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...

Friday, April 19, 2024

How GoodRx is Evolving Its Reimbursement Approaches to Help Pharmacies and Consumers

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 to network@goodrx.com.

Read on for Jim’s insights.

Tuesday, April 16, 2024

The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents

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.

Friday, April 12, 2024

How Patient Engagement Can Reduce Brand Launch Risks

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.

To learn more about enhancing patient engagement and adherence, download CareMetx's new report: Driving Brand Success: Minimize Risk and Capture Missed Value from Patient Engagement and Adherence.

Read on for Jessica’s insights.

Tuesday, April 09, 2024

The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead

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.

Monday, April 08, 2024

SAVE THE DATE: Drug Channels Leadership Forum, March 17-19, 2025

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.

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 very 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, April 05, 2024

Tales of the Unsurprised: U.S. Brand-Name Drug Prices Fell for an Unprecedented Sixth Consecutive Year—And Will Fall Further in 2024 (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.

One important update: In the article below, I suggested that the IRA will make high-list/high-rebate products less attractive to Medicare plans. But this appears not be accurate, as I explain in Surprise! Thanks to the IRA, Part D Plans Will Prefer High-List, High-Rebate Drugs.

Click here to see the original post from January 2024.


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?

Thursday, April 04, 2024

Vertical Integration Lessons: The Economics and Strategies of Hospital-Owned Specialty Pharmacies (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.

For updated data on hospital-owned specialty pharmacies, see Chapter 3 of DCI's new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Click here to see the original post from November 2023.


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.

Vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels gets most of the attention. But a parallel vertical integration has been occurring among hospitals, specialty pharmacies, and physicians. Manufacturers and payers must adapt to the growing power and market tactics of hospital-owned specialty pharmacies.

Wednesday, April 03, 2024

The Big Three PBMs’ 2024 Formulary Exclusions: Biosimilar Humira Battles, CVS Health’s Weird Strategy, and the Insulin Shakeup (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.

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.

Click here to see the original post from January 2024.


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.

Tuesday, April 02, 2024

What CVS Pharmacy’s New Cost-Plus Reimbursement Approach Means for PBMs, Pharmacies, Plan Sponsors, and Prescription Prices (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.

For more on acquisition cost reimbursement for pharmacies, see Sections 8.4. and 12.3.4. of our new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Click here to see the original post from December 2023.


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.

Monday, April 01, 2024

Understanding CVS Health/McKesson and Why Pharmacies Lose Money on GLP-1s (rerun)

This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.

Click here to see the original post from December 2023.


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.

This morning’s announcement of CVS Health’s CostVantage pharmacy reimbursement model reflects the latest attempt to fix the system’s wacky economics. Tomorrow on Drug Channels, I’ll delve into the pros and cons of this new approach.

Thursday, March 28, 2024

Navigating Market Access Challenges in Life Sciences Commercialization

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.

Read on for Bill’s insights.

Tuesday, March 26, 2024

Drug Channels News Roundup, March 2024: My $0.02 of CarelonRx/Kroger & CVS, Provider-Owned Pharmacies, Shady AFPs, 340B Deception, and Lilly’s GLP-1 Ad

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
Plus, Lilly trolls our nation’s celebrities.

P.S. Join my nearly 54,000 LinkedIn followers for daily links to neat stuff.

What’s ahead for the drug channel? Find out during Drug Channel Implications of the Inflation Reduction Act, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at our April 5 webinar.

Friday, March 22, 2024

Three Digital Intake Strategies For Eliminating Patient Enrollment Forms

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.

To learn about AssistRx’s digital intake solutions, download Digital Intake for Specialty Drug Programs: Q1 2024 Progress Report.

Read on for Adam’s insights.

Thursday, March 21, 2024

Mark Cuban: Five Ways that Big PBMs Hurt U.S. Healthcare–And How We Can Fix It

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.

How will the most consequential change in federal drug pricing policy affect drug pricing? Find out during Drug Channel Implications of the Inflation Reduction Act, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the April 5 webinar.

Tuesday, March 19, 2024

NOW AVAILABLE: The 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

I am pleased to announce our new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, available for purchase and immediate download.
We’re offering special discounted pricing if you order before April 8, 2024.

The 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, our 15th edition, provides a comprehensive, fact-based, and non-partisan tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. This 2024 edition includes substantial new material—outlined on page ix of the report overview.

12 chapters, 500+ pages, 262 exhibits, nearly 1,100 endnotes: There is nothing else available that comes close to this valuable resource.

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to contact us if you would like to pay by corporate check or ACH.

Email Paula Fein (paula@drugchannels.net) if you’d like to bundle your report purchase with access to DCI’s video webinars.

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 your email.

Read on for some additional details.

Monday, March 18, 2024

Informa Connect’s Life Sciences Pricing & Contracting USA

Informa Connect’s Life Sciences Pricing & Contracting USA
May 21-23, 2024 | New Orleans
Drug Channels readers save 10% with code 24DRCH10*

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.
  • And more!
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).

Friday, March 15, 2024

The Four Key Factors to Evaluate When Insourcing vs. Outsourcing Patient Support Programs

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.

To learn more, download the results from Cardinal Health’s survey: Insourcing and Outsourcing Trends for Patient Hubs.

Read on for Josh’s insights.

