The Drug Discount Ecosystem’s “Mission Critical”

Today’s guest post comes from Vishali Amin, Chief of Staff to the Office of the President and Senior Director of Customer Success at Kalderos.

Vishali discusses the persistent challenges of duplicate discounts between the 340B Drug Pricing Program and the Medicaid Drug Rebate Program. The Inflation Reduction Act of 2022 will further complicate duplicate discount issues.

To learn more, sign up now for priority access to Kalderos’ 2023 annual report: Mission Critical: Bringing Drug Discount Stakeholders Together so Patients Win. The 2023 report will be released on June 13, 2023.

Read on for Vishali’s insights.

Drug Channels News Roundup, May 2023: 340B Shame, OptumRx vs. Humira Biosimilars, ICER on White Bagging, Hospitals vs. Taxes, and Dr. G

Summer unofficially began over the weekend. Check out these noteworthy delicacies, seared to perfection on the Drug Channels grill:

• Fresh evidence of 340B abuses by hospitals and contract pharmacies

• OptumRx rewrites its biosimilar Humira strategy

• ICER discovers channel markups

• Tax-exempt hospitals are not holding up their end of the bargain

Plus, Dr. Glaucomflecken helps you pick an insurance plan!

P.S. Join my more than 41,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,400 followers. (I recommend that you follow me on LinkedIn, because the quality of comments is much higher than they are on Twitter.)

Speaking of PBMs, be sure to join me for my new live video webinar, PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding, on June 23, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Five (or Maybe Six?) Reasons that the Largest PBMs Operate Group Purchasing Organizations

In The Top Pharmacy Benefit Managers of 2022: Market Share and Trends for the Biggest Companies, I shared Drug Channels Institute's analysis showing that three pharmacy benefit managers (PBMs)—the Caremark business of CVS Health, the Express Scripts business of Cigna, and the OptumRx business of UnitedHealth Group—accounted for about 80% of total equivalent prescription claims in 2022.

In recent years, each of these companies has launched new group purchasing organizations (GPOs) to further consolidate the number of covered lives in rebate negotiations with pharmaceutical manufacturers. Today, I examine these PBM-owned GPOs and then speculate on five plausible explanations for their existence. I also highlight a sixth, alleged rationale that is currently the subject of litigation.

The Federal Trade Commission (FTC) has recently started investigating these GPOs. I wonder if this additional focus will deepen the FTC’s ongoing investigation—or slow it down even further?

For more on PBMs, sign up for my new live video webinar, PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding, on June 23, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and register.

The Top Pharmacy Benefit Managers of 2022: Market Share and Trends for the Biggest Companies

In 2022, the PBM market remained highly consolidated—although there were some intriguing share shifts among the largest players.

Below, you’ll find Drug Channels Institute's latest estimates of pharmacy benefit manager (PBM) market share based on equivalent prescription claims. I also provide commentary on recent market developments and offer some helpful tips for interpreting the figures.

PBMs are facing unprecedented scrutiny from Congress, state legislatures, and the Federal Trade Commission (FTC)—although the PBMs' largest customers have not been vocally protesting the current marketplace. Tomorrow, I’ll examine one new evolution—the new group purchasing organizations that the largest PBMs have formed.

In the meantime, tune in for more PBM-bashing at today's House hearing: The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part I: Self-Interest or Health Care?

Speaking of PBMs, join me for my new live video webinar, PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding, on June 23, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

PBMs and the Battle Over Patient Support Funds:Accumulators, Maximizers, and Alternative Funding (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:

PBMs and the Battle Over Patient Support Funds:
Accumulators, Maximizers, and Alternative Funding
This event will be broadcast live on
Friday, June 23, 2023, from 12:00 p.m. to 1:30 p.m. ET.

This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

This event is part of The Drug Channels 2023 Video Webinar Series.

WHAT YOU WILL LEARN

As expensive specialty therapies come to dominate drug spending, pharmaceutical manufacturers are paying a growing share of patents’ out-of-pocket costs for these prescriptions. At the same time, plans and PBMs are turning to novel—and often controversial—benefit design tools that access manufacturers’ patient support spending.

