Like many of you, I was disappointed that Asembia had to cancel its 2020 Specialty Pharmacy Summit.

As a small consolation, Asembia is providing a series of on-demand business sessions. You can view them for FREE if your registration to the 2020 Specialty Pharmacy Summit was transferred to the 2021 Summit. Everyone else will have to pay a small fee.

Click here to register for access to Asembia’s Specialty Pharmacy Summit Virtual Experience. (You must register and create a new account, even if you are eligible for free access.)

Virtual business sessions cover such topics as market trends, the specialty pipeline, accreditation, federal health policy, digital health, and more.

Two highlights:

• The State of Specialty Pharmacy 2020: Market Data and Trends—Adam J. Fein, Drug Channels Institute (That’s me!)

• US Specialty Pharmaceuticals Trends, Issues and Outlook—Doug Long, IQVIA

For the full Las Vegas experience, I suggest that you review this important story before viewing the business sessions.

In the meantime, mark your calendars for the 2021 Specialty Pharmacy Summit, which is scheduled for May 2 to 5, 2021.

        

Source: Post feed

FWIW: Summer is finally here. Before you venture outside for your lockdown barbeque, check out these noteworthy items off the Drug Channels grill:

• Payers predict how COVID-19 will affect formularies

• Our analysis of the 2020 retail-to-mail shift

• AmerisourceBergen profiles biosimilars

Plus, CVS pharmacy offers a clever way to measure appropriate social distancing.

P.S. Join the nearly 9,400 followers of my curated links to neat stuff at @DrugChannels on Twitter. My recent tweets have highlighted: hospital profits, drug spending, prior authorization at specialty pharmacies, legal issues for drug importation, private equity funding for a start-up PBM, physicians vs. PBMs, trends in Google Trends, and more. I continue to tweet under-the-radar stories about how the coronavirus is affecting drug channels and healthcare spending.

Read more »

        

Source: Post feed

Today’s guest post comes from Kyle Grimslid, Market Development Director at CoverMyMeds.

Kyle describes the complications that providers and patients encounter in the specialty prescription process. He describes how AMP: Access for more Patients™ enhances access, affordability and adherence—including a reported 27% reduction in time to therapy.

Click here to learn more about how CoverMyMeds and RxCrossroads by McKesson are using technology to solve patients' medication access challenges.

Read on for Kyle’s insights.

Read more »

        

Source: Post feed

In Copay Maximizers Are Displacing Accumulators—But CMS Ignores How Payers Leverage Patient Support, I explained a new Centers for Medicare and Medicaid Services (CMS) final rule regarding health plans’ use of copay accumulator adjustment. I also highlighted why plans have responded to the negative patient impact from accumulators with copay maximizer programs.

However, maximizers are being implemented very differently from accumulators.

The two largest PBMs—CVS Health’s Caremark and Cigna’s Express Scripts—have each partnered with secretive and independent private companies to operate specialty drug maximizer programs for their plan sponsor clients. What’s more, at least one of these private companies earns fees equal to 25% of the manufacturer’s copay support program.

These arrangements are very odd. Why do multi-billion-dollar public companies rely on these private companies to administer their maximizer programs? Why do these small companies deserve such outrageous fees? Why are beneficiaries required to affirmatively sign up with the companies—or face ludicrous costs that far exceed their plan’s out-of-pocket maximums? Does any oversight exist for these arrangements?

Here’s what I managed to uncover about these businesses. See what you think.

Read more »

        

Source: Post feed

COVID-19 has not stopped the wheels of policy bureaucracy from grinding. Last week, the Centers for Medicare and Medicaid Services (CMS) released its final Notice of Benefit and Payment Parameters for the 2021 benefit year. You’ll find the document links below.

This final rule permits insurers to exclude the value of a pharmaceutical manufacturer’s copay support program from a patient’s annual deductible and out-of-pocket maximum obligations.

Translation: CMS has confirmed that insurers have the option to use copay accumulator adjustment for their pharmacy benefit programs.

Patients on specialty drugs lose big from accumulators, while plans profit from the lower spending that results. Consequently, copay maximizers have emerged as a more patient-friendly alternative to accumulators. Below, I remind you of the math behind these alternatives.

