Pharmacy Channels delivers timely analysis and provocative opinions on pharmaceutical economics and the pharmacy distribution system. It is written by Adam J. Fein, Ph.D., one of the country's foremost experts on pharmaceutical economics and channel strategy. Pharmacy Channels reaches an engaged, loyal and growing audience of more than 20,000 subscribers. Learn more...

Monday, May 21, 2018

CBI's Reimbursement and Access 2018

Reimbursement and Access 2018
August 15-16, 2018 | Philadelphia, PA
www.cbinet.com/reimbursement

For all companies within the life sciences arena, staying on the pulse of emerging trends, ensuring favorable reimbursement and justifying product prices are core pillars of overall product success. Whether your organization is pre-commercial or managing multiple products, CBI’s highly-acclaimed Reimbursement and Access arms attendees with invaluable learning, practical strategies and tangible takeaways on the most impactful ways to reduce barriers to access.

Join CBI in Philadelphia this August 15-16 at Reimbursement and Access 2018 for unparalleled insights and practical expertise.

Register today! Pharmacy Channels readers will save $500 off the standard registration rate when they use discount code JUR627*

High-Impact Topics Transforming Access Strategy Including:
  • Copay Accumulators and PBM Restrictions
  • Evolving Health Policy Landscape
  • Value-Based Contracting
  • Formulary Management
  • Biosimilar Strategy and Access
  • Payer Engagement
  • Cell and Gene Therapies
  • Temporary Supply and Quick Start Programs
Dynamic Dialogue Driven by a Multistakeholder Speaking Faculty Representing:
AbbVie • Adama’s Pharmaceuticals • America’s Health Insurance Plan (AHIP) • Avalere, an Inovalon Company • BIO • Boehringer Ingelheim • Braeburn • Covington & Burling • CSL Behring • Eisai, Inc. • Frier Levitt • Health Results Group • Heron Therapeutics • Ipsen Biopharmaceuticals • Johnson & Johnson Health Care Systems • Jupiter Life Sciences Consulting • Kaiser Permanente Institute for Health Policy • King and Spaulding • Kite, a Gilead Company • Pfizer • Regional Cancer Care Associates • Sobi • Spark Therapeutics • U.S. Attorney’s Office for the District of New Jersey • U.S. Attorney’s Office for the Eastern District of Pennsylvania • U.S. Attorney’s Office for the Western District of Oklahoma • Walgreens • Xcenda • And More!


Visit www.cbinet.com/reimbursement for more information. Pharmacy Channels readers will save $500 off the standard registration rate when they use discount code JUR627*

*Discount expires 06/22/2018 and may not be combined with other offers, category rates, promotions, or applied towards an existing registration. Offer not valid on workshop only or academic/nonprofit registrations. Other restrictions may apply.


The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Pharmacy Channels, or any of its employees.

Tuesday, May 15, 2018

The Trump Pharmacy Pricing Plan: Short Term Reprieve, Long Term Disruption

Last Friday, the U.S. Department of Health & Human Services (HHS) released American Patients First, a report billed as “The Trump Administration Blueprint to Lower Pharmacy Prices and Reduce Out-of-Pocket Costs.” This administration’s blueprint offers a thoughtful diagnosis of U.S. pharmacy pricing along with the unintended consequences and warped incentives of our pharmacy channel system.

The report also proposes a very long list of more than 50 regulatory and legislative fixes. It therefore doesn’t translate to quick action or simple sound bites. Many people are discounting the plan as no big deal and therefore underestimating how radically the system could change.

Below, I review some of its more radical notions—and highlight why the document's ideas pose substantial long-term risks for pharmacy channel companies and their profit models. I also examine proposed changes for modernizing the Medicare Part D program and discuss two popular but ineffective ideas that were omitted from the document. While I don’t cover it in this article, I suspect changes to the Medicare Part B program may arrive soon.

The blueprint avoids facile diagnoses and simplistic solutions. It therefore looked on Friday like a weak political move. However, I expect last Friday’s announcement will mark the start of many coming changes.

