Profits in the 2013 Fortune 500: Wholesalers, PBMs, and Pharmacies vs. Manufacturers

Time once again for my annual review of the latest Fortune 500 list. Here, I explore the relative profitability of the largest drug wholesalers, chain pharmacies, pharmacy benefit managers (PBMs), and pharmaceutical manufacturers. I also compare these groups with independent pharmacies. These data will help you understand how drug channel intermediaries make money.

Key observations from the new Fortune list:

• Drug channel companies have higher revenues than pharmaceutical manufacturers, so they rank higher on the Fortune 500. This results from quadruple-counting of prescription revenues within the channel. See my explanation below.

• Drug channels companies are profitable. When their profits are measured by Return on Sales, profits of wholesalers, PBMs, and pharmacies are only one-tenth of manufacturer profits. But when these profits are measured by Return on Assets, channel company profitability is about half that of pharmaceutical manufacturers.

• For the second straight year, investors earned higher returns from drugmakers than from the drug channels group. However, the drug channels group has still outperformed manufacturers over the past 10 years.

• The profitability of a typical independent pharmacy is higher than the profitability of the eight largest drug channels companies, including PBMs. Sorry to be the bearer of...good news?

You’ll find the the technical notes are at the bottom. Add a comment or opinion. Enjoy!

Speed to Therapy

Check out the agenda for CBI’s 2013 Speed to Therapy: A Multi-Stakeholder Examination of Time to Fill and the Patient Journey.

This new conference hits a hot spot for anyone planning a channel strategy that will improve the patient’s real world experience. The agenda hits all the right topics, including: payer strategies, benchmarking, measurement, technology, and the role of specialty pharmacies. Speakers come from such companies as Aegerion Pharmaceuticals, Alkermes, AmeriCares, Avera McKennan Hospital, Celgene, GlaxoSmithKline, Novant Health Oncology Specialists, Sigma-Tau Pharmaceuticals and more.

Until June 7, Drug Channels readers can register with discount code KXJ559 and save $400. (Sorry, this special discount cannot be combined with the advantage pricing offer.) After June 7, register with discount code EHF627 and save $300 (no expiration date). Thanks CBI!

More Drug Trend Forecasts: An Exclusive Look at Prime Therapeutics vs. the Big Two PBMs

In New Drug Trend Forecasts: Express Scripts vs. CVS Caremark, I analyze and compare the latest drug trend projections from the two largest pharmacy benefit managers (PBMs)—Express Scripts (NASDAQ: ESRX) and CVS Caremark (NYSE: CVS).

Feeling left out, Prime Therapeutics sent me its heretofore unpublished 2013-2015 forecasts. So, today’s article is a Drug Channels exclusive. Highlights:

• Prime expects traditional trend to be much higher than either Express Scripts or CVS Caremark. See below for their explanation.
• Prime’s specialty forecast is comparable to the outlook from the big two PBMs.
• In 2017, Prime expects specialty drugs to be 50% of combined pharmacy and medical benefit drug spending.

Below, I also give Prime an opportunity to explain why it stopped publishing a conventional drug trend report in favor of its 10-foot long comic strip.

Check back in three years and we’ll see which PBM turned out to be right. In the meantime, Prime has started a Drug Trend blog.

New Drug Trend Forecasts: Express Scripts vs. CVS Caremark

Last week, Express Scripts released its projection for drug trend—the annual change in prescription drug expenditures of its clients. Surprisingly, the new projections differ significantly from CVS Caremark’s forecasts. Highlights:

• Express Scripts expects traditional (non-specialty) drug trend to remain negative, while CVS Caremark sees traditional drug trend increasing. The outcome has significant implications for the retail pharmacy industry.

• Both PBMs agree that specialty trend will remain high (>15% per year), but Express Scripts sees slightly slower growth.

Read on for the details. Regardless of which forecast you believe, specialty drugs will be at least 50% of pharmacy benefit spending within 6 years. Get ready.

Drug Channels News Roundup: May 2013

Summer is just around the corner. Time to clean the barbecue and start grilling! In the meantime, enjoy my latest selection of noteworthy news stories from the Drug Channels universe.

In this issue:

• Skewered—Ranbaxy was naughtier than you thought (MUST READ)
• Smoky—340B is worse than you imagined
• Tasty—Duane Reade is more innovative than you think
• Grilled—Walgreen’s SmartD Part D plan was also naughty

Plus, SNL highlights an important new indication for Xanax, just in time for the summer wedding season.

P.S. Before you enjoy the long weekend, please consider a donation to the American Red Cross Disaster Relief.

Armada 2013: Specialty Pharmacy Gets More Competitive

In early May, I hit the always-energizing Armada Specialty Pharmacy Summit in Las Vegas. Larry and Robert Irene certainly know how to throw a top-quality networking event. And the Wynn, my favorite Vegas hotel, never disappoints.

In violation of Vegas code, I'll tell you what happened there…or at least the part related to the specialty pharmacy market.

