More Than a Feeling: Five Key Challenges When Walking Away From Commercial/340B Duplicate Payments

Today’s guest post comes from Micah Litow, Chief Operating Officer at Kalderos.

According to Kalderos, at least 5% of commercial rebates are paid for prescriptions that also have discounts under the 340B Drug Pricing Program. Micah outlines why it's more than a feeling that manufacturers struggle to walk away from these duplicate payments. But as he explains, reliable data is crucial to avoid hearing that old song that PBMs play.

To learn about Kalderos’ Commercial Discount Monitoring solution, close your eyes and slip away with Micah at his free webinar on November 1, 2023, at 2:00 p.m. ET: Sharpening Focus: How Data Analytics Transforms Commercial Contracting Strategies.

Read on for Micah’s insights.

Drug Channels News Roundup, September 2023: PBM Profits, Specialty Rx Markups, CVS Spending Trends, Pharmacy Pricing Secrets, and Deductibles 101

Autumn is here! Curl up with your favorite pumpkin-spiced blog and savor these stories harvested from the great Drug Channels patch:

• A must-read report on hidden sources of PBMs’ profits

• How generic drugs drive specialty pharmacy profits

• CVS Health’s unadvertised 2022 drug trend report

• A shocking look at how PBMs set prescription prices

Plus, Dr. Glaucomflecken teaches us about our insurance benefits.

P.S. Join my more than 45,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter/X, where I have more than 16,900 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. I’m not posting to Threads yet.)

EXCLUSIVE: The 340B Program Reached $54 Billion in 2022—Up 22% vs. 2021

Drug Channels has just obtained new details on the size of the 340B Drug Pricing Program. I couldn’t wait to share the news, hence this special Sunday post.

For 2022, discounted purchases under the 340B program reached a record $53.7 billion—an astonishing $9.8 billion (+22.3%) higher than its 2021 counterpart. The difference between list prices and discounted 340B purchases also grew, to $52.3 billion (+$2.6 billion). 

Hospitals accounted for 87% of 340B purchases for 2022. Every 340B covered entity type experienced double-digit growth, despite drug prices that grew more slowly than overall inflation.

Another surprise: HRSA estimated that manufacturers' contract pharmacy restrictions reduced 340B purchases by only $470 million—or less than 1% of 2022's total purchases. That's far below the figure quoted by 340B lobbyists.

Once again, the data demonstrate that 340B advocates are wrong when they claim that manufacturers are “stripping critical resources from the nation’s health care safety net.” As I noted last year, only in the U.S. healthcare system can billions more in payments and spreads be considered a cut.

Read on for full details and analysis, including the opportunity to download your own copy of the raw data from HRSA.

A Clear Path to Medication Affordability Requires Meeting Patients Where They Are

Today’s guest post comes from Kristina Crockett, VP of Product Management at CoverMyMeds.

Kristina shares the story of a patient who cut pills in half to extend her prescriptions. Unfortunately, this patient didn’t know about manufacturer affordability programs.

In this article, Kristina reviews how brands can help patients make connections that address medication affordability challenges, whether at the prescriber’s office, the pharmacy, or at home.

To learn about CoverMyMeds’ medication affordability solutions that engage patients, download the CoverMyMeds white paper: Overcoming Affordability Challenges with Patient-Centered Solutions.

Read on for Kristina’s insights.

NEW: The Drug Channels 2024 Video Webinar Series

Drug Channel Institute is pleased to announce The Drug Channels 2024 Video Webinar Series.

Join Dr. Adam J. Fein for three live video webinars during 2024. These live, interactive events will be broadcast via Zoom from the Drug Channels Video studio in beautiful downtown Philadelphia.

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 the following dates:

• March 29, 2024

• June 21, 2024

• December 13, 2024 (Drug Channels Outlook 2025)

For 2024, we are offering a Corporate Pricing option that will allow larger organizations to register hundreds of colleagues for one fixed price. Please contact Paula Fein (paula@drugchannels.net) for details and custom pricing for your organization.

Read on for full details on pricing, including substantial discounts for multiple sites.