Join Dr. Fein as he helps you and your team deepen your understanding of this complex subject and its crucial implications for drugmakers, payers, PBMs, and patients. During the event, Dr. Fein will cover a wide range of topics, including:

• What’s driving patients’ out-of-pocket obligations

• Trends in the value of manufacturers’ financial assistance

• Copayment offset programs vs. patient assistance programs (PAPs)

• Conventional pharmacy benefit management tactics

• The new tools that offset specialty drug costs: copay accumulators, maximizers, and alternative funding programs

• The latest market data on adoption of the new spending drug management tools

• Prescription economics of copay accumulators, maximizers, and alternative funding programs

• How PBMs profit from—and are challenged by—the new tools

• Plan sponsor perspectives

• State and federal legislation over pharmacy benefits

• Major lawsuits between manufacturers and vendors

• Outlook for specialty drug spending management

• Controversies and unresolved questions

• And more!

PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last 90 minutes to accommodate audience questions.

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data. He will draw from exclusive information found in DCI's 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Read on for full details on pricing and registration.

PRICING OPTIONS

You can register for this unique educational opportunity for only $380 per viewing device. Within 24 hours of your purchase, you will receive an email from Zoom with a unique link to access the live event.

We are offering substantial discounts for multiple registrations from the same organization. We know that many of you may be working remotely, so rates for multiple registrations are as low as $265 per device—a 30% savings. An unlimited number of people may watch at one location if they can watch from a single device.

Click here to order. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)

PBMs and the Battle Over Patient Support Funds:
Accumulators, Maximizers, and Alternative Funding

Please contact Paula Fein (paula@drugchannels.net) if you have any questions. If you purchase access for multiple devices, we will contact you for a list of your participants and their email addresses. Or, download this spreadsheet and email your registrants’ information to Tamra Feldman (admin@drugchannels.net).

Click here to register for the full Drug Channels 2023 Video Webinar Series

Payment can be made with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to email us if you would like to pay by corporate purchase order or check.

IMPORTANT THINGS TO KNOW

• Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.

• We use Zoom technology for this webinar. Every registrant will receive an email from Zoom with a link to watch the event. This link is unique to the registrant and can only be accessed once. We recommend that every registrant download the Zoom client software/app.

• Within one day of purchasing a registration, each registrant will receive an email from Zoom with a link to access the event and add it to their calendar. Every registrant will also receive reminder emails from Zoom one week, one day, and one hour before the event.

• This event is part of The Drug Channels 2023 Video Webinar Series. If you have already purchased the full series, then you should have received an email from no-reply@zoom.us with your unique link to access the June event.

• Purchase of the webinar series includes a replay video of Drug Channels’ March 31, 2023, webinar Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook. Within 24 hours of purchasing the 2023 series, you will receive an email from Zoom with a link to access that video replay.

• Organizations that purchased corporate access for The Drug Channels 2023 Video Webinar Series will receive a custom, branded signup link so employees can easily register. We will automatically refund payments from anyone at a company with corporate access who purchases a single registration using their corporate email account.

• Unfortunately, we are unable to offer refunds.

Four Ways for Field Teams to Tackle Drug Utilization Management and Optimize Patient Access

Today’s guest post comes from Patrick Leary, Chief Commercial Officer at Phil, Inc.

Patrick describes how barriers to medication access affect manufacturers and patients. He offers four tactics that can help field teams unlock coverage for patients.

To learn more about Phil’s access and commercialization solutions, download their free whitepaper, Modernize the Patient Access Experience: Transform Your Pharmaceutical Brand. You can also visit https://phil.us/life-sciences/.

Read on for Patrick’s insights.

Employers Expand Use of Alternative Funding Programs—But Sustainability in Doubt as Loopholes Close

Last August, I warned you about alternative funding programs (AFPs)–the shady schemes by which commercial plan sponsors drop drug coverage in order to grab charity support intended for uninsured and indigent patients.

I’m sad to report that the manipulation of charitable patient assistance programs continues to expand. As you will see below, employers have significantly ramped up their adoption of AFPs, while health plans seem more skeptical. Meanwhile, a new AbbVie lawsuit sheds light on the alleged activities of a major AFP vendor.

