This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from January 2018.

Let’s kick off 2018 with a Last Jedi-themed look at copay accumulator programs—a benefit design option that I expect to become highly controversial this year.

Accumulator programs target specialty drugs for which a manufacturer provides copayment assistance. Unlike conventional benefit designs, the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum.

As you will see below, plan sponsors—employers and health plans—will save big money because accumulators shift a majority of drug costs to patients and manufacturers. Accumulator programs will further lower a plan’s drug spending by discouraging the appropriate utilization of specialty therapies and reducing adherence. What’s worse, many patients won’t understand their new “benefit.”

Given the direct human healthcare impact of copay accumulator programs, I don’t see how they can be considered value-based designs. Is it any wonder that people think their employers and insurance companies are from the dark side?

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This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from March 2018.

Below is our exclusive Drug Channels Institute list of the 15 largest pharmacies, ranked by estimated 2017 revenues from dispensing specialty pharmaceuticals.

The battle for control of the specialty market accelerated in 2017, though pharmacies owned by pharmacy benefit managers (PBMs) continued to capture most of the market share. The top four specialty pharmacies are all owned or co-owned by a PBM. They accounted for about two-thirds of prescription revenues from pharmacy-dispensed specialty drugs.

Vertical integration M&A has been in the news. But as our data shows, the integration of PBMs and specialty pharmacies has already happened.

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Baseball season is finally here! Oil up your glove, lace up your cleats, and let's run the bases around this month's news stories. Remember: Sometimes you win, sometimes you lose, and sometimes it rains.

In this issue:

• Green Monster: The drug manufacturers that are most vulnerable to copay accumulators

• Pop Fly: Express Scripts wants to pop the gross-to-net bubble?

• Foul! Fresh evidence that uninsured consumers pay rip-off cash prices at retail pharmacies

• Strikeout: My $0.02 on Amazon’s decision not to sell drugs to hospitals

Plus, from the diamond to the green: the secret pharmacy history of golf legend Jack Nicklaus.

P.S. For my daily pitches on the industry’s hits and misses, follow @DrugChannels on Twitter. My recent tweets have covered copay accumulators, the oncology market, drug costs, biosimilars, PBMs, and more.

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In 2017, the gross-to-net bubble—the ever-growing pile of money between a manufacturer’s list price for a drug and the net price after rebates and other reductions—hit a new high.

Based on new data from IQVIA, manufacturers of brand-name drugs in 2017 reduced list price revenues by an astonishing $153 billion. Those reductions came primarily from rebates, discounts, and other payments to the drug channel. That figure has grown by 10% from the 2016 figure, even though net prices for brand-name drugs grew by only 1.9%.

We can no longer ignore the warped incentives created by our bubble buddy. As regular readers know, I think plan sponsors and insurers should be more transparent about what they do with the billions collected via pharmacy benefit managers (PBMs) from manufacturers—or even be forced to pass through these rebates to point of sale. Read on and let me know what you think.

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CBI’s 14th Annual Commercial Contract & Chargeback Excellence

June 20-21, 2018 | Philadelphia, PA

CBI’s Commercial Contract & Chargeback Excellence Summit, take a deep dive into ways to improve chargeback efficiency, navigate class of trade assignments, streamline membership management and optimize contract administration and operations. Through 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 retain revenue.

Download the agenda here.

2018 Program Highlights:

• Partnership Pavilion – Collaborate with Distribution Partners, Manufacturers and Legal counterparts
• Manufacturer Panel – Overcome Key Challenges of Contract Operations and Administration
• Advanced Discussions on the hottest Topics Impacting Commercial Contracting:
• Manage Tier Commitments and Compliance in Complex Contracting
• Explore Key Benefits and Challenges of Outsourcing Chargebacks and Membership Functions
• Apply Data Analytics to Sales and Chargebacks to Enhance Business Decision-Making

Visit www.cbinet.com/chargebacks for further details and to register. Drug Channels readers will save $400 off the standard rate when they use discount code XYC552 and register prior to May 18th.

CBI will see you there!

*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 Bill Nolan, VP/GM of McKesson Specialty Health.

Bill discusses ExpressCoverage™, a solution from McKesson and CoverMyMeds^®. It offers new ways for McKesson’s Patient Support Services to electronically access and efficiently communicate with a vast network of physicians, payers, and pharmacies. Bill highlights how this tool improves the specialty patient’s access and adherence to therapy.

