakout session track)
• Clinical and Patient Care collaboration (breakout session track)
• Pre-recorded PBM member company webinar briefings (for manufacturer registrants only)
• More than 15 hours of CPE sessions
• Dedicated time and private facilities for customer meetings
• Pre-conference networking through the virtual conference platform. The virtual platform includes a full attendee list, the ability to message and send meeting requests to other attendees, hotel maps and meeting room locations, and much more

Register Today!

Contact PCMA
Please contact Kayla Firriolo (kfirriolo@pcmanet.org) with questions or to request further information.

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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).

Tales of the Unsurprised: Brand-Name Drug Prices Fell for the Fourth Consecutive Year

Reality has again failed to cooperate with the politically motivated cries of “skyrocketing drug prices” or anecdotes about companies “jacking up prices” (as President Biden recently claimed).

Brand-name drug prices continue to decline, while the prices of other healthcare products and services continue to rise. For 2021, brand-name drugs’ net prices dropped for the fourth consecutive year. Meanwhile, brand-name drug list prices grew more slowly than overall inflation. What’s more, we project that the gross-to-net bubble for patent-protected brand-name drugs will exceed $200 billion in 2021. See our updated analysis below.

The factors that drive declining brand-name drug prices remain for 2022, suggesting that these trends will continue.

Pharmaceuticals account for less than 15% of U.S. healthcare spending—but absorb 99% of the political heat and attention. Let’s hope that this peek through the truth binoculars intrudes on any future legislative attempts to address drug pricing and the reimbursement system.