P.S. If you're not familiar with our webinars, click here to watch brief excerpts from our 2023 video webinars.

Do Plan Sponsors Understand How Their PBMs Make Money?

Today, the House Committee on Oversight and Accountability will hold a hearing with a subtle and not-at-all pejorative title: The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part II: Not What the Doctor Ordered.

To help you prepare, I share fresh insights from a new survey of PBMs’ plan sponsor clients. As you will see, clients are somewhat more satisfied with the perceived transparency of smaller PBMs. However, satisfaction with transparency of the Big Three PBMs—CVS Caremark, Express Scripts, and OptumRx—is only a smidge behind smaller PBMs.

From my perspective, this counterintuitive result reflects how the PBM profit model has evolved. A plan sponsor can feel satisfied with its larger PBM’s transparency, while remaining blissfully unaware of how its PBM actually earns money. I outline some of these novel profit sources below.

Can plan sponsors get some satisfaction? Read on for what I say.

Informa Connect’s Patient Support Services Congress

Informa Connect’s Patient Support Services Congress
November 7-9, 2023 | The Inn at Penn, Philadelphia, PA
https://informaconnect.com/patient-support-services/

Exclusive Offer – Be sure to use your exclusive promo code 23DC10 to save 10% off* of your registration.

The Patient Support Services Congress is a dialogue-driven meeting that arms the industry with innovative trends and next-generation approaches to patient services for optimal performance. Showcasing high level discussions on access strategy, patient interactions, case management, compliance practices and more, this two-and-a-half-day event helps navigate complex compliance hurdles to advance and enhance your patient-oriented programs. Benefit from key stakeholder interaction, dedicated breakouts, and detailed case studies on control enhancement and operational excellence to further strengthen your programming.

Drug Channels subscribers: Save 10% off the current registration rate
with promo code 21DC10*. Register today.

In-Depth Discussions and Actionable Takeaways on Critical Topics:

• Enforcement Update – Explore Rising Oversight and High Priority Risk Areas for Patient Services Compliance
• Digitizing the Patient Services Sector – Implications of AI and Machine Learning
• Patient Data and Privacy – An Essential Component in your Support Program
• Fostering Value through Cross-Functional Collaboration

Featured Faculty Driving the Conversation:

• Peter Agnoletto, Compliance Officer, General Medicines and Consumer Healthcare, Sanofi
• Kelley Allison, Senior Vice President, US Market Access, Horizon
• Marianne Gandee, Vice President, Patient Solutions & Alliances, Pfizer
• Matt Giordano, Director of Patient Services Field Operations, Krystal Biotech, Inc.
• Tom Hiney, Privacy Counsel, Blueprint Medicines
• Matt Howatt, Assistant U.S. Attorney, U.S. Attorney’s Office for the Eastern District of Pennsylvania
• Suzanne Marinakos, Director, Patient Services Operations- Rare Disease, Novo Nordisk
• Snigdha Santra, Director, Business Insights and Strategy, Chugai Pharmaceuticals
• Kinshuk Saxena, Pharm.D., MBA, Lead Commercialization Strategy, Novartis
• Anthony Scatamacchia, Head, Patient Support Services – Innovation, Specialty Care, Sanofi
• Susan Stein, Executive Director, Head of Patient Engagement and Professional Alliances, Agenus Bio
• Donna White, Vice President, Compliance Officer, Chiesi USA, Inc.
• And so many more!

Comprehensive Content and Dynamic Features Include:

• 2.5 days of live content from industry thought-leaders
• 15+ on-demand sessions, tailored to both access and compliance
• Over 4 hours of live speaker Q&A
• AI-powered virtual networking with colleagues and counterparts
• Private meeting and chat rooms
• Access to live and on-demand content for 30 days post-event

Drug Channels subscribers — Save 10% off the current registration rate with promo code 21DC10*. Register 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).

How Payers Are Reacting to Insulin Price Changes

Today’s guest post comes from Nicole Mayer, Senior Analyst at MMIT.

