Tuesday, September 27, 2022

Drug Channels News Roundup, September 2022: Patients vs. SaveonSP, PBMs’ Oncology Exclusions, Medicare Advantage Winners, HRSA’s 340B Reveal, and New DCI Offerings

Autumn is here! Please savor these Drug Channels acorns that we’ve squirrelled away for you:
  • One patient’s troubling experience with SaveonSP
  • PBMs ramp up formulary exclusions for oncology drugs
  • The mega-players dominating Medicare Advantage
  • My 340B FOIA efforts yield change at HRSA!
Plus, two new resources from Drug Channels Institute.

P.S. Join my 32,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 15,200 followers.

Tackling cancer while battling the insurance system, The Washington Post

Check out Annabelle Gurwitch’s powerful first-person account of her challenges working with the SaveOnSP copay maximizer program offered by Cigna's Express Scripts business. It’s a scary story of how a secretive, profiteering intermediary can disrupt patient care. Annabelle’s story echoes the experience of Anndi McAfee

I also recommend AIS Health’s valuable roundup of the latest copay maximizer news and views: Copay Maximizers Face Criticism as J&J Files Legal Challenge. The article includes my $0.02 about something that "really blew my mind.”

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

IQVIA has updated its analysis of PBM formulary exclusions for oncology drugs. As you can see from the report’s first exhibit (reproduced below), exclusions continue to soar—even for oncolytics that lack a generic or biosimilar alternative.

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This year’s IQVIA report includes an insightful analysis of the access issues faced by patients who were prescribed two (unnamed) breast cancer drugs.

There is still an urgent need for independent research on how exclusions affect physicians’ prescribing decisions, patients’ ability to access oncology therapies, and clinical outcomes. Here’s a notable example: Analysis of Drug Formulary Exclusions from the Patient's Perspective. This article examined Express Scripts’ 2022 formulary. It found that almost 50% of exclusions have questionable economic and/or medical benefits for the patient. Hmm.

Medicare Advantage in 2022: Enrollment Update and Key Trends, KFF

Whoa. For 2022, the large insurer/PBM/pharmacy companies dominate Medicare Advantage (MA), which now accounts for half of eligible Medicare beneficiaries. UnitedHealthcare and Humana together account for 46% of all Medicare Advantage enrollees nationwide. In nearly one-third of U.S. counties, these two companies account for at least 75% of Medicare Advantage enrollment.

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I suspect that the Inflation Reduction Act of 2022 (IRA) will end up being another big win for the vertically-integrated mega-organizations. The IRA seems poised to trigger a collapse of the stand-alone Part D prescription drug plans (PDP) market. Medicare Advantage plans will pick up the slack and may account for 80% of Medicare beneficiaries by the end of the decade.

Meet the new boss, same as the old boss.

2021 340B Covered Entity Purchases, HRSA

Hooray! For the first time ever, the Health Resources and Services Administration (HRSA) posted public data about 340B covered entity purchases on its website.

Long-time readers know that I have been pestering the agency about these data for many years. I presume HRSA finally got tired of my Freedom of Information Act (FOIA) requests.

Alas, HRSA neglected to post any historical data. Fortunately, my 2022 FOIA efforts extracted purchases by 340B covered entity type for 2015 through 2021. Download the data here: The 340B Program Climbed to $44 Billion in 2021—With Hospitals Grabbing Most of the Money.

P.S. ICYMI, The New York Times just published two shocking articles about 340B hospitals behaving badly: Bon Secours Mercy Health and Providence health system.


During the past month, Drug Channels Institute (DCI) has announced two valuable new resources to help you understand our complex health system.

On October 11, we will release The 2022–23 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. This report—our thirteenth edition— remains the most comprehensive, fact-based tool for understanding and analyzing the U.S. pharmaceutical distribution industry. We are offering special preorder and launch pricing discounts through October 21, 2022.

During 2023, I will deliver three live video webinars as part of the Drug Channels 2023 Video Webinar Series. I hope you will join me!

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