Time for our annual update on pricing at five of the largest pharmaceutical manufacturers—Eli Lilly, Janssen, Merck, Novartis, and Sanofi. You can find links to each company’s data below.

When rebates and discounts were factored in, drug prices declined—or grew slowly—in 2019. Consistent with our previous analyses, rebates and discounts reduced the selling price of brand-name drugs to about half of their list prices.

This growing disparity between list and net prices continues to inflate the gross-to-net bubble. As the companies’ insulin data illustrate below, the bubble raises costs for patients who are not always benefiting from lower net selling prices.

These data also highlight the lunacy of inflationary rebates that are based on a government pricing metric that approximates a brand-name drug's list price. This is what Senator Charles Grassley (R-IA) has proposed in the Prescription Drug Pricing Reduction Act of 2020. Legislation should shield patients from the excesses of the gross-to-net bubble while enhancing the competitive pressures that are reducing drug prices. Is that too much to ask?

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Today’s guest post comes from Rob Brown, VP/GM of RxCrossroads by McKesson Program Pharmacy.

Rob reviews how COVID-19 is changing patient access and adherence to specialty therapies. He then describes specific RxCrossroads’ program changes that are helping patients and providers remain on therapy and navigate this challenging environment.

To learn more, visit www.McKesson.com/RxCrossroads.

Read on for Rob’s insights.

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Last Friday’s Executive Orders, revived the government’s effort to reform rebates in federal programs. Whether that effort succeeds, today's update reminds us what's still at stake in reforming rebates within the U.S. drug channel.

For 2019, Drug Channels Institute estimates that the gross-to-net bubble—the dollar gap between sales at a brand-name drug’s list price and its sales at its net price after rebates and other reductions—reached $175 billion.

The bubble reflects—and drives—many of patients’ problems and misunderstandings of U.S. drug prices.

However, the political and practical challenges to rebate reform remain daunting. Few people grasp the complex economic interplay of patient out-of-pocket spending, cost-shifting, premiums, and payer incentives.

Despite the pandemic, I remain hopeful that we can help this bubble pop.

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NASP 2020 Annual Meeting & Expo Virtual Experience

September 14-18, 2020 | Virtual Experience

www.naspmeeting.com/registration

Utilizing innovation and cutting-edge technology, the National Association of Specialty Pharmacy (NASP) is hosting its 2020 Annual Meeting & Expo, September 14-18, as a full-scale virtual conference experience that includes all that attendees have come to expect and love from the live event. The NASP 2020 Annual Meeting & Expo Virtual Experience promises to be the next best thing to being there!

The conference agenda is jam packed and offers something for everyone, whether you are new to the industry or a seasoned expert. Conference highlights include:

• 26 unique educational sessions and panel discussions, organized into four dynamic CORE tracks – Clinical, Operational, Regulatory, and Patient Experience – to help you focus on what is most important to you
• Earn CPE and CLE credits through in-line programming, satellite symposia and pre-conference workshops
• Encore presentations of the popular sessions
• THREE KEYNOTE PRESENTATIONS
• Jim Kelly, former NFL quarterback and Pro Football Hall of Fame member, will share what it means to be “Kelly Tough”
• Former interim chair of the Democratic National Committee (DNC) Donna Brazile and former chairman of the Republican National Committee (RNC) Michael Steele will give a joint keynote presentation on the political landscape and the 2020 election
• Allan Lichtman, a distinguished professor at American University, scholar, and author will share his predictions for the 2020 election

• Five pre-conference workshops: the CSP Exam Preparation Course, Legal Day, Home Infusion Workshop (1/2 day) and our two newest workshops, Technology Day and Hospital/Health Systems Workshop (1/2 day) (additional fee required for workshops)
• The interactive Virtual Exhibit Hall will feature 50+ exhibitors, representing stakeholders from across the specialty pharmacy industry
• The ever-popular Women in Specialty Pharmacy event, featuring motivational keynote speaker Courtney Clark
• CE satellite symposia
• Poster presentations and author discussions
• NASP Annual Meeting Award presentations – including two new awards – the Specialty Pharmacy Service Excellence award and the Strategic Partner of the Year award
• The NASP Ron Bookman Scholarship Awards
• Direct interaction with industry thought leaders and experts through live Q&A and private chats
• Ample networking opportunities
• Virtual wellness initiatives on Tuesday and Wednesday mornings to help you get up and going
• Personalized avatars and MUCH More!

Register today for this must-see virtual experience!

