Summer's in full swing, but the drug channel didn't take a break.
What better way to spend the summer than reading about new pharmacy resources in the Drug Channels News Roundup?
In this issue: Extra: Who are the Villains in the Drug Channel?
P.S. Join my nearly 40,000 LinkedIn followers for valuable daily posts at 9 a.m. ET.
Generic and Biosimilar Economics in a Payer-Engineered Market, IQVIA
Between 2009-2013, generic drugs reached 57% of peak uptake within 1 month of launch.
In the last five years, it took 6 months on average to reach the same level.
This slowdown in adoption isn't necessarily from reduced competition or prescriber resistance—it's coming from more control of coverage from payers/PBMs.
A Drug Channels Institute analysis from earlier this year covers how Optum Rx formularies for Humira include only two preferred options, both from Amgen including the Nuvaila-branded version. Most other biosimilars were removed entirely.
Loss of exclusivity is now a PBM-determined process rather than a passive market event.
In the last five years, it took 6 months on average to reach the same level.
This slowdown in adoption isn't necessarily from reduced competition or prescriber resistance—it's coming from more control of coverage from payers/PBMs.
[Click to Enlarge]
A Drug Channels Institute analysis from earlier this year covers how Optum Rx formularies for Humira include only two preferred options, both from Amgen including the Nuvaila-branded version. Most other biosimilars were removed entirely.
Loss of exclusivity is now a PBM-determined process rather than a passive market event.
2026 Medicare Trustees Report, CMS
The CMS Chief Actuary used two words to describe Part D spending trends in this year's Trustees report vs last year's:
"Considerably higher."
Medicare Part D spending jumped 15% in one year from $157 billion in 2024 to $180 billion in 2025.
It's projected to jump another 21% to $218 billion for 2026.
According to the Trustees report, the three primary drivers of these considerably higher trends are:
"Considerably higher."
Medicare Part D spending jumped 15% in one year from $157 billion in 2024 to $180 billion in 2025.
It's projected to jump another 21% to $218 billion for 2026.
According to the Trustees report, the three primary drivers of these considerably higher trends are:
- GLP-1 utilization
- Specialty drug spending, particularly in non-low-income populations
- Lower Direct and Indirect Remuneration (DIR, A.K.A. rebates) than projected
[Click to Enlarge]
Analysis of 340B Program Impact on Rural Hospitals, Avalere
Another one of the differences in 340B that highlights the disparities in the program is rural 340B hospitals vs non-rural.
The National Grange, a family/community organization with its roots in agriculture, hired Avalere Health to parse the data on 340B using Medicare claims by rural vs non rural.
Here are some of the major differences:
The analysis performed dozens of other comparisons of the data, so go to the source for more!
Based on this data, it appears any 340B reform that treats rural and non-rural hospitals the same could have unintended consequences, so reforms need to consider these differences.
The National Grange, a family/community organization with its roots in agriculture, hired Avalere Health to parse the data on 340B using Medicare claims by rural vs non rural.
Here are some of the major differences:
[Click to Enlarge]
The analysis performed dozens of other comparisons of the data, so go to the source for more!
Based on this data, it appears any 340B reform that treats rural and non-rural hospitals the same could have unintended consequences, so reforms need to consider these differences.
340B considerations for self-funded employers, Milliman
Every dollar of 340B profit growth for covered entities is coming from somewhere, and a major portion are commercial plans like employers. We covered the math for Minnesota in Minnesota’s 340B Hospitals Make One Billion More From 340B Than They Spend on Uncompensated Care.
However, there are actions that plans can take to contain the impact to their plan spending.
The image below summarizes five ways Milliman covers how plans can protect themselves from paying more 340B margins to covered entities and losing the plan’s rebates.
More details on each strategy are in the white paper.
However, there are actions that plans can take to contain the impact to their plan spending.
The image below summarizes five ways Milliman covers how plans can protect themselves from paying more 340B margins to covered entities and losing the plan’s rebates.
[Click to Enlarge]
More details on each strategy are in the white paper.
Hard Pills to Swallow for the Drug Channel, LinkedIn
The drug channel doesn't have a villain.
It has a structure, and every structure has consequences.
When one cost gets addressed, that money was someone else's revenue and not everyone is willing to accept less money for the same work.
We have to decide which tradeoffs we're willing to accept, and who ends up holding the pressure from the downsides of those tradeoffs.
It has a structure, and every structure has consequences.
When one cost gets addressed, that money was someone else's revenue and not everyone is willing to accept less money for the same work.
[Click to Enlarge]
We have to decide which tradeoffs we're willing to accept, and who ends up holding the pressure from the downsides of those tradeoffs.
No comments:
Post a Comment