This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from January 2017.

Last week delivered significant announcements that will shake up the market for epinephrine auto-injector pens. CVS began promoting a lower-cost EpiPen alternative. Small pharma company Kaléo relaunched the AUVI-Q. Meanwhile, Mylan’s new generic EpiPen continued to gain traction.

It’s a good time to revisit the EpiPen situation and see what it tells us about U.S. pharmaceutical industry pricing. After last week’s announcements, there are now four key products, each with its own list price and rebate arrangements:

• An EpiPen with a $608 list price and rebates to pharmacy benefit manages (PBMs)

• An EpiPen with a $300 list price, but no rebates

• Adrenaclick, an alternative product with a $110 cash price at CVS pharmacies

• Auvi-Q, another alternative, with a $4,500 (!) list price

As I explain below, these variations wonderfully illustrate the warped incentives embedded in our crazy drug channel. Will we make progress in popping the gross-to-net bubble?

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This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from December 2016. FYI: I updated a few links with our more current market data.

Modern Distribution Management recently published my article 2016 MDM Market Leaders | Top Pharmaceuticals Distributors. It is an excerpt from the 2016-17 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Below, I republish the section highlighting five significant industry trends affecting the U.S. drug wholesaling industry. I think Drug Channels readers will enjoy this summary as we look toward an eventful 2017.

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This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from December 2016.

Pharmacy benefit managers (PBMs) are facing unprecedented criticism about their business practices and levels of transparency. Which got me wondering: What do plan sponsors—the PBMs’ customers—think about their PBMs?

For the answer, I turned to Pharmacy Benefit Management Institute (PBMI) 2016 Pharmacy Benefit Manager Customer Satisfaction Report (available for purchase.) It rates 11 PBMs based on feedback from more than 500 plan sponsor customers.

The data show a strong association between a PBM’s perceived transparency and a plan sponsor’s satisfaction. As you will see in the charts below, plan sponsors are more satisfied with PBMs that are more transparent.

Yet the causality of this relationship isn’t entirely clear. Smaller plan sponsors tend to work with smaller PBMs, which are rated more highly on transparency and alignment of goals. Are more transparent PBMs truly better? Or, are we observing a selection effect, whereby plan sponsors with fewer internal resources choose PBMs with different business and profit models? And if PBM transparency is so wonderful, why don’t all plan sponsors insist on it?

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DIR Fees, Rebates, Pharmacy Economics, and the Future of Medicare Part D

This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from February 2017.

The Centers for Medicare & Medicaid Services (CMS) just released a controversial and important new report: Medicare Part D – Direct and Indirect Remuneration (DIR).

The report shows mixed consequences of DIRs in the Medicare Part D program. For example, manufacturer rebates (the biggest part of DIRs) reduce plan costs and Part D premiums. However, beneficiaries pay higher out-of-pockets costs because coinsurance amounts are based on the undiscounted, pre-rebate retail price. Meanwhile, the government is paying a growing share of drug costs due to catastrophic coverage.

The CMS report has important implications for how we think about rebates, gross-to-net discounts, plan premiums, and patients’ out-of-pocket expenses. That’s why industry reactions have ranged from outrage to defensiveness. I encourage you to read the report and think about how it lays the groundwork for changing the Medicare Part D program.

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This week, I’m rerunning some popular posts while I attend Asembia’s 2017 Specialty Pharmacy Summit. Click here to see the original post and comments from February 2017.

Next week, Drug Channels Institute will release our updated 2017 Economic Report on Pharmacies and Pharmacy Benefit Managers (known in our previous editions as The Economic Report on Retail, Mail, and Specialty Pharmacies)

The exhibit below—one of 143 in our new report—provides a first look at the largest pharmacies, ranked by total U.S. prescription dispensing revenues for calendar year 2016. As you will see, the growth of specialty drugs is reshaping the pharmacy and PBM industries.

For a sneak peek at the complete report, download the free overview. Enjoy!

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Today’s guest post comes from Scott Pribyl, CEO of mRx Ventures.

Scott discusses outcomes-based contracts for specialty drugs. He describes the challenges associated with data collection and collaboration among all the stakeholders—physicians, specialty pharmacies, pharmacy benefit managers (PBMs), third-party payers, Medication Therapy Management (MTM) companies, and patients.

To address these issues, Scott describes SamplifyRx, an outcomes infrastructure solution that allows all the stakeholders in the patient’s journey to track and manage patient outcomes and data. He argues that this technology can enable and manage outcomes-based contracts and reimbursement.

