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Friday, July 26, 2024
Crafting Effective, Patient-Centric Channel Strategies
Josh discusses the importance of a customized channel strategy for manufacturers. He outlines four key considerations that will ensure a successful strategy.
Click here to learn more about Cencora’s manufacturer solutions.
Read on for Josh’s insights.
Tuesday, July 23, 2024
Gross-to-Net Bubble Update: 2023 Pricing Realities at 10 Top Drugmakers
This year’s review includes the following 10 companies: Bristol Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, Merck, Novo Nordisk, Sanofi, Takeda, Teva, and UCB. You can find links to each company’s data below.
These data remain inconvenient for drug pricing flat earthers (#DPFE):
- When rebates and discounts were factored in, brand-name drug prices again declined—or grew slowly—in 2023. For the companies that experienced net price gains in their portfolios, net prices grew more slowly than—or only slightly faster than—the overall inflation rate.
- Rebates and discounts reduced the selling prices of brand-name drugs at the biggest drugmakers to less than half of their list prices.
- For the eight companies with multiple years of data, the gross-to-net difference in price changes remained sizable. See the second chart below.
Friday, July 19, 2024
Optimizing Product Commercialization in Today’s IDN Environment
Greg, Krista, and Faruk explain how and why integrated delivery networks (IDNs) have become crucial stakeholders for drug commercialization. They outline a two-pronged strategy to help brand teams thrive in today’s IDN landscape.
To learn more, read EVERSANA’s free report: IDN Trends and Engagement Strategies Every Drug Manufacturer Needs to Know.
Read on for Greg, Krista, and Faruk’s insights.
Tuesday, July 16, 2024
PBM Power: The Gross-to-Net Bubble Reached $334 Billion in 2023—But Will Soon Start Deflating
PBMs’ negotiating leverage against pharmaceutical manufacturers has been a key factor inflating 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, discounts, and other reductions.
For 2023, DCI estimates that the total value of manufacturers’ gross-to-net reductions for all brand-name drugs was $334 billion. (As we describe below, our latest estimates make a crucial change in the presentation of these figures compared with previous editions.)
Multiple forces are poised to pop the gross-to-net bubble for high-list/high-rebate products. This will force PBMs to further evolve their business models, while challenging plan sponsors and the FTC to follow the dollars.
Alas, patients remain caught in the drug channel's murky waters. I still can’t predict when SpongeBob SquarePants departs from Drug Channels—although I wish him a happy 25th birthday!
Friday, July 12, 2024
At the Breaking Point: The Unsustainable Future of Government Drug Discount Programs
Gavin discusses the three key reasons for duplicate discounts between the 340B Drug Pricing Program and the Medicaid Drug Rebate Program. He then explains Oregon’s novel approach to fixing the problem.
To learn more, register for Kalderos’ August 21, 2024, webinar: Revolutionizing Government Discount Programs: Why Traditional Methods Fail.
Read on for Gavin’s insights.
Tuesday, July 09, 2024
Who Will Pay for Prescription Drugs in 2032: Four Takeaways from the New Government Forecasts
As you will see below, CMS projects that outpatient prescription drugs dispensed by retail and mail pharmacies will remain a small share of total U.S. healthcare spending. The Inflation Reduction Act’s changes to the Medicare Part D program, along with coming demographic shifts, will have a significant impact on future spending by government programs and consumers.
Nonetheless, taxpayers—primarily via Medicare and Medicaid—will continue to dominate the employer-sponsored insurance market. Like it or not, vertically integrated insurers, PBMs, specialty pharmacies, and providers will continue to prosper.
Friday, June 28, 2024
Breaking Down Medication Access and Affordability Barriers
Kristina discusses challenges patients face accessing, affording, and adhering to prescribed medications. She goes on to describe how manufacturers can overcome these challenges to improve outcomes for both patients and brands.
Click here to learn more about CoverMyMeds’ technology solutions.
Read on for Kristina’s insights.
Tuesday, June 25, 2024
Drug Channels News Roundup, June 2024: Cordavis Humira Update, OptumRx’s New Biosim Biz, Generic Drugs' Wild Ride, IRA Predictions, and Dr. G on Med School
- CVS Health’s Cordavis is winning the Humira biosimilar battle
- Meet NUVAILA, OptumRx’s new biosimilar procurement business
- The acquisition cost revolution hits a speedbump following NADAC volatility
- Five predictions about the IRA’s impact on the drug channel
P.S. Join my nearly 57,000 LinkedIn followers for daily links to neat stuff along with commentary from the Drug Channels community. Note that we will soon migrate our social media activity to the Drug Channels Institute LinkedIn page.