Nicole summarizes MMIT’s research on payers’ views of two crucial market changes: (1) the Inflation Reduction Act of 2022’s requirement to cap insulin prices at $35 for Medicare beneficiaries, and (2) manufacturers’ reduction in list prices for certain insulin products. She also discusses MMIT’s research on such glucagon-like peptide 1 (GLP-1) drugs as Ozempic and Mounjaro.

Click here to learn more about MMIT’s Biologics & Injectables Index, a research series that provides unblinded payer perspectives.

Read on for Nicole’s insights.

White Bagging Update 2023: Saving Money or Shifting Costs?

Time for our annual update on the channels for provider-administered drugs.

For 2023, specialty pharmacies—via white, brown, and clear bagging—retained a meaningful share of the distribution channels for provider-administered oncology drugs. Despite the concerted efforts of insurers such as UnitedHealthcare and Elevance Health, however, buy-and-bill remains the most common channel for these products. Below, I review the latest data on trends over the past five years.

Strategies for white and brown bagging reflect the broader battle over oncology margins—and plans’ attempts to shift costs to providers, patients, and manufacturers. The persistence of buy-and-bill reflects this channel’s legacy infrastructure as well as providers’ push back on white bagging mandates. But perhaps patients and manufacturers will start paying more attention to the higher costs from white bagging.

FYI: The material in today’s article is adapted from Chapter 3 of our forthcoming 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, now available to preorder at special introductory pricing.

Available for Preorder: The 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

On October 10, 2023, Drug Channels Institute will release 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. This report—our fourteenth edition—remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry.

9 chapters, 300+ pages, 163 exhibits, 600+ endnotes: There is nothing else available that comes close to this valuable resource.

We are providing you with the opportunity to preorder this thoroughly updated, revised, and expanded 2023-24 edition at special discounted prices. This means that you can be among the first to access our new report. Those who preorder will receive a download link before October 10.

CLICK HERE to download a free pre-publication overview

(including key industry trends, the Table of Contents, and a List of Exhibits)

You can pay online 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.

Special preorder and launch pricing discounts will be valid through October 20, 2023.

2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors is the definitive, nonpartisan resource thoroughly updates our annual exploration of the distribution industry’s interactions with—and services for—other participants in our healthcare system.

Our 2023-24 edition contains the most current financial and industry data. As always, we have updated all market and industry data with the most current information available. The report also updates our annual analyses of the strategies, market positions, and executive compensation of the three largest companies: AmerisourceBergen (Cencora), Cardinal Health, and McKesson.

The notable new material in this 2023-24 edition includes new data about commercial pricing and reimbursement for provider-administered biosimilars as well as updated, expanded, and reorganized data about pharmacy services administrative organizations and group purchasing organizations for small pharmacies and physician practices. New sections analyze emerging challenges from direct distribution models that bypass wholesale distribution, the acquisitions of physician practices by corporate entities and private equity, and the Inflation Reduction Act’s likely consequences for wholesalers. Download a free report overview for more details on the new sections and content.

Thank you for your interest in our work. If you have any questions before purchasing a license to the report, please email me (afein@drugchannels.net). Enjoy!

What Pharmaceutical Manufacturers Value Most from a Hub

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

Nasir discusses how hubs help patients initiate and adhere to drug therapies. Based on CareMetx research, he outlines the key factors that drug manufacturers value in their hub partners.

Learn more by downloading CareMetx’s full report: The Evolving Landscape of Digital Healthcare Hubs.

Read on for Nasir’s insights.

What’s Behind CVS Health’s Novel Vertical Integration Strategy for Humira Biosimilars

CVS Health has finally revealed its strategy for biosimilars of AbbVie’s Humira.

Rather than announce multiple biosimilars for its pharmacy benefit manager (PBM) formulary, the company will instead launch Cordavis, a new subsidiary that will market a private label, low-list-price version of Sandoz’ Hyrimoz. Here’s the press release: CVS Health Launches Cordavis.

Below, I highlight how CVS Health could profit from this strategy and outline crucial unanswered questions about this latest vertical integration move. Let’s see if plan sponsors, patients, and legislators will pay attention to the man behind the curtain.