The industry’s rapid growth has created a large, diverse specialty pharmacy marketplace. But at this year's Armada Summit, it’s clear that all levels of the specialty industry are also becoming much more competitive. Below are my observations from the meeting, a brief video interview discussing marketplace competition, and a bonus photo of me hard at work in Las Vegas.

Special thanks to the many, many Drug Channels readers who introduced themselves during the Summit. I truly enjoyed our conversations and your insights, and I feel privileged to have such enthusiastic readers.

Will Narrowing Pharmacy Networks Squeeze Manufacturers?

Pharmaceutical Executive's May 2013 issue includes Pharmacy Benefit Networks: The Big Squeeze, a new article by yours truly.

The article's first half, excerpted from Chapter 8 of the 2012-13 Economic Report on Retail, Mail, and Specialty Pharmacies, analyzes the narrow pharmacy network trend and highlights its economic appeal to payers and pharmacies.

The article's second half contains my heretofore unpublished views on:

• How the narrow network revolution will affect pharmaceutical manufacturers’ commercial activities
• How manufacturers can best prepare for and respond to the risks and challenges of narrow pharmacy networks

Read the article's introduction below. As always, I welcome your comments.

How the Pharmacy Industry Ch-ch-changed in 2012

Last week, the IMS Institute for Healthcare Informatics released its official 2012 market data in the report Declining Medicine Use and Costs: For Better or Worse? (Free download with registration.) The report offers loads of interesting stats, but I focus here on the prescription data.

The highlights:

• Total retail prescription growth was 1.2% in 2012, a rebound from 2011’s especially weak growth of 0.3%.
• For the first time in nine years, chains lost market share, as they grew more slowly than the overall industry.
• Supermarkets staged an unexpected comeback, outpacing all other dispensing formats.
• Independents and mail pharmacies shrank both in absolute size and market share.

Read on for my observations on the 2012 data and the five-year (2008-2012) pharmacy market evolution. Time may change us, but we can't trace time.

Pharmacist Salaries Hit $117K and Keep Climbing

The Bureau of Labor Statistics (BLS) just released the 2012 Occupational Employment and Wages data. Once again, pharmacist salaries grew faster than did overall wages.

The highlights:

• In 2012, average gross salary for pharmacists at retail, mail, and specialty pharmacies was $117,000—up 2.7% from 2011.
• Of the 1,089 occupations in the Occupational Employment Statistics (OES) survey, the “pharmacist” classification ranked 35th in compensation. (The top 10 most highly compensated U.S. occupations are all physician-related.)
• Pharmacist salaries grew faster than did overall healthcare worker salaries and overall U.S. salaries.

Are pharmacists undervalued? Not if money equals appreciation. Read on for the details.

My Controversial 340B Op-Ed

Last week, congressional news site The Hill published my editorial on the 340B drug discount program. Read it here: Hospitals twist prescription assistance program for their own benefit. (The full text is also pasted below).

Some of you will agree with my perspective. Others of you will violently disagree. Please post your comments on Drug Channels. All points of view welcome!

For background, here are my two most recent articles on 340B:

• Hospitals' Extraordinary 340B Pharmacy Profits from Insured Patients
• The Coming Battle Over 340B Contract Pharmacies

Get Ready for the 2013 Armada Specialty Pharmacy Summit

Next week, I’ll be attending the always-great Armada Specialty Pharmacy Summit in Las Vegas. I enjoy meeting Drug Channels readers, so please introduce yourself. Email me to schedule a one-on-one meeting, especially if you're with a bio/pharm manufacturer and working on specialty channel strategies.

This year's agenda looks especially strong. To help you get ready, below are a selection of Drug Channels articles related to next week's business sessions.

To coincide with the 2013 summit, the Drug Channels Institute is offering a special discount on our 2012–13 Economic Report on Retail, Mail, and Specialty Pharmacies. Use discount code ARMADA2013. Hurry, because the discount expires on May 20, 2013!

See you in Vegas!

What’s Behind AmerisourceBergen’s Disappointing Oncology Results?

Last week, AmerisourceBergen (NYSE: ABC) reported financial results for the March 2013 quarter. Here’s the press release: AmerisourceBergen Reports $0.87 in Diluted EPS from Continuing Operations, and Revenue of $20.5 Billion for the March 2013 Quarter.

One surprise was the “disappointing performance” in ABC’s oncology business, which accounts for about 40% of its Specialty Group business and 7% of overall revenues.

While management pointed to the sequester, such oncology market changes as practice consolidation and white-bagging are bigger long-term negatives for specialty distributors. Below, I highlight some telling comments by CEO Steve Collis regarding the industry’s evolution.

Specialty distributors face significant risks from changes in the community oncology market. Do ABC’s results foreshadow an oncology market turning point, or simply reflect a short-term government reimbursement cut? Will the specialty distribution and full-line wholesale trade classes blur together? Read on and see what you think.