Monday, May 14, 2018

Partnering with IDNs BioPharma Strategy Summit

Partnering with IDNs BioPharma Strategy Summit
August 15-16, 2018 | Philadelphia, PA
www.cbinet.com/IDNStrategy

In this complex healthcare market, integrated delivery networks have different decision-making processes, the size to leverage price discussions and access to real-world data in order to assess a therapy’s value. It is up to manufacturers to understand what IDNs require to meet their goals and adapt their sales teams to support and communicate effectively with these customers.

CBI’s 3rd annual Partnering with IDNs BioPharma Strategy Summit convenes manufacturers and integrated delivery networks to discuss how to create a mutually beneficial partnership for data-driven product advancement, greater patient engagement and adherence, and optimal care coordination.

Pharmacy Channels readers will save $400 off the standard registration rate when they use discount code FGD662.* REGISTER TODAY!

Diverse Perspectives from Industry Pioneers:
  • Scott Canfield, Specialty Pharmacy Clinical Programs Manager, John Hopkins Home Care Group
  • Mark Fisher, Director – Key Account Lead, Sanofi Joint Health
  • Scott Garrett, Respiratory Institutional Regional Business Manager, Sunovion Pharmaceuticals
  • Brandon Newman, PharmD, MMHC, CSP, Program Director, Specialty Pharmacy, Vanderbilt University Medical Center
  • Elliot Jones, Regional Account Executive, IDNs-Northeast, Bayer
  • John Robicsek, Assistant Vice President, Strategy, Business and Program Development, Pharmacy Administration, Atrium Health
  • Michelle Templin, Vice President, Government Affairs and Business Development, MHA ACO Network
  • Ameet Wattamwar, Pharm.D., Pharmacy Manager, Transition of Care, NYU Langone Medical Center
Take Your Health System Strategy to the Next Level with Dynamic Sessions:
  • Engage with industry pioneers at this highly collaborative event and benefit from 5+ hours of dedicated networking opportunities
  • Learn new sales models for engaging large hospital systems and IDNs
  • Hear case studies around system care coordination and population health management
  • Analyze the impact of an outcomes-driven marketplace for payers and providers
  • Take away contracting strategies that provide the most value to organized customers
  • Initiate and nurture network-based relationships
  • Overcome the challenges of specialty data management
  • And more!

Visit www.cbinet.com/IDNStrategy for more information. Pharmacy Channels readers will save $400 off the standard registration rate when they use discount code FGD662*

*Applies to standard rates only and may not be combined with other offers, category rates, promotions or applied to an existing registration. Offer not valid on workshop only or academic/non-profit registrations.


The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Pharmacy Channels, or any of its employees.

Thursday, May 10, 2018

Reflections from #Asembia18: The State of Specialty Pharmacy 2018

Last week, Paula and I had the pleasure of attending Asembia’s 2018 Specialty Pharmacy Summit.

The Specialty Pharmacy Summit remains the most important forum in the specialty marketplace. This year, a record 6,500 people learned, networked, and connected in Las Vegas. It was another year of record attendance. (Here’s the official press release.) Pharmacy Channels again salutes Larry and Robert Irene for sustaining and growing an annual event that unites the entire industry.

Today marks the eighth year that I will violate Vegas code and tell you what happened there.

Below, I offer reflections on the meeting and highlight key specialty industry trends. You’ll also find a link to the conference’s Featured Session slides and a few cool photos. Feel free to add your own observations and photos in the comments section below.

Tuesday, May 08, 2018

Integrate 2018: Three Co-Located Summits

Integrate 2018: Three Co-Located Summits
July 23-25, 2018 | Philadelphia, PA
www.worldcongress.com/events/Integrate/

This July 23-25, Philadelphia will become home to Integrate 2018 featuring three one-day Pre-Summits and three Full Summits.
Choose one of three Pre-Summits:
  • The 2018 Copay Summit
  • Specialty Data & Access Strategies Master Class
  • AI & Blockchain Strategies Summit
Main Day Summits include:
  • 2nd Annual Patient Services Compliance Summit
  • 5th Annual Patient Support Services & Hub Design Summit
  • 5th Annual Specialty Network Design & Channel Optimization Summit
Truly customize your experience by selecting one-, two-, or three-day options and the specific tracks of your choice. One ticket price allows you access to any session from any of the three main day Summits.