Top exceutives from Cencora, Eli Lilly, Optum Rx, and Walgreens will be headlining the inaugural Drug Channels Leadership Forum. Attendance will be limited, so click here to request an invite for our March 2025 event.
Monday, June 24, 2024
Meet the Four Executives Headlining the Drug Channels Leadership Forum
I’ll be leading one-on-one conversations with each of these executives:
- Steven H. Collis, Chairman, President, and CEO, Cencora, Inc.
- Patrick Conway, MD, MSc, CEO, Optum Rx
- Frank Cunningham, Group Vice President, Global Value and Access & Lilly Direct, Eli Lilly and Company
- Tim Wentworth, CEO, Walgreens Boots Alliance, Inc.
The event will also include panel discussions covering a range of important topics. Participants in these panels will be announced this fall.
IMPORTANT: To maximize the value of networking and learning, the event will have a limited number of attendees. Click here to request an invitation.
We will also have a limited number of sponsors. Click here to learn more about sponsorship opportunities.
Read on for the full press release. Hope you can join us!
Friday, June 21, 2024
Mark Cuban: Five Ways that Big PBMs Hurt U.S. Healthcare–And How We Can Fix It (rerun)
Click here to see the original post from March 2024.
Today’s guest post comes from Mark Cuban, co-founder of the Mark Cuban Cost Plus Drug Company
A few weeks ago, Mark participated in the White House Roundtable on Lowering Healthcare Costs and Bringing Transparency to Prescription Drug Middlemen. I found Mark’s comments to be intriguing and highly provocative, so I invited him to publish an edited version exclusively here on Drug Channels.
Read on for Mark’s unfiltered view of the PBM industry. Feel free to add your own thoughts below or on LinkedIn.
Thursday, June 20, 2024
Copay Accumulator and Maximizer Update: Adoption Expands as Legal Barriers Grow (rerun)
Click here to see the original post from February 2024.
It's Valentine’s Day—and commercial plan sponsors remain smitten with copay accumulators and maximizers.
Our latest update finds that as of late 2023, about half of commercial lives were in plans that utilize a copay accumulator and/or a maximizer. These programs’ growth continues to divert the value of a manufacturer’s copay support payments away from patients and toward plans and PBMs. Check out the data below.
Patient advocacy groups and some big legal wins are starting to reverse Cupid’s arrow. But given the money at stake, I suspect that plans will keep looking for love in all the wrong places.
Wednesday, June 19, 2024
Independents Outshine PBMs in Manufacturers’ Exclusive Specialty Pharmacy Networks (rerun)
Click here to see the original post from April 2024.
Last week, we documented the substantial concentration of dispensing revenues for specialty drugs. See The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents.
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.
Tuesday, June 18, 2024
The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents (rerun)
One important update to the figures below: We (and many others) had significantly underestimated Walgreens' revenues and market share. As we discuss below, its market share is closer to 10%, compared with the 3% that we originally reported.
Click here to see the original post from April 2024.
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.
Monday, June 17, 2024
The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead (rerun)
Click here to see the original post from April 2024.
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.
Friday, June 14, 2024
Expanding our Definitions of Out-of-Pocket Costs: Three Imperatives for Biopharmaceutical Manufacturers
Chris discusses new research on how patients perceive out-of-pocket costs. As she explains, many patients and unpaid caregivers consider out-of-pocket costs for medication within the context of their total spending. She then recommends three ways that manufacturers can improve patients' access and affordability.
Click here to learn more about Real Chemistry’s suite of market access consulting and payer/IDN marketing solutions. You can also sign up for its weekly Value Report, summarizing the week in drug pricing, access, and value news.
Read on for Chris' insights.
Wednesday, June 12, 2024
Hospitals Are Relying More on PBMs to Manage Manufacturers' 340B Contract Pharmacy Restrictions: DCI's 2024 Market Analysis
- About 33,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—act as contract pharmacies for the hospitals and federal grantees that participate in the 340B program.
- Five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via OptumRx), and Walgreens, Walmart—continue to dominate the 340B contract pharmacy market.
- Federal grantees are aligned primarily with the vertically intergated organizations' retail pharmacies, while hospitals rely on mail and specialty pharmacies.
For an updated look at what’s next for the 340B contract pharmacy market, join Adam J. Fein, Ph.D., on June 21 for his latest live video webinar: The 340B Drug Pricing Program: Trends, Controversies, and Outlook.