Tuesday, March 12, 2024

The Top 15 U.S. Pharmacies of 2023: Market Shares and Revenues at the Biggest Chains and PBMs

Next week, Drug Channels Institute (DCI) will release our 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the 15th edition of our popular and comprehensive examination of the entire U.S. drug pricing, reimbursement, and dispensing system.

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.

For a sneak peek at the complete report, click here to download our free report overview (including key industry trends, the table of contents, and a list of exhibits). We’re offering special discounted pricing if you order before April 7, 2024.

How will the most consequential change in federal drug pricing policy affect the largest pharmacies and PBMs? Find out at my upcoming live video webinar, Drug Channel Implications of the Inflation Reduction Act, on April 5, 2024, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Friday, March 08, 2024

Copay Comes Full Circle: An Industry Ready for Disruption

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.

Read on for Logan’s insights.

Thursday, March 07, 2024

Available for Preorder: The 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

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.
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.

Email Paula Fein (paula@drugchannels.net) if you’d like to bundle the report purchase with access to DCI’s video webinars.

Special preorder and launch pricing discounts will be valid through April 8, 2024.

Read on for more details.

Tuesday, March 05, 2024

Drug Channel Implications of the Inflation Reduction Act (NEW Live Video Webinar)

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:

Drug Channel Implications of the Inflation Reduction Act
This event will be broadcast live on
Friday, April 5, 2024, from 12:00 p.m. to 1:30 p.m. ET

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.

This event is part of The Drug Channels 2024 Video Webinar Series.

WHAT YOU WILL LEARN

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.

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 new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

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.

Friday, March 01, 2024

The Promise and Challenges of Workflow Integration for Biopharma-Sponsored Patient Support Programs

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.

Click here to learn more about Cencora's Access Network technology solution, which offers an in-workflow, digitized enrollment process.

Read on for Era’s insights.

Tuesday, February 27, 2024

Drug Channels News Roundup, February 2024: Pharmacy Shakeout Update, High Drug Prices, 340B Realities, MDs vs. Pharmacists, and Foo Fighters

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.)

Friday, February 23, 2024

Four Keys to Success for Retail and Specialty-Lite Hub Services

Today’s guest post comes from Nicole Grycan, VP of Commercialization at Phil, Inc.

Nicole discusses how hubs can improve access and adherence. She outlines four success factors for manufacturers that use a digital hub partner.

To learn more, register for Phil's upcoming webinar: Improving Access, Coverage, and GTN with a Digital Hub.

Read on for Nicole’s insights.

Wednesday, February 21, 2024

Surprise! Thanks to the IRA, Part D Plans Will Prefer High-List, High-Rebate Drugs

Like many of you, I have believed that the Inflation Reduction Act of 2022 (IRA) will encourage Medicare Part D plans to adopt low-list-price products over their high-list/high-rebate counterparts, thereby popping the gross-to-net bubble.

Actually, maybe not.

Below, I explain 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. Just another IRA-inflicted hit for biosimilars?

The warped incentives don't stop there. Even more weirdly, both products with a negotiated maximum fair price (MFP) and low-list-price products will raise total costs for the healthcare system and increase beneficiary premiums.

Did I get this latest unintended consequence right? Or have I been spending too much time underwater in Bikini Bottom? Read on and see what you think. As always, I encourage you to share your own thoughts with the Drug Channels community on social media.

P.S. Want to learn more? Join me on April 5 for DCI's next live webinar: Drug Channel Implications of the Inflation Reduction Act. Official announcement coming soon!

Friday, February 16, 2024

The Drug Discount Ecosystem Needs Clarity in 2024 and Beyond

Today’s guest post comes from Gavin Magaha, Senior Director of Value Delivery at Kalderos.

Gavin discusses the problems manufacturers face in accessing and standardizing drug discount data. These data are necessary to avoid duplicate discounts and comply with regulatory requirements.

To learn more about how the Inflation Reduction Act adds to challenges of drug discount programs, download Kalderos’ whitepaper:

Operational Complexity and Evolving Challenges: What Drug Manufacturers Need to Know Now About Drug Discount Programs, the Inflation Reduction Act, and 340B.

Read on for Gavin’s insights.

Wednesday, February 14, 2024

Copay Accumulator and Maximizer Update: Adoption Expands as Legal Barriers Grow

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.

Friday, February 09, 2024

New Survey Reveals Manufacturers’ Patient Services Priorities for 2024

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

Nasir shares findings from CareMetx’s new 2024 Patient Services Report research study: Revealing Manufacturer Priorities: Patients Naturally Take Center Stage.

As he explains, manufacturers want hub partners that can take a holistic approach and address each patient’s individual needs. Nasir also discusses how hub selection criteria are evolving.

Read on for Nasir’s insights.

Wednesday, February 07, 2024

Latest CMS Data Reveal the Truth About U.S. Drug Spending

The boffins at the Centers for Medicare & Medicaid Services (CMS) recently dropped the latest National Health Expenditure (NHE) data, which measures all U.S. spending on healthcare. (Links below.)

As you will see, retail and mail prescription drug spending remain a consistently small share of the $4.5 trillion that we spend on U.S. healthcare.

And contrary to what you might read, drug spending growth was *not* driven by purportedly “skyrocketing” drug prices. In reality, nearly all drug spending growth occurred due to growth in the number of people treated, prescriptions dispensed, and other nonprice factors.

Tomorrow, we’ll be treated to a Senate show trial featuring pharmaceutical company executives. Sadly, pharma industry perma-critics 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. Will drug pricing flat earthers (#DPFE) ever acknowledge the data?