While you wait for kickoff, please enjoy this month’s playbook of articles, intercepted for you from the Drug Channels gridiron: Plus: Will Ozempic's new ad campaign make us nostalgic for 2006?
P.S. Join my more than 67,000 LinkedIn followers for daily links to neat stuff, along with sharp, thoughtful commentary from the DCI community.
Payment and Delivery Innovation in Healthcare, Johns Hopkins University
Grab some popcorn and watch this outstanding debate between Mark Cuban and Patrick Conway, expertly moderated by the fabulous Ge Bai. (Start watching at 1:29:20.)
Cuban directly challenged Dr. Conway in a way that we rarely see on stage. They covered OptumRx’s PBM practices, biosimilars, reimbursement, networks, cost-plus pricing, and much more.
We could use more open and unscripted conversations like this one.
P.S. Thanks for the shout-out around 2:05:36, Mark!
Cuban directly challenged Dr. Conway in a way that we rarely see on stage. They covered OptumRx’s PBM practices, biosimilars, reimbursement, networks, cost-plus pricing, and much more.
We could use more open and unscripted conversations like this one.
P.S. Thanks for the shout-out around 2:05:36, Mark!
Private Label Biosimilars: A New Twist on Wholesalers’ Vertical Integration, LinkedIn
Here we go.
McKesson's NorthStaRx business recently received a national drug code (NDC) for Stimufend, Fresenius Kabi's pegfilgrastim-fpgk biosimilar of Neulasta.
This development qualifies as an “inevitable surprise.” As I pointed out in The Future of Buy-and-Bill Market Access: Five Drivers of Wholesalers’ Vertical Integration with Physician Practices, wholesalers' vertical integration strategies give them newfound leverage over market access for provider-administered drugs.
The key question remains: Can wholesalers successfully transform from transactional intermediaries into true market makers that can leverage ownership, contracting, data, and access to influence therapy and extract incremental profits?
Private label biosimilars show one major way wholesalers will operationalize their growing channel power.
McKesson's NorthStaRx business recently received a national drug code (NDC) for Stimufend, Fresenius Kabi's pegfilgrastim-fpgk biosimilar of Neulasta.
[Click to Enlarge]
This development qualifies as an “inevitable surprise.” As I pointed out in The Future of Buy-and-Bill Market Access: Five Drivers of Wholesalers’ Vertical Integration with Physician Practices, wholesalers' vertical integration strategies give them newfound leverage over market access for provider-administered drugs.
The key question remains: Can wholesalers successfully transform from transactional intermediaries into true market makers that can leverage ownership, contracting, data, and access to influence therapy and extract incremental profits?
Private label biosimilars show one major way wholesalers will operationalize their growing channel power.
State Copay Accumulator Bans Now Affect At Least 17% of Commercial Lives, Avalere
A growing number of states now restrict copay accumulator programs. These state laws apply only to fully insured plans and those sold through a health insurance marketplace. States lack authority to ban accumulators in self-insured health plans, which still account for the majority of commercial coverage.
For 2025, an estimated 17% of the total U.S. commercial market—more than 34 million individuals—were enrolled in plans that must count copay assistance toward patient cost sharing limits. Three weeks ago, New Jersey became the 26th state to enact an anti-accumulator law.
Good news for patients, but bad news for the PBMs and businesses that profit from these programs.
Unfortunately, Avalere believes that shady alternative funding programs (AFPs) are the next insurance company loophole. Let’s hope they’re wrong!
ICYMI, I reviewed copay accumulators, copay maximizers, and alternative funding programs in this short video.
For 2025, an estimated 17% of the total U.S. commercial market—more than 34 million individuals—were enrolled in plans that must count copay assistance toward patient cost sharing limits. Three weeks ago, New Jersey became the 26th state to enact an anti-accumulator law.
[Click to Enlarge]
Good news for patients, but bad news for the PBMs and businesses that profit from these programs.
Unfortunately, Avalere believes that shady alternative funding programs (AFPs) are the next insurance company loophole. Let’s hope they’re wrong!
ICYMI, I reviewed copay accumulators, copay maximizers, and alternative funding programs in this short video.
Variations in outpatient hospital reimbursement for autoimmune drugs , Milliman
This new analysis from Milliman finds that 340B hospitals continue to earn substantially higher margins on specialty drugs than non-340B hospitals. For 16 drugs, estimated 340B profit margins ranged from 167% to an outrageous 180,721%—far above margins at non-340B hospitals.
Despite these windfall gains, no one can say where the 340B profits go, which patients benefit, or whether the funds are being used properly.
Alas, most people and their elected representatives fail to understand how providers and channel participants mark up drugs. In many cases, the manufacturer gets a small fraction of what plans pay for a drug, while hospitals earn thousands of dollars more per drug than the drug’s manufacturer does.
Meanwhile, insurers blame “drug prices” while conveniently overlooking their own role in allowing powerful providers to inflate drug spending.
What a mess.
[Click to Enlarge]
Despite these windfall gains, no one can say where the 340B profits go, which patients benefit, or whether the funds are being used properly.
Alas, most people and their elected representatives fail to understand how providers and channel participants mark up drugs. In many cases, the manufacturer gets a small fraction of what plans pay for a drug, while hospitals earn thousands of dollars more per drug than the drug’s manufacturer does.
Meanwhile, insurers blame “drug prices” while conveniently overlooking their own role in allowing powerful providers to inflate drug spending.
What a mess.
Game Show, Ozempic® (semaglutide) on YouTube
Remember those amusing “I’m a Mac, and I’m a PC” commercials from about 20 years ago?
Well, Novo Nordisk certainly hopes you do. It just launched a new “There’s Only One Ozempic” campaign featuring Justin Long and John Hodgman, the stars of those nostalgic computer ads.
Click here to watch the first one. It’s about 45 seconds of cringe followed by Justin Long reading the entire package insert for almost 3 minutes.
If you’re a glutton for punishment, you can view all of the ads on the Ozempic® (semaglutide) YouTube channel. Caveat viewer.
P.S. Novo Nordisk has blocked embedding, so you’ll have to click the links to watch the videos.
Well, Novo Nordisk certainly hopes you do. It just launched a new “There’s Only One Ozempic” campaign featuring Justin Long and John Hodgman, the stars of those nostalgic computer ads.
Click here to watch the first one. It’s about 45 seconds of cringe followed by Justin Long reading the entire package insert for almost 3 minutes.
If you’re a glutton for punishment, you can view all of the ads on the Ozempic® (semaglutide) YouTube channel. Caveat viewer.
P.S. Novo Nordisk has blocked embedding, so you’ll have to click the links to watch the videos.
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