Friday, June 07, 2024
Choosing the Right Hub Partner: A Blueprint for Decision-Makers
Nasir highlights manufacturers' top objectives and vendor metrics from CareMetx’s recent survey of leaders and decision makers in the specialty pharmaceutical industry. He then outlines key questions to help manufacturers evaluate their potential hub partners.
You can donwload CareMetx’s full 2024 Patient Services Report here: Revealing Manufacturer Priorities: Patients Naturally Take Center Stage.
Read on for Nasir’s insights.
Tuesday, June 04, 2024
Pharmacist Salaries and Employment in 2023: The Grass Keeps Getting Greener in Hospitals
2023 was another tough year for pharmacists working in retail settings. While average salaries grew, they did not keep pace with overall inflation. Pharmacist employment at drug stores shrank but grew at supermarkets and mass merchants.
Meanwhile, employment and salaries in non-retail settings—hospitals, physician offices, outpatient centers, and home healthcare—continued to grow. These settings now employ one in three U.S. pharmacists. Greener grass—or just different soil?
Full salary and employment data below for your enjoyment or sorrow.
What’s ahead for 340B-eligible hospitals? Find out during The 340B Drug Pricing Program: Trends, Controversies, and Outlook, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the June 21 webinar.
Friday, May 31, 2024
Wednesday, May 29, 2024
Drug Channels News Roundup, May 2024: CVS & Cordavis & Humira, 340Boom, AFP Slowdown, Asembia Wrap-Up, and GLP-1 Humor
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdU7Lbd8uXBCqjHjXmdXyHSXo60fjJFnkPt39DMpyxrWzTbq4tftZNKmY12yINd9nxnT9slPpdni9kOl_wCWoEKmLR_IwbhuL_z3g9g0eSFfi_-1XVsQp2T_PJH4l-9hS1CHWaX5MuwTwKsYD-E359r-41AYRHjVplnhWeEyoYf2LrDlLA-Xg-2w/s1600/May2024-Card.png)
- CVS Health’s Cordavis business seems to want quasi-regulatory oversight of Humira biosimilars
- 340B’s skyrocketing growth continues, but the market is changing
- Plans sponsors' fading interest in alternative funding programs
- A post-Asembia review from DCI’s trip to Las Vegas
P.S. Join my nearly 56,000 LinkedIn followers for daily links to neat stuff.
Register now for The 340B Drug Pricing Program: Trends, Controversies, and Outlook, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the June 21 event.
Wednesday, May 22, 2024
Why the IRA Will Encourage Part D Plans to Prefer High-List, High-Rebate Drugs (video)
In the video excerpt below, I walk through a mathematical example to show why the IRA will encourage Part D plans to prefer high-list, high-rebate specialty drugs, even as the government and manufacturers will prefer a low-list-price version. What’s more, a product with a maximum fair price (MFP) may also raise total costs for the healthcare system—despite the likely political posturing and spin.
If this clip whets your appetite for more, register to watch a replay of the full 90-minute video webinar from April.
Click here if you can’t see the video below.Curious about the IRA will disrupt the 340B market? Then register for The 340B Drug Pricing Program: Trends, Controversies, and Outlook, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the June 21 webinar.
Tuesday, May 21, 2024
The 340B Drug Pricing Program: Trends, Controversies, and Outlook (NEW Live Video Webinar)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgf1m6Ufvv2Ll5MNfRiqmoPL_reWLRxILZmQ6-Lgz1LF2TtJAXZp4w91J7B1h5685uSFpq_bKi4n_3L4PvXKxR4pfdVDj5uXqTgqdk6YkqU9UFPWehCNPhfc0aL6Hg9UVrXAh9e5GA29OL_f_UIetVQXWf2YA3HcMajWyj6zjKGmdveFxz-VXIB4g/s1600/June2024-webinar-banner-SM.jpg)
This event is part of The Drug Channels 2024 Video Webinar Series.
WHAT YOU WILL LEARN
The federal 340B Drug Pricing Program continues to grow much more quickly than the overall pharmaceutical market. For 2023, total purchases under the 340B program exceeded $124 billion. DCI estimates that 340B discounts equated to more than 17% of total value of gross-to-net reductions for brand-name pharmaceuticals. The 340B program also remains a significant and controversial source of profits for the pharmacy and pharmacy benefit management (PBM) industries.