Read on for our update on these suspect programs—and the growing risks to their sustainability. Caveat payer.

Adapt or Fall Behind: The Need for Agile Copay Programs in Today's Shifting Payer Landscape

Today’s guest post comes from Nasir Ali, Chief Product Officer at CareMetx

Nasir discusses manufacturers’ strategies for mitigating the patient impact of copay accumulators and maximizers. He then outlines two key tactics that manufacturers should include in hub programs.

To learn more how digitally-enabled hub programs help patients, download CareMetx’s report: The Evolving Landscape of Digital Healthcare Hubs.

Read on for Nasir’s insights. .

Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A May 2023 Update

Yesterday’s reflections on Asembia’s Specialty Pharmacy Summit included a link to the general session slides. My portion of the deck included an updated mapping of vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels. Many readers asked for a standalone version of this infamous chart.

So, for your viewing and slide making pleasure, below you’ll find my latest illustration of the major vertical business relationships among the largest companies.

I estimate that at least half of all public and private U.S. healthcare spending flows through these seven familiar entities: Blue Cross Blue Shield, Centene, Cigna, CVS Health, Elevance Health, Humana, and United Health Group. Just like the heroes in Dawn of the Seven, they are here to serve and protect you.

Enjoy the artwork. In the meantime, I suspect that vertical integration may come up during today's Senate hearing on insulin.

The State of the Specialty Market 2023: Reflections, Trends, and Photos from #Asembia23

Last week, Paula and I had the pleasure of attending Asembia’s 2023 Specialty Pharmacy Summit at the wonderful Wynn Las Vegas.

As I do every year, I will violate Vegas code and tell you what happened there. I offer reflections on my keynote session with Seema Verma, share my experiences during the featured session, and highlight some crucial specialty industry trends.

You’ll also find a link to my general session slides and some fun photos. FYI, Managed Healthcare Executive (accurately) described my presentation as "mixing jokes with data and PowerPoint slides." Yes, that sounds about right.

Enjoy!

RareMed Expands Concierge Patient Support Services to Complex Conditions

Today’s guest post comes from Justin Smerker, VP of Business Development at RareMed Solutions.

Justin introduces us to RareMed Solutions, a patient service provider that caters to patients with complex and rare diseases.

To learn about RareMed and their approach to the delivery of patient services for complex or rare conditions, visit www.raremed.com or email info@raremed.com.

Read on for Justin’s insights.

How Discount Cards Work: A Primer on GoodRx and Its Competitors (video)

In my most recent video webinar, I explored how the rapid expansion of patient-paid prescriptions—via cash-pay pharmacies and discount card vendors—is transforming the prescription market.

Below, I follow the dollar when a patient uses a discount card to pay for a generic drug prescription.

As you’ll see, a discount card can save money for consumers by leveraging several quirks of U.S. retail pharmacy pricing. Such cards also enable novel profit streams for both pharmacy benefit managers (PBMs) and the card vendors themselves.

For a deep dive into patient-paid prescriptions, see Sections 4.3. and 12.4.3. of our 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Click here if you can’t see the video below.

If this clip whets your appetite for more, register to watch the full 90 minute Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook video webinar.

Don’s Story: Patients Shouldn’t Have to be Resilient to Get Their Medications

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

Megan shares the story of Don, a cancer patient who struggled to access and afford his medications. She describes how human care plus an innovative, technology-driven patient support solution can help patients start therapy and get on the road to recovery.

To learn more about CoverMyMeds’ specialty therapy solutions, visit Booth 1519 at Asembia's Specialty Pharmacy Summit in Las Vegas, April 30-May 4, 2023. Additionally, sign up for CoverMyMeds’ on-site recaps from the summit.

Read on for Megan’s insights.