Register with discount code DC200 and save $200 off of current registration rates!

Attendees will have the opportunity to break down silos and engage in forward-thinking discussions with cross-functional colleagues in order to develop best practices for improving support and access from manufacturer to patient, provider and networks.

Shared Keynotes include:
  • Examine Specialty Trends, Advancements, Emerging Partnerships, and Opportunities to Impact the Patient Journey and Improve Channel Strategies
  • MULTI-STAKEHOLDER PERSPECTIVES: Advance Stakeholder Collaborations to Navigate the Evolving Specialty Pharma Marketplace, Improve Channel Strategies and Align Stakeholders Across the Patient Journey
  • POLITICAL KEYNOTE: Insight into the Present Healthcare Landscape and its Implications on Patient Services, Specialty Pharmacy and Hub Design
  • PATIENT INSIGHTS: Understand the Patient Journey to Enhance Channel Strategies, Ensure Affordable Patient Services, Improve Specialty Distribution Operations, and Impact the Patient Experience
Confirmed speakers include executives representing:
Otsuka Pharmaceuticals | Walgreens | UPMC Health Plan | Pfizer | LuckFupus | Patient Advocate Foundation | CVS Specialty Pharmacy | Asembia | Accredo Express Scripts | Teva | Chiesi USA | Eisai | Sandoz Novartis | and many more!

Don’t miss out on this opportunity to experience unprecedented value, networking and education. Register with discount code DC200 and save $200 off of current registration rates!


The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Pharmacy Channels, or any of its employees.

Monday, May 07, 2018

EXCLUSIVE: The 340B Program Reached $19.3 Billion in 2017—As Hospitals’ Charity Care Has Dropped

The 340B Pharmacy Pricing Program continues to expand at double-digit rates. Our research reveals that these discounted sales hit a record $19.3 billion in 2017.

What’s more, we found that since 2014, purchases under the program have grown at an average rate of 29% per year. By comparison, manufacturers’ net pharmacy sales grew at an average rate of less than 5% over the same period.

Consequently, the 340B program has grown to account for at least 6% of the total U.S. pharmacy market.

Here’s another uncomfortable fact: Nearly all of the billions in 340B discounts have accrued to hospitals. Yet hospitals' charity care has dropped by almost $8 billion amid the 340B program’s astounding growth.

Read on for the latest details and ponder who really benefits from the 340B program's growth.

Friday, May 04, 2018

Employers Are Getting More Rebates Than Ever—But Sharing Little With Their Employees (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from January 2018.

Yesterday, I examined new data showing that employers are receiving an increasing share of the rebate money collected by pharmacy benefit managers. See Employers Are Extracting More of Their Rebate Dollars from PBMs.

The data, from a Pharmacy Benefit Management Institute (PBMI) survey, also documented a troubling reality. Employers acknowledged that they are hoarding rebates rather than sharing the savings with the employees whose prescriptions generated the rebate funds. It’s the first time that I’ve seen such an admission from plan sponsors.

Consider the data below as confirmation of the warped incentives caused by the gross-to-net bubble—the growing spread between a manufacturer’s list price for a pharmacy and the net price. Consider the diabetes example below. Fixing this situation will be more challenging than walking to Mordor. Point-of-sale (POS) rebates may be a good place to start, but employers seem unwilling to part with their precious.

Thursday, May 03, 2018

A Lesson from McKesson: How Specialty Pharmacy Growth Is Hurting Wholesalers (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from February 2018.

Last week, McKesson released its quarterly earnings for the fourth calendar quarter of 2017. See the links below.

