Once again, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have increased the number of drugs they have excluded from their standard formularies. 

Today, I update our annual tracking of the number of exclusions by each PBM. I also highlight the expansion of exclusions into major specialty therapy classes. The 2021 formulary exclusion lists are available below for your downloading pleasure.

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PAP Critical Update

March 8-10, 2021 | Virtual Event

www.informaconnect.com/pap21

Set the tone and strategy for 2021 with PAP Critical Update taking place March 8-10 in a fully virtual format, and benefit from critical and timely updates addressing the upcoming challenges for patient access and assistance professionals. In a time of unprecedented need, join influential stakeholders as they come together for collaborative and meaningful discussion and dive into policy updates, COVID-19 impacts, election implications, technology advances and so much more affecting the patient access community.

Exclusive Offer – View the agenda at a glance and register today – Be sure to use your exclusive promo code PAP10 to save 10% off* of your registration.

PAP Critical Update serves as a three-day conference experience, featuring top experts ready to lead robust discussions on the changing legal environment, industry best practices, policy watch‑outs and more, including:

• State of the Industry of Legislation and Pending Health Policy
• The Intersection of Access and Affordability
• Leading Perspectives from Regulatory, Foundations and Payers
• Technology Advances Ensuring Access
• COVID-19 and PAP Support
• Accumulator and Maximizer Programs

Unparalleled Virtual Capabilities:

• Interactive presentations and panels
• Live Q&A and polling
• Live and on-demand sessions, all available 30-days post-event to review at your leisure
• 1-1 meeting opportunities and peer-to-peer engagement
• Sophisticated and seamless scheduling tools

Exclusive Offer – View the agenda at a glance and register today – Be sure to use your exclusive promo code PAP10 to save 10% off* of your registration.

Informa Connect will see you there!

*Cannot be combined with other offers, promotions or applied to an existing registration. Other restrictions may apply.

        

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Today’s guest post comes from Julia Phillips, VP of Pharma Accounts and Enablement at CoverMyMeds.

Julia discusses common patient access and affordability issues. She describes CoverMyMeds’ technology solutions that are designed to help patients access, afford, and adhere to their prescribed medications.

To learn more about CoverMyMeds’ medication access solutions, download their Technology Solutions Overview.

Read on for Julia’s insights.

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It was another year of unexpected drug price developments.

In 2020, brand-name drug net prices dropped for the third consecutive year. Meanwhile, brand-name drug list prices grew at their slowest rate in at least 20 years. See our updated analysis below.

I also review the factors behind declining brand-name drug prices. These factors are firmly in place for 2021.

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Our new Congress may try tackle drug prices in the new year. Let’s hope that their policy perceptions catch up to today’s realities.

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16th Hub and SPP Model Optimization Spring Stakeholder Summit

March 3-5, 2021 | Virtual Event

www.informaconnect.com/hub-spp

This important event convenes key stakeholders to showcase innovative hub programs and patient-centric services to maximize access, reimbursement and adherence. Highlighting top-line regulatory actions, updates on the evolving affordability landscape, and industry perspectives on access strategy, this virtual program tackles immediate challenges and delivers actionable, cutting-edge strategies for a successful hub program.

Drug Channels readers will save $100 off the current registration rate when they use code HUBSDC10*.

Can’t Miss Content on Tap:

• Delivering Value to Empower and Educate Patients to Enhance Medication Adherence
• Navigate the Challenges and Complexities of Medical Benefit Products
• Discover Best-in-Class Service for Streamlined Stakeholder Workflow and Access
• Trailblazer Talk – Develop Innovative Models and Novel Strategies to Ensure Access
• Explore eServices Management Strategies to Optimize Value
• Strategy Insights and Metrics for Launch in a New Normal

Innovative Features:

• Main Stage Keynotes, New Year Enforcement Updates from Regulatory Agencies, Industry Panels and Strategic Case Studies
• Industry Only Rapid-Fire Solution Showcase Luncheon: In a series of short demonstrations and presentations by leading experts and solution providers, experience cutting-edge, innovative services and offerings, while enjoying a complimentary lunch during this invite-only showcase
• Peer-to-Peer Exchange – Best Practice and Knowledge Sharing Table Talks: Benchmark pain points, share best practices and unpack challenges with peers around top of mind topic areas that are affecting the access world today in three interactive brainstorming sessions
• Virtual Access to the Sponsorship Pavilion and VIP Matchmaking
• Videos and Presentations Available On-Demand with Access for 30 Days Post Event