In this all-new webinar, Dr. Fein will provide a fact-based look at the 340B program, summarize the multiple controversies surrounding the program’s operations, and deliver a clear-eyed outlook for the program’s future. Key topics will include:
- Current operations of the 340B program
- 340B growth trends by dispensing/administration channel and covered entity type
- Following the 340B dollar
- Contract pharmacy controversies
- Impact of CMS’s latest 340B guidance for the Inflation Reduction Act
- PBM and pharmacy profits from the 340B program
- Vertical integration and third-party administrators
- How state Medicaid program reforms are affecting the 340B program
- Manufacturers’ 340B strategies
- State and federal legislative actions and outlook
- And much more!
As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data. He will also draw from exclusive information found in DCI's 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
Read on for full details on pricing and registration.
Friday, May 17, 2024
HCP Perspectives: Access Challenges in Treating Diabetes & Obesity
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5M2W7EOyqpgkpTRvg9sIzEphlC50KZe9VQPuDQfEZzEqjHVWXcCmANxBaVuZtdmuB8-gtc0GJknu9dEjToY0yG3OewscEkmHNsoWVxU348gMhT2bqxX1XXJwojP_128-J7tNtnCdpFh8IumwDDAGgKOBVQzXMxVxlVal2_TpyPNv-uVXOqMdjlA/s1600/Photo%20of%20Drs%20Parikh%20and%20Sood%20at%20PHM%20HealthFront.jpg)
At the recent Publicis Health Media HealthFront event, Preeti hosted a dialogue on the main stage with Dr. Minisha Sood. They discussed new GoodRx research and had a candid discussion about their daily challenges in caring for patients—especially those living with diabetes and obesity.
Click here to watch the full video of the conversation between Drs. Parikh and Sood.
Read on for Preeti’s insights.
Tuesday, May 14, 2024
Another IRA Surprise: Part B Coinsurance Inflation Adjustments Are Increasing Patient Costs
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqQCyoWoCxn87QZl5qTyhccvb42xMGe4flxHrMzxWGXM5vPKbKRIBt1y8RMmVAAODTUWzPGGfXr15-8WGud23GnTr-a7wWogA4gqmtqanm9tPVKR9GHo3CRXa3Lnxggu3OhKWStJ6xwALtxO6AMSES3FlFo3mODeJKMBDSf7ljoWmNhatv8K3XBg/s1600/PartB-coinsurance-adjustments-2023Q2-to-2024Q2-return-to-20.jpg)
As we document below, a growing share of Part B drugs have inflation-adjusted coinsurance rates that have been increasing, not declining. In many cases, the coinsurance rate declines only briefly before rebounding back to the standard 20% rate. What’s more, these fluctuations have triggered huge jumps in patients’ out-of-pocket obligations for some drugs—even when a drug’s costs were falling.
Chalk off these coinsurance surprises to yet another unintended consequence of the IRA. Seniors who are expecting to see costs drop may find they are instead being taken for a rollercoaster ride.
Friday, May 10, 2024
Solving Access Barriers in Biomarker Testing: 5 Tips for Manufacturers
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVEZl0Sufvd39ILILI6T9bqmGEOJhX_cxGzgwOC75oz8y7ISoirRGM8AR4G3vtwpTEcDD28YYEcTEroLf9sSHvEJP6MkkfL7if4Y8VXBiEXa5R3N0ZzDZZrRlupyYOfMS6DzDaxJ31LOQJINGKtmlBecD8PLXUdxZ4zNp1mTsOoxhPIwkvHXUfA5IGl4Po/s1600/linkedIn%20ad_drug%20channels_consulting%20services.jpg)
The authors discuss the access barriers facing patients who need biomarker testing. They discuss five ways manufacturers can prevent these barriers from affecting patients.
To learn more about navigating the complexities of market access, contact MMIT and its sister company, The Dedham Group.
Read on for their insights.
Tuesday, May 07, 2024
Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A May 2024 Update
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSAHbaOfvMvZ8CtE9QnF00Z2eHIW0ctCGw__3AnJTZ3xfCiAABhh8yJvdBj_cFJa_ZEWDSs4ORdDLo6gf8BHFOdg4hS5i_tdvcNVNf9tPxYJmafIRx9fxLlJDe-D0LKkBj4aNhzsVOJCwamfwhdO0iM7cSmcKZS9oq0UN79AufFnoGMV1pFacCkw/s1600/Vertical-Integration-DCI-May2024.jpg)
Below you’ll find our latest illustration of the major vertical business relationships among the largest companies along with some of the notable activity since our previous update. These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical efforts.
The companies face renewed scrutiny from the Federal Trade Commission, the Office of Inspector General, and members of Congress. But until anyone takes action, we will continue to live with the golden rule of the drug channel: Whoever has the gold gets to make the rules.