Drug Channels News Roundup, August 2023: Maximizer Problems, Hospital vs. MD Reimbursement, Bureaucracy vs. Costs, And My Favorite Chart Updated

We’re wrapping up one of newsiest summers in recent memory. Time to pack away your bathing suit, send the kids back to school, and cherish these curated curiosities that I combed from the Jersey Shore:

• Fresh evidence of patients’ copay maximizer pain

• How payers pay more to hospitals than to physician offices

• Surprise? Rationing care via bureaucracy saves money

Plus, the June 2023 update to my all-time favorite chart.

P.S. Join my more than 44,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter/X, where I have more than 16,700 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. I’m not posting to Threads yet.)

Key Predictions in the Accumulator/Maximizer Battle

Today’s guest post comes from Chris Dowd, Senior Vice President of Market Development at ConnectiveRx.

Chris discusses how such copay adjustment programs as accumulators and maximizers impact patients. He also discusses current legal cases that cover prescription medication access.

To learn more, register for ConnectiveRx’s free October online panel discussion with Chris: The Battle Over Accumulators and Maximizers: What You Need to Know for 2024.

Read on for Chris’ insights.

A Reality Check on That Blue Shield of California Announcement

Last week, Anna Matthews of The Wall Street Journal scored a market-moving scoop with her story about Blue Shield of California’s decision to ditch CVS Health’s Caremark pharmacy benefit manager (PBM) in favor of five separate vendors. ICYMI: A Big Health Insurer Is Ripping Up the Playbook on Drug Pricing

I commend Blue Shield of California for undertaking a noble experiment to unbundle the PBM business model. But let’s curb our enthusiasm over any purported “disruption.” The model is intriguing, but less novel than advertised—and retains an unexpected reliance on the largest pharmacy benefit managers (PBMs).

Read on for some industry context and my unanswered questions.

Specialty Treatments in the New Age of Affordability

Today’s guest post is from Divya Iyer, Vice President of Strategy & Business Development, Pharma Manufacturer Solutions, at GoodRx.

Divya discusses the challenges patients face in accessing specialty therapies prescribed by their healthcare providers. She suggests how the pharma industry can leverage GoodRx to help patients with access and affordability.

Learn more about GoodRx’s insights and solutions for specialty treatments by downloading their free yellow paper: Access and Affordability Insights: Differences Across Specialties.

Read on for Divya’s insights.

Surprising Data on Employer-PBM Rebate Pass-Through Arrangements in 2023

Hi, Barbie! The likelihood of major national legislation over the pharmacy benefit management (PBM) industry has never been greater. A serious effort exists to require greater transparency into PBMs’ activities and mandate full pass-through of rebates to plan sponsors.

Today, I review some surprising new data on a crucial aspect of the drug channel: how employer-sponsored health plans access the billions of dollars in manufacturer rebates that are negotiated by their PBMs.

As Barbie learned, the real world isn’t what you thought it was. Only about 60% of employers report that their PBM passes through all rebates on traditional and specialty drugs. What's more, one-third of employers choose spread pricing for their pharmacy network.

These data seem to contradict public statements by PBM executives, while also undermining the purpose of legislation that mandates rebate pass-through to plan sponsors. Notably, most of the proposed legislation fails to mandate pass-through to the patients whose prescriptions generated the rebates.

Read on for the details. Although when you find out that PBM reform isn’t about horses, you may lose interest.

Informa Connect’s Copay, Reimbursement and Access Congress

Informa Connect’s Copay, Reimbursement and Access Congress
Hybrid Event | October 2-4 at the Bellevue Hotel in Philadelphia, PA
www.informaconnect.com/copayreimbursement

Exclusive Offer: Be sure to use your exclusive promo code
USAVE10 to save 10% off* of your registration.

Copay, Reimbursement and Access Congress is back and we have a lot to talk about! With drug pricing legislation growing more complex, ongoing enforcement actions, accumulator and maximizer programs affecting patients and the rise of PBM cost-shifting strategies, there has never been a more important time for industry to unite. A program driven by marketplace insights and led by industry trailblazers, now is the time to join to drive adherence, access and commercialization forward–It's all happening October 2-4.