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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The steamy, socially distanced days of summer are here. Cool off by getting up close and personal with our refreshing selection of articles and insights. In this issue:

• Pricing problems for diabetes treatments

• Controversy over Regeneron’s copay support

• Massachusetts concedes that coupons help some patients (but accumulators hurt)

• A 2020 update to my all-time favorite chart

Plus, thoughtful perspectives on diversity from AmerisourceBergen CEO Steve Collis

P.S. Join the more than 9,700 followers of my curated links published on @DrugChannels on Twitter. My recent tweets have highlighted: VC’s pharmacy love, physicians’ biosimilar concerns, drug trend in workers’ comp, copay accumulator news, the outlook for insurance costs, remdesivir pricing, Philly pharmacies, how paid parking boosts telemedicine, and more.

ON SALE! We are offering our 2019–20 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors at discounts up to 35% off. Sale prices valid thru September 8, 2020. The updated 2020-21 edition will be available in October 2020.

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Surprise! President Trump signed four executive orders (EO) last Friday afternoon. They cover:

• Pass-through of 340B discounts for insulin and EpiPens

• Rebate reform (!)

• Importation

• Most Favored Nation (MFN) pricing for drugs

The fourth order on MFN has not been publicly released, so I will reserve comment for now.

I see significant challenges in implementing these far-reaching orders. Below, you’ll find the text of the first three along with my commentary and links to Drug Channels articles that will help you make sense of them.

Read on and see if you agree with me.

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Today’s guest post comes from Frank Dana, Chief Commercial Officer at ConnectiveRx.

Frank discusses how the loss of commercial insurance coverage will affect the newly unemployed. He describes how ConnectiveRx's affordability tools can help pharmaceutical manufacturers and patients.

To learn more, download ConnectiveRx’s free reference: Five Keys to Building a Successful Copay Strategy in the COVID-19 Era.

Read on for Frank’s insights.

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The stunning growth of specialty pharmacies in the 340B Drug Pricing Program has accelerated a troubling trend: Patients covered by commercial insurance and Medicare Part D are footing the bill for 340B savings.

That's the uncomfortable reality of the 340B program’s hidden prescription economics.

Whenever a prescription is eligible for 340B pricing, an insured patient could pay thousands of dollars out of pocket—even as the 340B hospital and its contract pharmacy generate substantial profits. Meanwhile, private health plans and Medicare pay full price for drugs that are sold to 340B covered entities at deep discounts, further subsidizing hospitals and PBM-owned specialty pharmacies.

Below, to show you how this occurs, I follow the dollar for a brand-name specialty drug used by a consumer with commercial insurance. Our indisputable math exposes the little-understood economics behind specialty pharmacies in the 340B program.

I hope that the program’s participants take an honest look at who is actually paying for their 340B savings. As always, I welcome your feedback via email or in the comments below.

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Last week, I documented that nearly half of U.S. pharmacies now participate in the 340B Drug Pricing Program. Below, we update our exclusive analysis of the biggest specialty pharmacies within 340B.

The four largest specialty pharmacies are owned by CVS Health, Cigna’s Express Scripts business, UnitedHealth Group’s OptumRx business, and Walgreens Boots Alliance/Prime Therapeutics.

As you will see below, these specialty pharmacies have dramatically increased their participation in the 340B program. Hospitals are the primary 340B covered entities that engage with these specialty pharmacies.

We estimate that specialty pharmacy dispensing accounted for nearly one-third of PBMs’ total gross profits in 2019. Consequently, the 340B program is a significant and growing component of profitability for these large, for-profit, publicly traded companies.

Later this week, I’ll examine how patients with commercial and Medicare Part D insurance are subsidizing the super-sized 340B profits of these companies.

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It’s time for our annual look at the 340B Drug Pricing Program’s booming pharmacy component.

Our exclusive analysis of government data finds that 28,000 pharmacy locations—almost half of the U.S. industry—now act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. Over the past 12 months, the number of pharmacies in the program has grown by more than 3,300 locations.

As you will see below, multi-billion-dollar, for-profit, publicly traded pharmacy chains—Walgreens, CVS, Walmart, Rite Aid, Kroger, and Albertsons—continue their unchecked 340B expansion.

Despite this astonishing growth, the contract pharmacy component does not have—and has never had—a regulatory infrastructure. That’s because the subregulatory notice that created contract pharmacies wasn’t subject to any rulemaking procedures. Eli Lilly recently challenged this notice, which forced the government to concede that its own pharmacy guidance is “not legally enforceable.”

As you review our analysis, ponder why manufacturers still comply with HRSA’s non-binding guidance—and why investors remain unconcerned with the risks of public companies’ participation in the out-of-control 340B program.

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