To learn more about the SamplifyRx outcomes infrastructure solution, email Scott Pribyl (Scott@SamplifyRx.com) or connect with him at Asembia’s 2017 Specialty Pharmacy Summit next week in Las Vegas.

Read on for Scott’s insights.

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Time for our monthly roundup of news stories that highlight key trends for U.S. drug channels. In this issue, get your claws into the following:

• Teva launches an Advair competitor with a gross-to-net bubble busting strategy

• A Diplomat Pharmacy exec gives us a great checklist for assessing specialty pharmacies

• Wow! 60% of oncology practices are now owned by hospitals and health systems

Plus, Starbucks has some exciting news for insulin makers!

P.S. Stay up to date on the news and reports that I find intriguing by following @DrugChannels on Twitter.

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In Which PBM Best Managed Drug Spending in 2016: CVS Health, Express Scripts, MedImpact, or Prime?, I examined the 2016 drug trend reports from four leading pharmacy benefit managers (PBMs). OptumRx, the PBM business of UnitedHealth, released its report too late to be included in that analysis.

The charts below remedy this omission. The data now include five major PBMs, which accounted for more than 80% of equivalent prescription claims in 2016. After we add OptumRx’s results, the claims-weighted average increase in drug spending for 2016 was only 3.3%.

These results again confirm that the supposed drug spending problem is a myth. However, some patients experience significant out-of-pocket cost increases, due largely to cost-shifting by plan sponsors. With such low overall spending growth, the next battle will be over how best to share the savings from PBM-negotiated rebates.

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CBI’s 13th Commercial Contract & Chargeback Excellence

June 21-22, 2017 | Parsippany, NJ

Take a deep dive into improving the wholesaler chargeback, navigating class of trade schema complexities, streamlining membership management and optimizing contract administration at CBI’s 13th Commercial Contract & Chargeback Excellence. By illustrating software solutions, case studies and perspectives from leading distribution partners, this conference is a comprehensive forum for pharmaceutical professionals to learn best practices and gain strategies to improve contract operations and administration.

Gain Actionable Takeaways From Speakers Including:

• Marijo Bustos, Director, Government Programs and Commercial Compliance, ProMetic BioTherapeutics, Inc.
• Lisa Ellington, Senior Manager, Contract and Chargeback Operations, McKesson
• Leonard Fairfield, Director, Contract Operations and Analytics, Actelion Pharmaceuticals US
• Harry Norsworthy, Associate Principal, Vizient
• Todd Cox, Senior Manager, Government Pricing and Contracts, Gilead Sciences
• Donna White, Vice President, Contracts and Compliance, Chiesi USA Inc.
• Sherice Koonce, Director, Contracts, West-Ward Pharmaceuticals
  
• Paula Martins, Director, Commercial Operations, Helsinn Therapeutics (U.S.), Inc.
• Mandy Talley, Manager, Contract Administration – Managed Healthcare Services, Lilly USA, LLC
• Jill Page, Director, Government Pricing Strategy Analysis, Fresenius Medical Care
• Andrew Wilson, Vice President, 340B Solutions, McKesson
• And more!

Interactive Discussions Surrounding:

• Changing dynamics impacting the commercial pricing and contracting landscape
• New strategies of risk-share agreements and value-based contracting
• 340B Program changes impacting business operations and strategy
• Benchmarking and organizational best practices for membership efficiency
• Chargeback adjudication for 340B contract pharmacies
• Efficiencies of med surg chargeback and roster management
• Chargeback management innovations, system automation and contract analytics
• Enhancing communication to facilitate wholesaler, GPO and manufacturer alignment

Download the complete agenda here, and visit www.cbinet.com/chargebacks for further details and to register. Drug Channels readers will save $400 off of the standard registration rate when they use discount code MHY489.

* *Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rate or non-profit rates. Other restrictions may apply.

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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Today’s guest post comes from Tom Doyle, Executive Vice President of Commercial Solutions at H. D. Smith.

To prepare for impending market changes, Tom suggests that a manufacturer’s commercial team partner with a flexible, integrated services provider to increase market share and optimize the patient journey. He also discusses mid-tier specialty products and the need for such cost-effective solutions as Triplefin's Hub-Lite approach.

Click here to download H.D. Smith’s free white paper on specialty product launch planning. You can also visit H.D. Smith’s companies at Booth #200 during Asembia’s 2017 Specialty Pharmacy Summit in Las Vegas.

Read on for Tom’s insights.

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