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 55,000 subscribers and followers. Learn more...

Tuesday, December 06, 2022

CVS, Walgreens, and Walmart Keep Position in 2023 Part D Preferred Networks—While Kroger Bails Over its Express Scripts Blowup

In Preferred Pharmacy Networks in 2023’s Medicare Part D Plans: Cigna, CVS Health, Humana, UnitedHealthcare, WellCare, and More, I highlighted how those networks have taken over the world of stand-alone Medicare Part D prescription drug plans (PDP) and become a major presence in Medicare Advantage prescription drug (MA-PD) plans.

Today, I examine the seven largest retail chains’ 2023 participation in the 22 major 2023 Part D preferred networks that the eight largest plan sponsors will offer. As always, I offer you a handy table for scoring each chain’s participation and changes from 2022 to 2023.

As you’ll see, Kroger’s decision to exit Express Scripts commercial pharmacy networks has had negative ramifications for its Part D position. Kroger will be out-of-network—not just non-preferred—in the major Part D networks for which Express Scripts acts as the PBM. That will be  a key factor behind its $1+ billion revenue hit.

Speaking of 2023, please join me for my upcoming live video webinar, Drug Channels Outlook 2023, on December 16, 2022, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.


PREFER ME

Preferred network models have grown rapidly within the Medicare Part D program. The Centers for Medicare & Medicaid Services (CMS) calls them preferred cost sharing networks. CMS calls the pharmacies in such networks preferred cost sharing pharmacies.

For 2023, nearly all of the total 804 Medicare Part D regional prescription drug plans (PDP) have a preferred network. See our previous article for more details on next year’s market.

We have examined the 22 Part D plans offered by eight major companies. There will be 21 major multi-regional Part D plans with preferred cost sharing pharmacy networks and 1 smaller plan (Elixir RxPlus). These companies will operate 725 regional PDPs, which equates to 90% of total regional PDPs. For each plan, we have identified the network status of seven large retail chains.

You can find our analysis of retail chain participation in 2022 plans here: CVS, Walgreens, Walmart, and Supermarkets Keep Position in 2022 Part D Preferred Networks—With a Little Help from 340B. For more on the economics and strategies of narrow networks, see Chapter 7 of our 2022 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

CHAIN REACTION

With the exception of Kroger and Rite Aid, the major chains will be in a comparable share of the total available networks in 2023 compared with 2022.

The table below summarizes retail chain participation as preferred pharmacies. The green shaded boxes indicate a chain’s addition as a preferred pharmacy to a 2023 network (vs. 2022). The red shaded boxes indicate a chain's removal as a preferred pharmacy from a 2023 network (vs. 2022). "n/a" indicates that chain is out-of-network for 2023. Click here to download the table as a PDF.

[Click to Enlarge]

Here are the highlights of pharmacy participation in 2023 Part D preferred networks:
  • CVS Health. Since the 2018 plan year, CVS Health’s retail pharmacies have actively pursued preferred status in Part D plans. For 2023, CVS pharmacies will be preferred in 13 of the 22 plans tracked in the table above. CVS’s participation is comparable to that of 2022.
  • Walgreens Boots Alliance. Since 2021, Walgreens has focused on participation in preferred networks. For 2023, it will be preferred in nine plans. However, for 2023, Walgreens will be an out-of-network pharmacy for Aetna’s SilverScript SmartSaver.
  • Walmart. Beginning in 2020, Walmart reengaged with preferred cost sharing networks. For 2023, it will again have a leading position as a preferred pharmacy in 18 of the 22 major plans. It did not lose preferred status in any plans, and gained position in the new Mutual of Omaha Rx Plus plan.

    Medicare history buffs should note that Walmart and Humana launched the first Part D preferred network plan, in 2010. This plan is now known as the Humana Walmart Value Rx Plan. Despite the plan’s name, Albertsons and Publix will again be preferred in it for 2023.
  • Rite Aid. The industry’s smallest large chain boosted its participation in the major networks, despite its limited geographic scope. For 2023, Rite Aid will participate as a preferred pharmacy in eight plans that are sponsored by external companies, as well as the two plans sponsored by Elixir, its in-house PBM. As you can see above, Rite Aid added five plans that exclude Kroger from their networks.
  • Other supermarket chains. Albertsons and Publix retained their participation in the preferred networks for the fifth consecutive year. Albertsons pharmacies will again be preferred in 16 plans, while Publix will be preferred in 14 plans.
Note that pharmacies that don't participate as preferred pharmacies can still access a substantial portion of the Part D market. That's because beneficiaries who qualify for the Low-Income Subsidy (LIS) face low out-of-pocket drug costs regardless of a pharmacy’s preferred status. For 2020, 14.2 million people received the full or partial LIS.

