Drug Channels delivers timely analysis and provocative opinions from Adam J. Fein, Ph.D., the country's foremost expert on pharmaceutical economics and the drug distribution system. Drug Channels reaches an engaged, loyal and growing audience of more than 80,000 subscribers and followers. Learn more...
Today’s guest post comes from Kevin Kettler, President of CoverMyMeds.
Kevin asks: What if there were no barriers across the therapy access and reimbursement process? In his view, eliminating barriers requires a combination of expert insight, actionable data, and simplification of the providers' experiences.
Today, we examine how manufacturers’ specialty networks contribute to this concentration. In DCI’s exclusive analysis below, we show that specialty pharmacies affiliated with pharmacy benefit managers (PBMs) play an outsized role in manufacturer-designated dispensing networks.
A typical network contains about five specialty pharmacies—but one in three specialty products with a manufacturer-designated network contains only a single specialty pharmacy. In those exclusive networks, independent and smaller specialty pharmacies are the big winners.
Read on for DCI’s updated profile of specialty networks—and ponder why smaller pharmacies are winning the battle for exclusive networks.
As you might expect, we will hit Vegas in true Drug Channels style. Stop by booth #1801 for fun and games:
Partake in a special in-person Ask Me Anything with Adam (#AMAWA) session with DCI president Adam J. Fein, Ph.D.! The AMAWA session will start on Monday, April 29, at 4:30 p.m. (Bring your phone if you want a selfie!)
Adam won’t be speaking at Asembia this year, so be sure to visit booth #1801 on Monday afternoon to get his hot take on whatever topic is vexing you.
Spin the Drug Channels Wheel O’ Fun and win fabulous prizes!
Meet Bar Stern, DCI’s newest and most bearded team member!
Today’s guest post comes from Jim Sheninger, Pharmacy Strategy Officer at GoodRx.
Jim describes GoodRx's emerging pharmacy contracting strategies. In addition to working through pharmacy benefit managers (PBMs), GoodRx now also contracts directly with Walgreens, CVS, and other national and regional pharmacies. These direct agreements are based on acqusition cost, which helps pharmacies stabilize gross margins while still providing low pricing for consumers.
To learn more about GoodRx and its pharmacy partnerships, reach out tonetwork@goodrx.com.
Drug Channels Institute’s (DCI’s) latest analysis finds that participants in the specialty pharmacy market continue to get more diverse—although revenues remain highly concentrated.
We have identified nearly 1,800 dispensing sites with specialty pharmacy accreditation—about 40% of which are owned by hospitals, physician practices, and other healthcare providers.
Alas, specialty pharmacies owned by the three largest pharmacy benefit managers (PBMs) have the most brass in their pocket, as they accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs.
Read on for DCI’s latest overview of the 2023 marketplace and revenues of the biggest market participants, along with key specialty pharmacy trends.
Today’s guest post comes from Jessica Lens, Chief Patient Experience Officer at CareMetx.
Jessica discusses the challenges of patient nonadherence. She then outlines how manufacturers can build adherence into their patient services program to increase patient engagement.
Three is still the magic number for pharmacy benefit managers (PBMs).
For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group.
Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the industry changes that will shift these shares over the next few years.
I am pleased to announce the inaugural Drug Channels Leadership Forum! This unique, new event will be held from March 17 to 19, 2025, at the Turnberry Resort and Spa in Miami.
The Leadership Forum will be an executive gathering where drug channel leaders can network and discuss key issues and challenges facing the commercial healthcare system. We intend to bring together people from the entire drug channel: pharmaceutical manufacturers, pharmacy benefit managers (PBMs), health plans, insurers, and plan sponsors, wholesalers and distributors, pharmacies, providers, buying groups, government officials, and more.
I’m personally assembling the agenda, which will be a mix of one-on-one fireside chats with industry leaders combined with hard-hitting, topical panel discussions. And of course, I'll be there to moderate the entire event and lead the fireside chats. Thanks to DCI’s partnership with HMP Global, we can bring this novel event to the drug channels community.
It's time for Drug Channels’ annual reality check on U.S. drug pricing.
For 2023, brand-name drugs’ list prices again grew at mid-single-digit rates. However, net prices dropped for an unprecedented sixth consecutive year. What’s more, after adjusting for overall inflation, brand-name drug net prices plunged by more than 7%. Details below.
Employers, health plans, and PBMs determine whether patients share in this ongoing deflation. Meanwhile, these data challenge drug pricing flat earthers (#DPFE) who remain committed to a false narrative of “skyrocketing” drug prices.
As I discuss below, manufacturers will face ongoing pressure on net prices from both commercial and government payers. They will also have new incentives to limit growth in list prices—and will even reduce list prices on certain drugs (as some are already doing).