Featured Speakers:

• Esther Langer, Head US Patient Services, Trade, and Distribution, Apellis Pharmaceuticals, Inc.
• Jourdan Russo, Director, Patient Services, Kyowa Kirin, Inc.
• Dave MacLeod, Head of Patient Services and Specialty Pharmacy Operations, Amylyx Pharmaceuticals
• Deepti Jaggi, Global Head of Patient Insights and Solutions, Astellas US
• Marina Allen, Executive Director, Patient Access and Reimbursement, Coherus BioSciences
• And more!

*Offer 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., Drug Channels, or any of its employees.

        

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This week, I’m rerunning some popular posts while I prepare for today's video webinar: Drug Channels Outlook 2021.

Click here to see the original post and comments from September 2020.

Will COVID-19 trigger long-term share gains for specialty pharmacies as suppliers to hospitals and physician offices?

Before the pandemic, specialty pharmacies—via white, brown, and clear bagging—had already displaced buy-and-bill distribution channels for a substantial chunk of provider-administered specialty drugs. See below for detailed data on oncology and non-oncology products.

We estimate that in the first half of 2020, the coronavirus pandemic accelerated this shift. Some of the changes will likely be transitory, as patients return to their healthcare providers. But payers will try to retain some of these gains—especially if they also own a specialty pharmacy.

Read on and see if you agree.

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This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Drug Channels Outlook 2021.

Click here to see the original post and comments from October 2020.

The biosimilar market is finally beginning to fulfill its promise.

The latest data show that provider-administered biosimilar drugs are successfully displacing their reference biological products. As I predicted last year, newer biosimilars are being adopted quickly, and their prices are declining rapidly. What’s more, manufacturers of reference products are cutting drug prices to defend their market shares.

Last year, Dr. Scott Gottlieb, a former FDA commissioner, argued that we shouldn’t give up on biosimilars and prematurely regulate prices. As you will see below, Dr. Gottlieb was right.

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This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Drug Channels Outlook 2021.

Click here to see the original post and comments from September 2020.

Last Friday, The Wall Street Journal published my opinion piece: The Federal Program That Keeps Insulin Prices High. The article text is pasted below for those who don't subscribe.

I summarize issues with the role of contract pharmacies in the 340B Drug Pricing Program. My arguments will be familiar to regular readers of Drug Channels. I wrote this piece for a general business audience, so it's highly readable and omits industry insider terminology. To help you get the most from the article, I have included additional links to source materials in the text.

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This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Drug Channels Outlook 2021.

GoodRx went public in September. Its current market cap is an astounding $17.6 billion. Amazon is now copying the GoodRx discount card model.

Click here to see the original post and comments from August 2020.

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On Friday, GoodRx filed its Form S-1 in preparation for going public. Link below.

The company is insanely profitable. Its adjusted net income—earnings before interest, taxes, depreciation, and amortization (EBITDA)—is an astonishing 40%.

Below, I provide my overview of how our crazy drug channel system enables GoodRx’s good fortune. You will admire the GoodRx management team’s business savvy in building a company that lowers out-of-pocket costs for consumers. But you will also wonder whether this business perpetuates a broken pharmacy drug pricing model.

P.S. This article updates and expands on the comments I posted to @DrugChannels on Friday evening.

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This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Drug Channels Outlook 2021.

Click here to see the original post and comments from October 2020.

Last week, news broke that Prime Therapeutics is expanding its relationship with Cigna’s Express Scripts to include mail and specialty pharmacy dispensing. So far, there's been very little written about this transaction.

Below, I share my thoughts on the following topics arising from the deal:

• The mail and specialty pharmacy market

• The future of AllianceRx Walgreens Prime

• The emerging Express Scripts industry platform

• A reminder about why the Federal Trade Commission won’t challenge the relationship

Prime is becoming increasingly dependent on outsourcing to Cigna’s Express Scripts business. This new pharmacy contract furthers the industry’s move toward vertical consolidation and the disappearance of the independent PBM industry. 

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