To learn more, download the free document ExpressCoverage™: Revolutionizing Patient Drug Access For Pharmaceutical Companies.

Read on for Bill’s insights.

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Consumer Reports recently published a fascinating survey of pharmacies’ cash prices for five common generic drug prescriptions.

The results were startling. Prescription prices ranged from $66 to $1,351—a nearly 2,000% difference. The big three retail drugstore chains—CVS, Walgreens, and Rite Aid—consistently had higher average prices compared with those of other pharmacies. Independent pharmacies had some of the lowest prices, but also some of the highest prices.

Our analysis of prescription profits highlights the pharmacy industry’s unfortunate pricing strategy for cash-pay prescriptions. Average profit margins ranged from $8 to $264 per prescription for the five drugs. We can only hope that consumers didn’t pay the pharmacies’ sky-high cash prices.

The results expose the insane soak-the-poor mentality baked into the U.S. pharmacy industry’s historical pricing models. The data also highlight the potential pharmacy opportunity for Amazon.

P.S. Before other states follow Maryland and pass laws against price gouging by generic manufacturers, perhaps they should take a closer look at the behavior of their own states’ pharmacies.

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Last week, McKesson announced the formation of Health Mart Atlas (HMA), a joint venture between McKesson’s Access Health business and American Pharmacy Network Solutions (APNS). Click here to read the press release.

The combination extends McKesson’s position as the largest pharmacy services administrative organization (PSAO). PSAOs are the awkwardly named intermediaries that operate between smaller pharmacies and pharmacy benefit managers (PBMs), per our U.S. Distribution and Reimbursement System flowchart.

When the Arete Pharmacy Network was formed, in 2016, I predicted that the fragmented PSAO sector would begin a long-overdue consolidation. Given the PBM titans now sitting atop Mt. Olympus, the remaining PSAOs can’t shrug off Health Mart Atlas.

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4th GPO Membership Eligibility & Class of Trade Maintenance

June 19-20, 2018 | Philadelphia, PA

www.cbinet.com/gpo

Assembling over 100 industry professionals representing manufacturers, GPOs, wholesalers, distributors, and solution providers, CBI’s 4th GPO Membership Eligibility & Class of Trade Maintenance conference provides a rare, interactive forum on membership data management, class of trade, and workflow efficiency. Join your colleagues this June to learn strategies and insights from peers and industry stakeholders, and acquire the ability to overcome significant operational challenges related to proper management of GPO membership data. For additional information on session topics and speaking faculty, download the agenda here.

Visit www.cbinet.com/gpo for further details and to register. Drug Channels readers will save $400 off the standard rate when they use discount code NHY548 and register prior to April 20th.*

Compelling Sessions and Actionable Takeaways on Topics, Including:

• Spotlight Panel Session: Ensure Seamless Membership Management and Accountability Across the GPO Supply Chain
• Understand Best Practices for Efficient Membership Maintenance in a World on HCP Service Evolution
• Kickback Risks of Arrangements with GPOs – Case Studies on Fraud and Abuse
• Audit COT Designations to Find Inaccuracies
• Develop Strategies to Streamline Communication With Your Distribution Network
• Distinguished Speaking Faculty Includes: Kendrion Biopharma, Anada Inc., Sanofi, UCB, Zydus Pharmaceuticals, Amneal Pharmaceuticals, Prometric Biotheraputics, Lilly USA, Chiesi USA Inc., and more.

Visit www.cbinet.com/gpo for further details and to register. Drug Channels readers will save $400 off the standard rate when they use discount code NHY548 and register prior to April 20th.*

CBI will see you there!

*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 Mark Bouck, President and CEO of TrialCard.

Mark reviews copay accumulator adjustment programs and shares some of TrialCard’s unique data about these programs. He also discusses TrialCard’s proprietary methodology for identifying patients affected by this benefit design. This topic is crucial for 2018 (per my own article from January), so I encourage you to review his commentary.

To learn more about TrialCard’s approach to copay accumulator programs, download the free e-book The Rise of Co-Pay Accumulator Programs: Are Your Brand’s Patients at Risk?

To learn more about TrialCard’s solutions for accumulators, email Mark Droke, TrialCard's Senior Vice President, Patient Affordability & Virtual Engagement Business Units, at mark.droke@trialcard.com. You can visit Trialcard in booth 610 at Asembia’s upcoming 2018 Specialty Pharmacy Summit.

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