Drug Channels News Roundup, April 2023: OptumRx’s Biosimilar Nonsense, Accumulator Inequity, Amazon Redux, AFPs, and My Meeting with Mark Cuban

Baseball season is here! While we wait for the Phillies turnaround, let’s oil up our gloves, lace up our cleats, and run the bases around this month's biggest hits:

• Foul ball: OptumRx prefers higher prices for the first Humira biosimilar (SEE UPDATE BELOW)

• Strikeout: Copay accumulators hurt health equity

• Bench warmer: Surprise? Amazon has still not disrupted healthcare

• Spitting mad: Shady alternative funding programs (AFPs) face more scrutiny

Plus, I sit down with Mark Cuban—and take a selfie.

P.S. Join my nearly 41,000 (!) LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,000 followers. (I recommend that you follow me on LinkedIn, because the quality of comments is much, much higher than they are on Twitter.)

Prescribers More Likely to Choose Brands with Automated Processes for Buy-and-Bill Copay Assistance

Today’s guest post comes from Ticia Cawley, VP of Client Solutions at ConnectiveRx.

Ticia reviews four interim findings from ConnectiveRx's survey of buy-and-bill prescribers and their support staff. The survey reveals new insights about how practices evaluate automation and digital tools for provider-administered specialty therapies.

To learn more, register for ConnectiveRx’s free online panel discussion on May 17th at 1:00 p.m. ET: Automation and Ease: The Future of Buy-and-Bill. Ticia will be joined by a buy-and-bill brand leader and a medical professional.

Read on for Ticia’s insights.

The Inflation Reduction Act: 10 Predictions About Market Access and Drug Channels

Like it or not, the Centers for Medicare & Medicaid Services (CMS) is barreling ahead with its implementation of the Inflation Reduction Act of 2022 (IRA). Last Friday was the last day to submit comments on CMS's initial guidance on the drug price negotiation program.

The IRA will alter many crucial aspects of the Medicare program and the overall drug channel. To help you anticipate what’s ahead, below I highlight 10 predictions on how the IRA will impact drug prices, demand for prescription drugs, Part D plan strategies, rebates, manufacturers’ revenues, retail pharmacies, and more.

While this is a longer-than usual post, I can still only barely scratch the surface of the many far-reaching effects of this legislation. As always, I encourage you to share your own thoughts in the comments below or on social media.

Digital Transformation: Facilitating Healthcare Provider and Patient Behavior Change

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

Edward discusses how a technology-first approach automates manual processes for therapy initiation. He argues that such an approach can increase patient adherence, speed access to therapy, and improve the healthcare providers’ workflow.

To learn about AssistRx’s technology-first solutions, click here to schedule a meeting at Asembia’s Specialty Pharmacy Summit.

Read on for Edward’s insights.

DCI’s Top 15 Specialty Pharmacies of 2022: Five Key Trends About Today’s Marketplace

In Drug Channels Institute’s list of the top 15 pharmacies of 2022, 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 rummaged around our DreamHouse to update our exclusive list of the top 15 pharmacies based on specialty drug dispensing revenues in 2022.

For 2022, pharmacy benefits managers (PBMs) and insurers expanded their dominance over specialty dispensing, though both hospitals and physician practices are growing their share of the market. The top three PBM-owned specialty pharmacies accounted for nearly two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. As predicted last year, Walgreens’ specialty pharmacy business has collapsed, which led to a slightly less concentrated industry.

Read on for additional observations about hospitals, independent pharmacies, the dynamics that created this market structure, and why life in plastic is fantastic.

Key Trends in Medical Benefit Contracting and Value-Based Agreements

Today’s guest post comes from Heather Roulston, Market Research Manager at MMIT.

Using MMIT’s proprietary data, Heather demonstrates that contracting for medical benefit drugs is now common for many therapeutic areas. She then highlights how manufacturers and payers are adopting value-based agreements (VBA) for medical benefit products—although VBA usage varies widely across therapeutic area. Heather also shares data on payers’ site-of-care management strategies.

For additional market insights, click here to learn about MMIT’s Biologics & Injectables Index.

Read on for Heather’s insights.

Four Trends That Will Pop the $250 Billion Gross-to-Net Bubble—and Transform PBMs, Market Access, and Benefit Design

Time for Drug Channels Institute’s annual update on the gross-to-net bubble—the ever-growing dollar gap between sales at brand-name drugs' list prices and their sales at net prices after rebates and other reductions.