Plan sponsors are publicly denouncing copay support programs—while they’re privately embracing them. CMS’s final rule ignores the troubling reality behind maximizers and accumulators: They encourage plans to use pharmacy benefit deductibles as a scheme that allows payers—not patients—to reap the greatest benefits from a manufacturer’s patient support program.

Read more »

        

Source: Post feed

I received good feedback on Tuesday's video about retail pharmacy.

So below, you'll find another brief video excerpt from my May 1 Industry Update and COVID-19 Impact video webinar.

In this clip, I highlight the growth and consolidation dynamics facing the specialty pharmacy industry. I also discuss the competitive challenges facing smaller pharmacies.

Never fear, Drug Channels traditionalists. I'll be back with a new article next week.

Read more »

        

Source: Post feed

Thanks to everyone who joined me for DCI's Industry Update and COVID-19 Impact video webinars. I enjoyed putting these events together and hope you benefited from watching them. If you missed these two live events, click here to find out how you can watch the replays.

Below is a brief video excerpt from my May 1 video webinar. In this clip, I summarize the perilous competitive dynamics facing retail pharmacies.

P.S. We are still experimenting with how best to use our new Drug Channels Video platform. Please drop me a line with any feedback or suggestions.

Read more »

        

Source: Post feed

This week, I’m rerunning some popular posts while I prepare for today’s video webinar: Industry Update and COVID-19 Impact: PBMs & Payers.

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

Manufacturers recently announced list price increases for many brand-name drugs. The typical increase was about 5%. Judging by recent history, these moderately higher list prices will translate into another year of falling brand-name drug prices in 2020.

This surprising conclusion comes from our analysis of SSR Health data on prices for more than 1,000 drugs. Details below.

SSR Health data reveal that list prices for brand-name drugs rose by about 5% in 2019. However, net prices (after rebates and discounts) decreased by -3.1%. Drug makers discounted their brand-name drug list prices by an average of 45%.

Too many journalists and politicians remain committed to the false narrative of “skyrocketing drug prices.” In 2020, Congress may again take up drug price legislation. Let’s all hope that our country builds its public policies based upon accurate facts and reliable data. Hope has to triumph over experience eventually.

Read more »

        

Source: Post feed

This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Industry Update and COVID-19 Impact: PBMs & Payers.

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

For 2020, the two largest pharmacy benefit managers (PBMs)—Express Scripts and the Caremark business of CVS Health—have again increased the number of drugs they have excluded from their standard formularies. The 2020 formulary exclusion lists are available below for your downloading pleasure.

Below, I highlight my key takeaways from the 2020 lists:

• The number of exclusions

• Management of specialty drugs

• Indication-based formularies

• The slow adoption of biosimilars

• The PBMs’ patient-unfriendly exclusions in the hepatitis C category

Formulary exclusions have emerged as a powerful tool for PBMs to gain additional negotiating leverage against manufacturers. The prospect of exclusion leads manufacturers to offer deeper rebates to avoid being cut from the formulary. Exclusions are therefore a key factor behind falling brand-name net drug prices.

Read on for a look at this year’s exclusions along with some closing thoughts on what exclusions mean for patients.

Read more »

        

Source: Post feed

This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Industry Update and COVID-19 Impact: PBMs & Payers.

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

Our high-list-price/high-rebate system remains a fundamental source of warped incentives and cascading problems within the Medicare Part D program.

For proof, check out the previously unpublished data below on market share for products that treat hepatitis C. Despite manufacturers offering products with lower list prices, Medicare Part D plans have rejected the therapeutically identical but lower-priced versions of these drugs.

List prices significantly affect seniors’ out of-pocket costs, so Part D plans are needlessly costing many of them thousands of dollars. The federal government's Medicare spending is also unnecessarily higher.

Anyone concerned about drug prices should pay close attention to this situation. Part D plans and seniors who don’t need specialty medications are benefiting, while seniors who need treatment with specialty medications are ripped off. Just another day inside the gross-to-net bubble!

Read more »

        

Source: Post feed