Perhaps these factors will finally start to deflate the gross-to-bubble and reduce its negative effect on patients and public policy discussions. Hope has to triumph over experience eventually, doesn’t it?
As many of you know, hospitals and health systems have emerged as significant participants in the specialty pharmacy industry. A new American Society of Hospital Pharmacists (ASHP) survey provides fresh insights into these specialty pharmacies.
Below, I review key findings on the economics and operations of these specialty pharmacies. I then highlight how hospitals steer prescriptions to their internal specialty pharmacies.
As you’ll see, hospitals use network strategies that would make any pharmacy benefit manager (PBM) proud—especially when combined with the prescribing activities of hospital-employed physicians.
The 2024 formularies described below should boost biosimilar adoption. As a new Biosimilar Council report shows, Humira retained 99% of market share in late 2023, despite being more expensive than its biosimilars.
For 2024, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again each excluded 600 or more drugs from their standard formularies. You can find our updated counting below.
This year, Humira and its 14 biosimilars will provide the most intriguing formulary drama. Unfortunately, the gross-to-net bubble will remain a fixture for this category, despite a price war led by almost half of the biosimilars. CVS Health will lean into the craziness with an unusual Humira strategy.*
There are also unusual formulary developments for insulin products, many of which experienced massive list price cuts for 2024.
Read on for my deep dive into these two therapeutic categories. I also highlight recent research that raises troubling questions about the patient impact of these ever-growing exclusion lists. As always, I welcome your comments below or on LinkedIn.
Is the world ready for new ways to price pharmacy and pharmacy benefit manager (PBM) services? CVS Health thinks so, as evidenced by two new initiatives that it announced yesterday. Below you'll find details and links to source documents.
I commend CVS Health for attempting to address key economic challenges facing the retail pharmacy industry and for tackling the hidden complexities of PBM pricing models. As I explain, a shift to cost-based pharmacy reimbursement could stabilize CVS Health’s retail business by improving its dispensing profits.
Nonetheless, CVS Pharmacy’s cost-plus model has some notable shortcomings for plan sponsors and is far less “disruptive” than the company would like us to believe. Mark Cuban should be flattered—but not fearful.
What's more, other large pharmacies will likely follow CVS with attempts to force payers and PBMs to accept some form of cost-plus reimbursement. (Et tu, Walgreens?) If that happens, expect higher prescriptions prices, less efficiency, and a slowdown in the inevitable retail pharmacy shakeout.
Consider two apparently unrelated drug channel anomalies:
In McKesson’s 2023 fiscal year, CVS bought $75 billion in pharmaceuticals from McKesson’s wholesale business—a jump of more than 35% compared with the previous year.
Despite skyrocketing sales for anti-obesity GLP-1 drugs, many retail pharmacies are losing money on every prescription.
The common factor behind these two disparate situations: Pharmaceutical wholesalers’ unusual pricing for brand-name drugs sold to pharmacies, hospitals, and other buyers. Below, I walk through the economic fundamentals to help you understand another obscure aspect of our opaque drug pricing system.
Today’s guest post comes from Bill Dupere, SVP of Product Development & Partnerships at Mercalis.
Bill discusses specialty therapy access barriers, including payer utilization management techniques and “no coverage” policies. Contact Mercalis to learn about their Patient Support Services.
It’s finally spring in Philadelphia, home of Drug Channels. Along with sunshine and fine weather, the vernal equinox has ushered in a crop of new and noteworthy stories:
What the CarelonRx/Kroger specialty pharmacy deal means for CVS Health
Provider-owned specialty pharmacies expand in Medicare
Payers are not keen on shady alternative funding programs (AFP)
Hospitals’ association spreads 340B misinformation
Today’s guest post comes from Adam Stotts, SVP of Customer Success at AssistRx.
Adam discusses how patients seeking to access specialty therapies can benefit from a digital intake approach. He then explains three ways that specialty pharmaceutical companies can use digital intake strategies to speed patient enrollment.
Whether your daily focus is on Medicaid, Government Pricing, 340B, Drug Price Transparency, Commercial Contracting or Chargebacks, we have you covered! Informa Connect is thrilled to announce Pricing & Contracting USA, an innovative summit that brings together three of the life science industry’s most well-known events (Medicaid & Government Pricing Congress, Drug Pricing Transparency Congress and the Contracts & Chargebacks Summit) together for enhanced learning and networking.
Join us in New Orleans on May 21-23 where you’ll gain critical insight into regulatory requirements, policy initiatives and best practices to enhance pricing and contracting models. Nearly 100 world class speakers are slated to present deep dive sessions, workshops and panels covering these topics and more:
Wendell Potter, President, Center for Health and Democracy and Publisher, HEALTH un-covered shares an out of the box forecast of upcoming regulations, litigation and policies affecting the industry in what is set to be an action-packed election year.
