Today’s guest post comes from Rick Fry, Senior Vice President of Commercial Solutions and Jason Zemcik, Senior Director of Product Management at TrialCard.

Rick and Jason outline their view of the crucial issues in the new proposed rule from Centers for Medicare and Medicaid Services (CMS) regarding copay accumulator adjustment programs. They preview the public comments that TrialCard expects to submit to CMS.

Please visit TrialCard’s copay accumulator program resources to learn more about mitigating copay accumulator programs. Contact sales@trialcard.com to discuss solutions for your organisation.

Read on for Rick’s and Jason’s insights.

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This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from April 2020.

In Drug Channels Institute's list of the top 15 pharmacies of 2019, we show that many of the largest U.S. pharmacies are now central-fill mail and specialty pharmacies operated by PBMs and insurers.

To complement that broader ranking, we present below our exclusive list of the top 15 pharmacies based on specialty drug dispensing revenues. Consistent with our previous analyses, PBMs and insurers have retained their dominance over specialty drug channels, while smaller pharmacies are facing increased competition and profit pressures.

I see upside for specialty pharmacies in the aftermath of the pandemic. This growth will come at the expense of provider-administered drug channels. I expect the top companies’ share will increase in 2020, due to mergers and business transitions among the largest PBMs. However, the increasing role of government payers may create opportunities for smaller pharmacies.

This Friday, I’ll discuss how COVID-19 will affect the specialty pharmacy market during the first of my two live video webinars.

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This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from April 2020.

The U.S. economy is in a medically-induced coma. Unemployment is soaring. Companies are teetering on the brink of bankruptcy. It is unclear when our lives will return to their pre-pandemic state.

One thing seems apparent: As people lose jobs and health insurance, Medicaid enrollment will jump, perhaps by as much as 20% to 30%. This will have profound implications for the drug channel.

Today, I focus on how this increase will affect retail pharmacies and pharmacy benefit managers (PBMs). Below, I review Medicaid enrollment trends, how states manage prescriptions, and the factors driving the coming boom in Medicaid enrollment.

As I explain, many (but not all) retail pharmacies will benefit from Medicaid growth. PBMs, however, will not fare as well. Read on and see if you agree.

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This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from February 2020.

Pharmacy-related price concessions in Medicare Part D—known as pharmacy DIR fees–have grown faster than most people realize.

We estimate that these payments reached $9.1 billion in 2019. This figure indicates that about 18% of total Medicare Part D rebates are now paid by pharmacies, not manufacturers. Details below.

To address concerns about how these fees are computed, the Centers for Medicare & Medicaid Services (CMS) has proposed some minimal transparency requirements for monitoring the metrics behind DIR fees. I suspect that the proposal will have no near-term impact on slowing the growth trends.

Our long time readers know that I’ve been skeptical about pharmacy owners’ claims regarding the impact of DIR fees. But it does now appear that these payments have become a significant economic burden. When the facts change, I change my mind. What do you do?

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This week (Monday through Thursday), I’m rerunning some popular posts. Click here to see the original post and comments from March 2020.

Next week, Drug Channels Institute will release our 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the 11th edition of our popular and comprehensive examination of the entire drug pricing, reimbursement, and dispensing system.

The exhibit below—one of 203 in our new report—provides a first look at the 15 largest pharmacies, ranked by total U.S. prescription dispensing revenues for calendar year 2019. I also highlight business developments that shifted market share among the biggest players.

As you will see, pharmacy industry prescription dispensing revenues reached a record $446 billion in 2019. Revenues were highly concentrated due to the rapid growth of large specialty pharmacies and the multiple transactions that we discuss throughout our report.

For a sneak peek at the complete report, click here to download a free pre-publication draft overview (including the table of contents and a list of exhibits). We’re offering special discounted pricing if you order before March 22, 2019.

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Happy 244th birthday, America! Before you declare your (socially-distanced) independence, get up close and personal with these Drug Channels fireworks:

Plus, powerful and important comments from Ken Frazier, CEO of Merck.

P.S. Join the more than 9,500 followers of my curated links to neat stuff at @DrugChannels on Twitter. My recent tweets have highlighted: Amazon’s activities, PillPack’s bad reviews, 340B outrages, rebate reform redux, biosimilar pricing, managed Medicaid market shares, drug pricing, blockchain hype, and the warp speed vs. hyperspace debate.

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It’s time for our annual Drug Channels examination of PBM drug spending reports. For 2019, we again aim our magnifying glass at the annual trend reports from the largest pharmacy benefit managers (PBMs): CVS Health, Express Scripts, and Prime Therapeutics. (See their report links below.)

Once again, we find that commercial drug spending did not race higher—contrary to what you keep hearing from journalists and politicians. Spending rose by less than 3% in 2019, continuing a multiyear trend of slow growth. At some plan sponsors, total drug spending even declined. For specialty drugs, higher utilization—not drug costs—was again the biggest factor driving specialty spending growth.

Notably, clients of Prime Therapeutics fared worse than those of Express Scripts and CVS Caremark. Below, I explain three factors behind Prime’s underperformance. Its third place finish highlights why the PBM industry continues to consolidate.

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

Julia discusses how medication access challenges can negatively impact brand-name drugs.

For more, check out this overview of CoverMyMeds' technology solutions that enhance patients’ access: Enabling Medication Access Through Technology.

Read on for Julia’s insights.

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The 340B Drug Pricing Program has logged another year of incredible growth.

According to data provided to Drug Channels by the Health Resources and Services Administration (HRSA), discounted 340B purchases were at least $29.9 billion in 2019. That figure is an astonishing 23% higher than its 2018 counterpart.

Since 2014, purchases under the 340B program have tripled. Over the same period, manufacturers’ net drug revenues have grown at an average rate that’s below 5%. Consequently, the 340B program has grown to account for more than 8% of the total U.S. drug market and about 16% of the total rebates and discounts that manufacturers provide.

What’s more, the 340B program is now almost as large as the Medicaid program’s outpatient drug sales. However, 340B lacks Medicaid’s regulatory infrastructure and controls. Medicaid rebates directly and transparently lower drug costs for the government, while 340B discounts disappear into providers’ financial statements. It’s troubling and hard to defend.

Read on for our latest details on the 340B program’s ongoing and startling growth.

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The Bureau of Labor Statistics (BLS) recently released its employment data for 2019. That means it’s time to update our annual Drug Channels analysis of pharmacist salaries and employment.

Average base salaries were about $125,000, though there was substantial variation across practice settings.

Total pharmacist employment grew in 2019. Consistent with our previous analyses, the share of pharmacists who work at hospitals reached a new high.

However, the number of pharmacists working in retail settings decreased. The challenges facing the retail pharmacy industry, which I discuss in this video, are now showing up in the employment data. It’s more bad news for the pharmacists who are working for the weakened.

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