Tomorrow, I’ll delve into how smaller pharmacies will participate in the 2023 Part D plans, by examining the pharmacy services administrative organizations (PSAOs).

Friday, December 02, 2022

Developing a Channel Strategy that Optimizes Gross-to-Net

Today’s guest post comes from Deepak Thomas, Founder and CEO of PHIL Inc.

Deepak explains how a manufacturer’s net revenues are affected when that manufacturer helps patients access, afford, and adhere to medication therapy. He provides three suggestions for building a channel strategy to optimize gross-to-net while also improving clinical, financial, and operational outcomes.

Click here to learn about PHIL’s access and commercialization solutions.

Read on for Deepak’s insights.

Tuesday, November 29, 2022

Drug Channels News Roundup, November 2022: Mark Cuban vs. Elon Musk, Lessons from Semglee, Gen Z vs. Pharmacy Careers, 340B Transparency, and I ♥ the 90s

I hope everyone enjoyed the Thanksgiving holiday! Now that you’ve stretched your stomach, stretch your mind with some food for thought. In this issue:
  • Mark Cuban schools Elon Musk on PBMs
  • Market access lessons from Semglee
  • Gen Z rejects the pharmacy career path
  • A potent call for 340B transparency
Plus, get ready to love the ‘90s again!

P.S. Join my more than 34,000 LinkedIn followers for daily links to neat stuff. If you haven't quit Twitter, you can also find my daily posts at @DrugChannels on Twitter, where I have more than 15,500 followers.

Please join me for my upcoming live video webinar, Drug Channels Outlook 2023, on December 16, 2022, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Friday, November 18, 2022

Engage Specialists in Their Workflow With GoodRx Provider Mode

Today’s guest post comes from Bansi Nagji, President of Healthcare at GoodRx.

Bansi explains how GoodRx Provider Mode delivers a prescription savings flow that offers health care professionals (HCPs) efficient access to the information they need at critical moments of care.

Click here to learn how GoodRx Provider Mode can help manufacturers reach and engage HCPs.

Read on for Bansi’s insights.

Tuesday, November 15, 2022

Behind the GoodRx-Express Scripts Partnership: How PBMs Profit from Discount Cards in Pharmacy Benefits

Last week, GoodRx announced that it would become the exclusive prescription discount card provider for the commercial beneficiaries of Cigna’s Express Scripts. Links below.

The rise of discount card pricing within pharmacy benefit plans is a positive development. Patients get access to market prices that can  be lower than their PBM’s contracted rate. All out-of-pocket spending with a discount card counts toward a patient's deductibles, and all prescription activity gets captured.

However, I suspect few people understand that placing discount cards within the pharmacy benefit enables a PBM to monetize a new fee stream from the card vendor. Below, I walk through this booming business and highlight some of the conflicts and contradictions underneath the coconuts.

I’ll cover what’s next for PBMs and discount cards during my upcoming live video webinar, Drug Channels Outlook 2023, on December 16, 2022, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Friday, November 11, 2022

Cell and Gene Therapy Roundup: What the Road to Success Looks Like

Today’s guest post comes from Lung-I Cheng, Vice President of Cell & Gene Therapy at AmerisourceBergen.

Lung-I discusses advancements in cell and gene therapy and explains how to tackle the challenges facing manufacturers, providers, and patients.

Click here to learn about AmerisourceBergen’s Cell and Gene Therapy solutions for biopharma companies, providers, and patients.

Read on for Lung-I’s insights.

Wednesday, November 09, 2022

Drug Channels Outlook 2023 (NEW Live Video Webinar)

Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for a new live video webinar:

Drug Channels Outlook 2023
Friday, December 16, 2022
12:00 p.m. to 1:30 p.m. ET.

This page describes the event and explains how to purchase a registration to the live event. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

WHAT YOU WILL LEARN

Join Dr. Fein as he helps you and your team get ready for 2023 by outlining key issues and uncertainties that will surely affect your planning. This event can be both a capstone of your annual learning and a touchpoint for the future. Dr. Fein will draw from exclusive information found in DCI’s industry economic reports.