Understand the implementation and future of PDABs with Mallinckrodt and the director of the Colorado prescription drug affordability board and the manager of insurance data science.
Get an OIG Update on AMP cap removal and potential consequences.
Discuss the nuances of reporting and laws for key Medicaid and GP programs with Genmab and Miree Lee Consulting.
Listen in as IL HFS Medicaid Drug Rebate Unit reviews rebates, reasonable assumptions, BFSF and best price.
Hear from Lundbeck, Accord BioPharma, BeiGene and Mirati Therapeutics as they discuss best practices in operating a pricing review board.
Join Bioventus, Amneal Pharma and CSL Vifor for an overview of the contracting process, types purposes and key considerations.
Explore the commercial impact of GP decisions and vice versa with Pfizer.
Hear from PhRMA and BIO on landscape of drug pricing transparency pressures.
Hyman, Phelps & McNamara review the enforcement and penalties landscape within state drug pricing reporting.
Novo Nordisk takes a deep dive into confidentiality concerns within SPTR.
Hear from United Therapeutics and Lundbeck as they discuss synergizing MDRP and SPTR.
Listen in as Takeda and Sanofi discuss IRA and AMP Cap Removal and how policy changes and evolving regulations will transform the contracting atmosphere.
View the agenda for Pricing & Contracting USA to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pricing-contracting-usa for further details and to register. Drug Channels readers will save 10% off when they use code 24DRCH10 and register prior to April 19, 2024.*
*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.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish a guest post on Drug Channels, please contact Paula Fein(paula@DrugChannels.net).
Today’s guest post comes from Josh Marsh, Vice President and General Manager of Sonexus™ Access and Patient Support at Cardinal Health.
Josh discusses factors that drive manufacturers to insource versus outsource patient support services. He shares data from a Cardinal Health survey of biopharmaceutical companies and offers four factors to consider when evaluating your patient support program.
For 2023, DCI estimates that U.S. prescription dispensing revenues reached $621 billion in 2023, driven by accelerating GLP-1 prescriptions and an expanding post-pandemic market. The table below—one of 262 in our new report—provides DCI's first look at the 15 largest organizations that battled for those revenues.
Today’s guest post comes from Logan Melchione, VP of Patient Affordability at Paysign.
Logan discusses the evolution of patient support programs. She then outlines how these programs must evolve to stay relevant and valuable.
To request an analysis of your copay savings program and learn more about Paysign’s patient affordability solutions, contact affordability@paysign.com or visit paysign.com/rx.
On March 19, 2024, Drug Channels Institute will release The 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This report—our fifteenth edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. This unique, encyclopedic resource is your ultimate guide to the complex web of interactions within U.S. prescription drug channels.
12 chapters, 500+ pages, 262 exhibits, nearly 1,100 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 2024 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 March 19.
Dr. Adam J. Fein, president of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for DCI’s latest live video webinar:
This post describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.
In 2023, the Inflation Reduction Act of 2022 (IRA) began to alter the Medicare Part D program and trigger changes in beneficiary out-of-pocket spending, drug prices, pharmacy economics, and market access strategies. The IRA’s impact will extend far beyond the Medicare program into many aspects of the overall drug channel.
In this all-new webinar, Dr. Fein will unpack the intended and unintended consequences of the IRA for the commercial market and drug channel participants, including:
What’s ahead for brand-name drug list and net prices
The coming battles over high-list/high-rebate products
The Medicare Advantage boom and the collapse of the stand-alone PDP market
The gross-to-net bubble outlook for Part D
The IRA’s spillover impact on the gross-to-net bubble in commercial markets
How the IRA will impact Medicaid rebates and change the 340B Drug Pricing Program
What’s ahead for utilization management
Retail pharmacies’ coming financial challenges
The uptick in consolidation of physician practices
Biosimilar market uncertainties
And much 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.
Please note that Dr. Fein will focus on the IRA’s patient and commercial market impacts. The potential effect of the IRA on manufacturers’ new drug research and development strategies is beyond the scope of this webinar.
Read on for full details on pricing and registration.
Today’s guest post comes from Era Prakash, Vice President of Product Management at Cencora.
Era contends that workflow integration can help biopharma companies address challenges that limit provider utilization of patient support programs. She also outlines three major challenges related to the provider workflow technology market.
February is longer than usual this year, which means that you’ll have extra time to leap into our monthly curated selection of noteworthy news. In this issue:
An update on the retail pharmacy shakeout
Arguing for high drug prices
A leading researcher provides a 340B reality check
Physicians don’t want pharmacists getting uppity
Plus, Dave Grohl fights for your right to…have healthcare price transparency?
P.S. Join my nearly 53,000 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 17,400 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. Sorry, no Threads.)