Exclusive Offer: View the agenda and register today! Be sure to use your exclusive promo code USAVE10 to save 10% off* of your registration.

Why should you attend this pivotal event?

The challenges of keeping up with shifting market dynamics in the midst of maximizing access while also meeting business objectives remains a deep concern and brings about many questions for access professionals.

How are you managing out-of-pocket costs for patients? Do you have clarity on the future of health policy? What is the impact of alternative funding programs on your organization?

In just two-and-a-half days, walk away with answers to these questions and more from experts from across the industry. Do not miss your chance to join seasoned leaders, your peers and leading solution providers as they navigate marketplace trends and dive into the impact coupons, benefit design, accumulators, maximizers, alternative funding programs and drug pricing legislation have on patient affordability and out-of-pocket costs. This is your chance to gain critical insights on industry standards, forward-thinking strategies to optimize your copay and cost sharing programs and so much more.

Can’t miss content highlights:

• Two Conference Workshops
• Copay and Reimbursement Basics
• Advanced Copay and Reimbursement Strategies
• State of the Industry Keynote: Patient Affordability Challenges
• Luminary Address–Reimbursement and Rebate Marketplace Challenges
• Stakeholder Perspectives: Copay and Reimbursement Marketplace Trends
• Enforcement Update: Exploring Regulatory Actions and Trends
• Build Sustainable Copay Programs While Balancing GTN
• Leveraging Data to Understand the Impacts of Copay Adjustment Programs on Historically Marginalized Communities
• Exploring Formulary Challenges
• And more!

HOW COULD IT GET BETTER?

Enhance Your Conference Experience with Optional Add-On Workshop: Understand the Nuances and Impact of Alternative Funding Programs:

Disrupting the industry, join Dawn Holcombe, MBA FACMPE ACHE, President at DGH Consulting as she leads this workshop, exploring the nuances and complexities of alternative funding programs, the evolution of AFPs and future industry impact these programs will have and what you need to know to fortify your cost-sharing program against AFPs. It may be optional, but with an expert like this, you won’t want to miss it.

Walk away with an understanding of these three main themes:

• The Basics of Alternative Funding Programs
• Industry Impact
• How to Prepare

Exclusive Offer: View the agenda and register today! Be sure to use your exclusive promo code USAVE10 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).

Digital as a Disguise: Beware the Illusion of an Automated Hub Experience

Today’s guest post comes from Rebecca Cotton, Executive Director of Strategy & Product Innovation at Cardinal Health™ Sonexus™ Access and Patient Support

Rebecca discusses the essential features biopharmaceutical manufacturers should seek in a digital hub that will help patients get their therapies faster. She argues that the most effective hub balances automation with the still-relevant value of human interactions.

Download the Cardinal Health™ Sonexus™ Access and Patient Support case study for more details about how ePA technology can accelerate time to therapy for patients. .

Read on for Rebecca’s insights.

What I (and Others) Told the Senate about the 340B Drug Pricing Program

Recently, a bipartisan group of six U.S. senators issued a request for information (RFI) for “input on bipartisan policy solutions that would provide stability and appropriate transparency to ensure the 340B program can continue to achieve its original intent of supporting entities serving eligible patients.” Click here to read the full letter.

I submitted a 14-page letter, which you can read below. I shared my $0.02 on the overall market, explained channel distortions from 340B contract pharmacies, and offered some policy recommendations. How could I not?

Click here to read the Drug Channels Institute letter to
Senators Thune, Stabenow, Moore Capito, Baldwin, Moran, and Cardin.

Below, I include links to publicly available comments from a diverse range of stakeholders, including 340B Health, the American Hospital Association, Biotechnology Innovation Organization, Community Oncology Alliance, National Association of Community Health Centers, and Pharmaceutical Research and Manufacturers of America. Enjoy!

Delivering a Modern Patient Access Experience

Today’s guest post comes from Jonas Boli, Chief Product Officer at Phil, Inc.