The profit outlook for its distribution business was lower than Wall Street’s expectations, due partly to what management termed “customer and product mix.” Below, I offer my take on the three interrelated mix changes that challenge wholesalers' profits from the growth of specialty pharmacy pharmacys.

Wholesalers have been trying to alter their conventional pricing and contracting approaches to address these pressures, though it’s not clear how successful these efforts have been. The specialty boom may prove to be a mixed blessing for wholesalers.

Wednesday, May 02, 2018

Cigna-Express Scripts: Vertical Integration and PBMs’ Medical-Pharmacy Future (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from March 2018.

Wow. Yesterday, Cigna announced that it would acquire Express Scripts. See the links below.

Though Cigna was an unexpected acquirer, the deal confirms the importance of pharmacy and medical benefit integration. It also reinforces the role that pharmacy benefit management (PBM) plays in the pharmacy channel. PBMs are now linked closely to the expensive specialty pharmacys that treat smaller patient populations, not to the primary care blockbusters of yesteryear.

The strategic logic, however, is much more compelling for Express Scripts than it is for Cigna. Perhaps that’s why the stocks reacted so differently yesterday. Express Scripts’ stock closed up 9%, while Cigna’s stock closed down 12%. Better to sell a PBM than buy one?

Below, I provide data about the PBM market, highlight vertical integration between PBMs and insurers, and discuss other industry implications.

Please feel free to leave your own $0.02 below. If you’re shy, you can comment anonymously.

Tuesday, May 01, 2018

Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from January 2018.

Let’s kick off 2018 with a Last Jedi-themed look at copay accumulator programs—a benefit design option that I expect to become highly controversial this year.

Accumulator programs target specialty pharmacys for which a manufacturer provides copayment assistance. Unlike conventional benefit designs, the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum.

As you will see below, plan sponsors—employers and health plans—will save big money because accumulators shift a majority of pharmacy costs to patients and manufacturers. Accumulator programs will further lower a plan’s pharmacy spending by discouraging the appropriate utilization of specialty therapies and reducing adherence. What’s worse, many patients won’t understand their new “benefit.”

Given the direct human healthcare impact of copay accumulator programs, I don’t see how they can be considered value-based designs. Is it any wonder that people think their employers and insurance companies are from the dark side?

Monday, April 30, 2018

The Top 15 Specialty Pharmacies of 2017: PBMs and Payers Still Dominate (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from March 2018.

Below is our exclusive Pharmacy Channels Institute list of the 15 largest pharmacies, ranked by estimated 2017 revenues from dispensing specialty pharmaceuticals.

The battle for control of the specialty market accelerated in 2017, though pharmacies owned by pharmacy benefit managers (PBMs) continued to capture most of the market share. The top four specialty pharmacies are all owned or co-owned by a PBM. They accounted for about two-thirds of prescription revenues from pharmacy-dispensed specialty pharmacys.

Vertical integration M&A has been in the news. But as our data shows, the integration of PBMs and specialty pharmacies has already happened.

Thursday, April 26, 2018

Pharmacy Channels News Roundup, April 2018: Copay Accumulators, Express Scripts, Pharmacy Pricing, Amazon, and Almost-Pharmacist Jack Nicklaus

Baseball season is finally here! Oil up your glove, lace up your cleats, and let's run the bases around this month's news stories. Remember: Sometimes you win, sometimes you lose, and sometimes it rains.

In this issue:
  • Green Monster: The pharmacy manufacturers that are most vulnerable to copay accumulators
  • Pop Fly: Express Scripts wants to pop the gross-to-net bubble?
  • Foul! Fresh evidence that uninsured consumers pay rip-off cash prices at retail pharmacies
  • Strikeout: My $0.02 on Amazon’s decision not to sell pharmacys to hospitals
Plus, from the diamond to the green: the secret pharmacy history of golf legend Jack Nicklaus.

P.S. For my daily pitches on the industry’s hits and misses, follow @PharmacyChannels on Twitter. My recent tweets have covered copay accumulators, the oncology market, pharmacy costs, biosimilars, PBMs, and more.