During the event, Dr. Fein will share his latest thinking on a wide range of topics, including:
  • Update on the retail pharmact market
  • The Medicare Part D Redesign
  • What's next for the Inflation Reduction Act of 2022
  • Vertical integration and consolidation trends
  • PBM industry developments and government actions
  • Disruption from discount cards and cash-pay pharmacies
  • Predictions for biosimilar Humira competition
  • The latest on copay accumulators and maximizers
  • Likely 340B Drug Pricing Program developments
  • Hospitals and health systems in the pharmacy channel
  • The primary care M&A boom
  • And more!
As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data. 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.

After the event, every registrant will receive a link to download the complete slide deck and have an opportunity to watch a replay of the live event.

Read on for full details on pricing and registration.

Tuesday, November 08, 2022

The Consolidated Drug Channel and Cash-Pay Drugs: My Podcast with a16z's Julie Yoo

I recently joined Julie Yoo on Bio Eats World, a podcast from legendary venture capital firm Andreessen Horowitz (also known as "a16z"). Julie is a General Partner at Andreessen Horowitz.

We chatted about the current state of the U.S. drug channel, the roles and controversies around pharmacy benefit managers (PBMs), GoodRx, Mark Cuban’s cost-plus pharmacy, the 340B Drug Pricing Program, and much more. I also shared some thoughts on opportunities for entrepreneurs in such a consolidated space. The episode is about 36 minutes long.

The podcast audio is embedded below, along with links to the episode on major podcast platforms.

Enjoy!

P.S. Let me know if you’d like to see more audio/podcast content on Drug Channels.

Friday, November 04, 2022

Innovate4Outcomes: Collaborating to Solve Antimicrobial Resistance

Today’s guest post comes from Matthew Balogh, Head of Digital Marketing at Melinta Therapeutics.

Matt discusses the ongoing global problem of antimicrobial resistance (AMR). He suggests that lessons learned from the COVID-19 pandemic can inform both innovation in AMR therapies and our understanding of AMR.

To learn more about the global challenge of AMR and brainstorm solutions, request an invitation to Innovate4Outcomes®. This virtual event is presented by OptimizeRx in collaboration with Melina Therapeutics.

Read on for Matt’s insights.

Tuesday, November 01, 2022

Preferred Pharmacy Networks in 2023’s Medicare Part D Plans: Cigna, CVS Health, Humana, UnitedHealthcare, WellCare, and More

Open enrollment is under way for the 2023 Medicare Part D plans. Our exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals that preferred cost sharing pharmacy networks will maintain their dominance as an established component of Part D benefit design.

For 2023:
  • 98% of stand-alone Medicare Part D prescription drug plans (PDP) will have a preferred network.
  • 52% of Medicare Advantage prescription drug (MA-PD) plans will have a preferred network.
Below, I provide historical data on preferred networks’ growth and update the top companies’ 2023 offerings.

The largest companies made only minor changes to their 2023 stand-alone plans, after streamlining their 2022 plans. I also update our analysis of the prevalence of preferred networks in three different types of MA-PD plans.

In upcoming articles, I’ll investigate what we can deduce from chain and independent pharmacies’ participation in the major 2023 preferred networks.

Friday, October 28, 2022

How the Therapy Warranty Model Shifts the Paradigm of Therapy Success

Today’s guest post comes from Brooks Wildasin, Vice President of Product Management at CareMetx.

Brooks introduces us to CareMetx’s specialty therapy warranty, a specialty patient outcome-based contract model. Download CareMetx’s 2022 Report: The Evolving Landscape of Digital Healthcare Hubs to learn more about digital hub services and CareMetx’s solutions that improve the patient journey.

Read on for Brooks’ insights.

Tuesday, October 25, 2022

Drug Channels News Roundup, October 2022: Mark Cuban on PBMs, Walgreens & 340B, Biosimilar Boom Update, Physicians vs. UM, and Wellness at Walgreens

Eeek! Time for my Halloween roundup of wicked Drug Channels’ tales. This month’s tricks and treats:
  • Eerie! Mark Cuban tells ghost stories about PBMs.
  • Shocking! Walgreens terrifies Wall Street with its 340B losses.
  • Vampiric! Sink your fangs into Amgen’s fantastic new report on the biosimilar boom
  • Wicked! Physicians think payers cast evil utilization management spells.
Plus, Walgreens launches a refreshing new wellness service.

P.S. Join my more than 33,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 15,400 followers.