Jonas describes the challenges patients face when accessing specialty therapies and explains how patient abandonment affects manufacturers over time. He argues that an effective telemedicine program can help patients via an end-to-end digital experience.

To learn more, register for Phil’s free webinar on August 29th at 2 p.m. ET: Your Guide to Building an Exceptional Telemedicine Program.

Read on for Jonas’ insights.

The Economics of Copay Accumulators, Maximizers, and Alternative Funding Programs (Video)

In my most recent video webinar, I explored how plans and PBMs are turning to novel—and highly controversial—benefit design tools that access manufacturers’ patient support spending: copay accumulators, maximizers, and alternative funding programs.

In the video excerpt below, I describe these new approaches that plans offset specialty drug expenses. I then follow the dollar to show how they impact plan, patient, and manufacturer costs when compared with traditional approaches to copay support.

During the full 90-minute webinar, I discussed seven crucial risks that could disrupt this market along with many other aspects of this emerging market. If this clip whets your appetite for more, you can purchase the 90-minute webinar replay and full slide deck here: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

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

Two recent Drug Channels article on these topics:

• Copay Accumulator and Maximizer Update: Adoption Plateaus as Insurers Battle Patients Over Copay Support

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

Errata: The formulary rebate in the mathematical example that begins at 4:40 should be shown as 16.7%, not 20%. We apologize for the error.

Drug Channels News Roundup, July 2023: GoodRx + CVS Caremark, Accumulators vs. Patients, Hospitals vs. Taxes, and UnitedHealthcare Prior Auth Humor

Let’s cut through the steamy summer haze with Drug Channels’ refreshing breeze of questions for you to ponder while on your favorite pink beach:

• Why does the biggest PBM need a discount card partner?

• How do copay accumulators affect prescription adherence?

• Do nonprofit hospitals deserve their tax exemption?

Plus, Dr. Glaucomflecken asks: What would happen if UnitedHealthcare hired physicians who practiced evidence-based medicine?

P.S. Join my more than 43,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,600 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. I’m not posting to Threads yet.)

How Prior Auth Solutions Can Empower Patients, Providers and Pharma Field Teams

Today’s guest post comes from Brent Clifton, Vice President of Product Management at CoverMyMeds.

Brent discusses the challenges that patients, caregivers, and providers face when seeking access to medications requiring prior authorization. He explains how an electronic prior authorization solution can reduce delays and help patients start their therapies sooner—especially when patients and brands can play an active role in the process.

Click here to learn about CoverMyMeds’ electronic prior authorization solutions.

Read on for Brent’s insights.

Four Crucial Questions about the Humira Biosimilar Price War

The Humira biosimilar market has arrived!

This month, nine biosimilar versions of adalimumab launched in the U.S. market. As I predicted in 2021, some products launched with list prices that are only slightly lower than Humira’s list price, while others are trying to tempt payers and pharmacy benefit managers (PBMs) with deep list price discounts.

Surprisingly, two PBMs—Express Scripts and OptumRx—will each offer at least one low-list-price biosimilar option on their main national formularies.

Below, I help you understand the current and future market dynamics by posing four questions about drug pricing, rebate walls, patient behavior, the gross-to-net bubble, pharmacy/wholesaler economics, and more.

No biosimilar has the trifecta of being high-concentration, citrate-free, and fully interchangeable. These shortcomings, combined with physician hesitancy, will limit the ability of price to drive adoption. But as I see it, the Humira price war signals that rebate walls will crumble and the gross-to-net bubble will pop. Will payers let Humira go?

Informa Connect’s Medicaid Drug Rebate Program Summit (MDRP)

Informa Connect’s Medicaid Drug Rebate Program Summit (MDRP)
September 18-20, 2023 in Chicago, IL
www.informaconnect.com/MDRP

Drug Channels readers save 10% with code 23DRCH10*

Join Informa Connect and the life science industry on September 18-20, 2023 in Chicago, IL at the 2023 Medicaid Drug Rebate Program Summitto master complex MDRP regulatory guidelines to deliver compliant government pricing and reporting programs.