We estimate that the gross-to-net bubble reached $223 billion for patent-protected brand-name drugs in 2022. If we include brand-name drugs that have lost patent protection and face competition from generic equivalents, the bubble was even higher, at $256 billion. Our latest data appear below.

Four crucial trends will deflate the gross-to-net bubble—thereby disrupting market access strategies, altering pharmacy benefit manager (PBM) profit models, and changing plan sponsor benefit designs. Perhaps it’s time to get ready for the day when SpongeBob SquarePants will depart from Drug Channels.

Brand-Name Drug Prices Fell for the Fifth Consecutive Year—And Plummeted After Adjusting for Inflation (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook.

Click here to see the original post and comments from January 2023.

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Time for the Drug Channels annual reality check on drug pricing. The data once again tell a different story than you might read in your favorite politician’s Twitter feed or misleading news reports.

For 2022, brand-name drugs’ net prices dropped for an unprecedented fifth consecutive year. What’s more, after adjusting for overall inflation, brand-name drug net prices plunged by almost 9%.

The factors behind declining drug prices will remain in the coming years—and become even stronger due to forthcoming changes in Medicare and Medicaid. Employers, health plans, and PBMs will determine whether patients will share in this ongoing deflation.

Read on for details and make up your own mind. And please pass the news along to the drug pricing flat earthers (#DPFE) who 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.

Even a purple gorilla professor understands these facts.

The Warped Incentives Behind Amgen’s Humira Biosimilar Pricing–And What We Can Learn from Semglee and Repatha (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook.

So far, it appears that PBMs are neither preferring Amgen's Humira biosimilar nor embracing the low-list/low-rebate version. In February, AbbVie stated that U.S. Humira sales would be decline by about 37% in 2023—which is at the lower end of its previous erosion projection of 35% to 55%. Much more to come. Click here to see the original post and comments from February 2023.

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As you've surely heard, Amgen has just launched Amjevita, the first non-interchangeable biosimilar of Humira. Our crazy drug channel led Amgen to launch both a high-list/high-rebate and a low-list/low-rebate version of the drug. Its strategy echoes the pricing of the first interchangeable insulin biosimilars—as I predicted in 2021.

Unfortunately, we should expect most PBMs and plan sponsors to embrace the high-list/high-rebate version. The plans that adopt the higher-priced biosimilar will get bigger rebates, while patients with coinsurance and deductibles end up paying more out-of-pocket.

As Mark Twain said: “History doesn’t repeat itself—but it often rhymes.” So, below, I revisit the surprising market dynamics for the interchangeable insulin biosimilars and highlight Amgen’s experience lowering the list price of its PCSK9i product. The story is more complex than you might expect, so perhaps there is hope that low-list-price versions will connect.

CVS, Walgreens, and Walmart Keep Position in 2023 Part D Preferred Networks—While Kroger Bails Over its Express Scripts Blowup (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook.

One follow-up to this rerun: Kroger’s participation as a preferred pharmacy declined significantly due to its Express Scripts relationship. Based on early 2023 enrollment data, Kroger is preferred in plans that enrolled only 11.8 million people—a decline of 33% from the 2022 figure. See Exhibit 154 of our new 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

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

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In Preferred Pharmacy Networks in 2023’s Medicare Part D Plans: Cigna, CVS Health, Humana, UnitedHealthcare, WellCare, and More, I highlighted how those networks have taken over the world of stand-alone Medicare Part D prescription drug plans (PDP) and become a major presence in Medicare Advantage prescription drug (MA-PD) plans.

Today, I examine the seven largest retail chains’ 2023 participation in the 22 major 2023 Part D preferred networks that the eight largest plan sponsors will offer. As always, I offer you a handy table for scoring each chain’s participation and changes from 2022 to 2023.

As you’ll see, Kroger’s decision to exit Express Scripts commercial pharmacy networks has had negative ramifications for its Part D position. Kroger will be out-of-network—not just non-preferred—in the major Part D networks for which Express Scripts acts as the PBM. That will be  a key factor behind its $1+ billion revenue hit.