View the agenda for the 2023 MDRP Summit to see the complete picture – the program, speakers, and more, and visit for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to August 11, 2023.*

This annual event provides you and your team unparalleled access to the government regulators creating the rules, policies and regulations, the industry leaders tasked with interpreting them and the manufacturer experts who will be implementing them.

Hear from more than 90 leading experts representing the Acadia Pharma, Ascendis, AstraZeneca, Bristol Myers Squibb, CSL Behring, Eisai, FTC, Genentech, Genmab, Gilead Sciences, GlaxoSmithKline, Helsinn Therapeutics, Kyowa Kirin, Lundbeck, Lupin Pharma, Novartis, OIG, Optum, Pfizer, PhRMA, Sandoz, Takeda, United Therapeutics, Vaitris and many more.

Sessions include coverage on multiple hot topics, including:

• CMS Stacking Rule
• Everything IRA and 304B
• FSS and Government Contracting
• GTN Best Practices
• State Drug Price Transparency and Reporting
• Value Based Agreements
• Bundling, Acquisitions and Divestitures
• AMP Cap Removal
• Rebates, Disputes and GP Calculations
• OIG Perspective on Prescription Drug Pricing and Payment
• And so much more!

View the agenda for the 2023 MDRP Summit to see the complete picture – the program, speakers, and more, and visit for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to August 11, 2023.*

*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).

New SingleCare Pharma Solutions Help Drugmakers Reach Cash-Paying Patients

Today’s guest post comes from Josh Bliss, SVP of Customer Acquisition and Head of Pharma Solutions at SingleCare

Josh discusses the challenges that pharmaceutical manufacturers face connecting with consumers who could benefit from patient financial support programs. He describes SingleCare's new Pharma Solutions, which offers manufacturers the opportunity to market their copay assistance programs directly to SingleCare's millions of monthly prescription discount users.

To learn more about SingleCare's Pharma Solutions, please visit www.singlecare.com/pharmasolutions.

Read on for Josh’s insights.

EXCLUSIVE: For 2023, Five For-Profit Retailers and PBMs Dominate an Evolving 340B Contract Pharmacy Market

Looks like pharmacy and PBM profiteering within the 340B Drug Pricing Program will never go out of style.

Drug Channels Institute’s (DCI) latest analysis reveals that more than 33,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. Over the past 12 months, the number of pharmacies in the program has grown by more than 1,000 locations, which was the slowest growth rate since DCI started tracking this figure more than 10 years ago.

Consistent with our previous research, five multi-billion-dollar, for-profit, publicly traded pharmacy chains and PBMs—CVS Health, Walgreens, Cigna (via Express Scripts), UnitedHealth Group (via OptumRx), and Walmart—account for 75% of all 340B contract pharmacy relationships with covered entities. These contract pharmacy operators’ total estimated gross profits from the 340B program were nearly $3 billion in 2023.

Manufacturers’ contract pharmacy policy changes have slowed profits at pharmacies and PBMs, while triggering change in hospitals’ pharmacy strategies. Read on for my latest effort to pierce these little webs of 340B opacity.

Optimizing Access: Balancing Speed-to-Therapy and Gross-to-Net

Today’s guest post comes from Sahil Naik, Chief of Staff to the CEO at Phil, Inc.

Sahil discusses how manufacturers can balance patients’ access to therapy with gross-to-net (GTN) goals. Visit https://phil.us/ to learn more about how Phil helps improve the patient experience while managing GTN.

Read on for Sahil’s insights.

Drug Channels News Roundup, June 2023: Humira Price War and Mark Cuban, Formulary Exclusions, Oncology Drug Benefits, and Our Wonderful Healthcare System

Happy 247st birthday, America! Before you launch your July 4 festivities, Drug Channels offers some fireworks of our own:

• My $0.02 on the Humira price war—and the role of cost-plus pharmacy pricing

• Fresh evidence that formulary exclusions hurt patients

• Disturbing oncology drug benefit management

Plus, an entertaining explanation of why the U.S. healthcare system is so hard to explain.

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