The Big Three PBMs’ 2023 Formulary Exclusions: Observations on Insulin, Humira, and Biosimilars (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook.

Click here to see the original post and comments from January 2023.

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For 2023, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again increased the number of drugs they exclude from their standard formularies.

Each exclusion list now contains about 600 products. Growth in the number of excluded drugs slowed for the second year, due partly to the fact that so many drugs have already been dropped from PBMs’ formularies.

Below, I highlight four takeaways from this year’s lists, including a look at biosimilar insulin and the forthcoming biosimilar competition for Humira. I also note some troubling research on the patient impact of exclusions—although much remains unknown.

As always, I welcome your comments below or on social media.

Behind the GoodRx-Express Scripts Partnership: How PBMs Profit from Discount Cards in Pharmacy Benefits (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook. Friday's webinar will include my latest thoughts on a key trend discussed in todays rerun: how plan sponsors are incorporating patient-paid prescriptions—cash-pay prescriptions and discount cards—within pharmacy benefits.

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

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Last week, GoodRx announced that it would become the exclusive prescription discount card provider for the commercial beneficiaries of Cigna’s Express Scripts. Links below.

The rise of discount card pricing within pharmacy benefit plans is a positive development. Patients get access to market prices that can  be lower than their PBM’s contracted rate. All out-of-pocket spending with a discount card counts toward a patient's deductibles, and all prescription activity gets captured.

However, I suspect few people understand that placing discount cards within the pharmacy benefit enables a PBM to monetize a new fee stream from the card vendor. Below, I walk through this booming business and highlight some of the conflicts and contradictions underneath the coconuts.

Winning the Race for Patient Access: Identifying Copay Accumulator Impact

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

Logan discusses the financial impacts of copay accumulators on manufacturers and patients. She describes how to reduce the strain on manufacturers' programs while  also increasing patient access. Click here to learn about the Paysign Solution.

Email affordability@paysign.com to set up a meeting with Paysign at Asembia’s Specialty Pharmacy Summit, April 30-May 4.

Read on for Logan’s insights.

Drug Channels News Roundup, March 2023: My $0.02 on Insulin Price Cuts, AbbVie vs. AFPs, Optum Expands, ASAP340B, and Hooray for Pharmacists

Spring is here in sunny downtown Philadelphia, worldwide headquarters of Drug Channels. The vernal equinox has brought us an unexpected bounty of noteworthy news:

• Thoughts on the recent insulin price cuts by Lilly, Novo, and Sanofi

• AbbVie gets tougher on alternative funding programs

• Optum quietly adds a new drug channel role

• A novel partnership emerges to modernize the 340B program

Plus, a celebration of pharmacists’ activities during the COVID-19 pandemic.

P.S. Join my more than 38,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,000 followers.

Join me for my new live video webinar, Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook, on March 31, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Informa Connect’s Annual Life Sciences Commercial Contracts & Chargebacks Congress

Informa Connect’s Annual Life Sciences Commercial Contracts & Chargebacks Congress
May 16-17, 2023
The Omni Shoreham Hotel | Washington, DC
Hybrid Event
informaconnect.com/contracts-chargebacks

Exclusive Offer for Drug Channels Readers: Register Now to SAVE 10%* using promo code 23DC10

Informa Connect’s 19th Annual Commercial Contracts & Chargebacks Congress, taking place May 16-17 in Washington, DC, offers crucial updates on policy changes and contracting best practices to increase efficiency, reduce revenue leakage, and streamline chargeback excellence. This annual event has become a must-attend for pricing and contracting professionals in the life sciences industry with seasoned leaders and forward-thinking strategies on display. Join industry stakeholders, including manufacturers, wholesalers, GPOs and more, for a robust two-day event offering extended content and actionable strategies in key interest areas in the ever-evolving contracting landscape.

Featured Faculty Driving the Conversation:

• Rosalind Davis, Government Pricing & Contracts Director, Vifor Pharma, Inc.
• Stephani Kupski, Director, U.S. Pricing & Government Reporting, CSL Behring
• Mallory O’Connor, Public Policy Executive Director, Mallinckrodt
• Cad Snyder, Director, Global Finance Shared Services, Cardinal Health
• Beth Stevens, Associate Director, Contracts and Pricing, Tolmar Inc.
• Roxana Santiago, Director Controlling Revenue Accounting, Fresenius Kabi USA LLC
• Jennifer Plemmons Crosswell, Director, Contracts & Pricing, Accounting, Azurity Pharmaceuticals
• Mitesh Ghia, Director, Chargebacks, Membership, Rebates & Contract Administration, Novartis Pharmaceuticals Corporations
• Elizabeth Johnson, President, National Association of Medication Access & Patient Advoacacy
• Erika Chiles-George, Pricing & Trade Director, Contracts, Neurocrine Biosciences
• And many more!

Hight Impact Topics Transforming the Market Include:

• Commercial Contract Model Landscape
• Assessing the Impact of IRA on Product Calculations
• 340B Drug Discount Program — Ongoing Monitoring of 340B Program Risks & Best Practices
• Multi-Stakeholder Panel — Membership and Class of Trade
• Updated Review and Interpretation of the Inflation Reduction Act
• GTN Forecasting Across Different Channels
• PLUS! — Customize Your Learning by Choosing Between Two Thought-Provoking Tracks:
• Contracts and Chargebacks Excellence
• Analytical and Technology Innovation
• and more!

NEW THIS YEAR! The 2023 Summit is Part of Life Sciences Pricing & Contracting USA Uniting three industry leading events — Medicaid & Government Pricing Congress, Drug Pricing Transparency Congress and Life Sciences Commercial Contracts & Chargebacks — Life Sciences Pricing & Contracting USA is the industry’s go-to resource for gaining critical insight on regulatory requirements, policy initiatives and best practices to enhance pricing and contracting models. Attend your preferred event and prepare for critical content tailored to your focus area, plus benefit from a more diverse speaking faculty and greater networking opportunities to expand your network and establish powerful partnerships.

ENHANCE YOUR EXPERIENCE!

Attendees of Commercial Contracts & Chargebacks 2023 have the option to add a third day of content to their schedule and join the Medicaid & Government Pricing Congress attendees for their final day. Benefit from a fireside chat, in-depth sessions and learning streams, plus additional networking opportunities!

Drug Channels readers are eligible for an exclusive savings of 10% off* the standard rate by using promo code 23DC10, so download the complete conference agenda and reserve your seat today!

*Expires 5/16/2023; applies to current rate only and may not be combined or applied to existing registrations; 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).

It's Not All Bad News: Data Shows There's a Collaborative Future for 340B

Today’s guest post comes from Rhiannon Naslund, Chief Marketing Officer at Kalderos.

Rhiannon discusses the growing collaboration between manufacturers and covered entities regarding 340B discount claims. She goes on to describe the Kalderos Discount Hub solution that reviews claims that have a high likelihood of being a duplicate discount.

To stay up-to-date with the latest drug discount developments, sign up for the Kalderos newsletter.

Read on for Rhiannon’s insights.

NOW AVAILABLE: The 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

I am pleased to announce our new 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, available for purchase and immediate download.

• Click here to download a free report overview (including key industry trends, the Table of Contents, and a List of Exhibits)

• New Drug Channels Institute Study Analyzes Impact of Inflation Reduction Act on U.S. Prescription Market (press release)

We’re offering special discounted pricing if you order before April 3, 2023.

The 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, our 14th edition, provides a comprehensive, fact-based, and non-partisan tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. The report has been thoroughly updated with the latest data and includes loads of new material and new sections.

12 chapters, 480+ pages, 241 charts/exhibits/data tables, 966 endnotes: There is nothing else available that comes close to this encyclopedic resource.

The chart below illustrates the depth and breadth of the 2023 edition. The numbers indicate the report chapter that corresponds to, explains, and analyzes each channel flow.

[Click to Enlarge]

If you would like to pay by corporate purchase order or check, please email Tamra Feldman. If you preordered the report, you should have already received an email with download instructions last week. Please contact us if you did not receive the email.

Read on for some additional details.