The National Pharmaceutical Council (NPC) recently released Toward Better Value, a fascinating survey of employers’ views about their pharmacy benefit managers (PBMs). (free download)

According to the results, employers are unhappy with PBMs’ performance on crucial services. (The PBMs were not identified by the survey.) Employers apparently also want to reform the rebate system at the heart of our complex distribution and reimbursement system.

These results imply a significant but as-yet-unexplained market failure—one that that somehow prevents employers from negotiating better deals and writing more effective contracts. Below, I review the NPC results and speculate on what they mean for the PBM industry and possible disruption of the PBM model.

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Specialty Pharmacy’s New Frontier: How to Deliver and Document Therapy Outcomes

A free webinar hosted by Therigy

Wednesday, December 13, 1pm-2pm EST

Register here.

Therigy is pleased to announce a free webinar exploring therapy outcomes on Wednesday, December 13, 1pm-2pm EST.

Therigy’s speakers will present background data and published insights to support the premise that specialty pharmacy services need further differentiation. The speakers will analyze the crucial roles of both predictive analytics and specialty pharmacy services in the actual delivery and documentation of patient outcomes.

Featured speakers include:

• Jon Hamrick, MBA, Chief Strategy Officer, Therigy
• Sheena Babin, Pharm D, Manager, Clinical Services and Business Development, Ochsner Specialty Pharmacy
• Brian Smith, Pharm D, Vice President, Clinical Services and Quality, Shields Healthcare Solutions

Featured topics include:

• Historical Specialty Pharmacy Activities and Impact on Adherence
• The role of specialty pharmacy in Outcomes
• Differentiating specialty pharmacy services
• The Evolution of Specialty Pharmacy Services
• Two case studies
• Lipid Identification and the Diabetic Patient
• Specialty Pharmacy’s Role in Disease Activity in Rheumatoid Arthritis

Case studies will provide examples of specialty pharmacy services which go beyond basic patient onboarding, adherence support and reporting to the next level of identifying at-risk patients. The case studies will identify opportunities for specialty pharmacies to actively impact patient outcomes.

Visit Therigy’s registration page for additional information and to register.

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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A few weeks ago, I highlighted the latest drug spending data in Reality Check: New Prime Therapeutics Data Show Very Low Drug Spending Growth in 2017. As I see it, these data contradict the public rhetoric about excessive growth in drug spending and prices. I concluded that drug spending is not actually "out of control."

Jim DuCharme, president and CEO of Prime Therapeutics, emailed me with an alternative and much more critical interpretation of the drug spending situation. Fortunately, he didn’t seem to mind my artistic choices.

Jim was kind enough to allow me to share his thoughts with the Drug Channels audience. Read on for his perspective.

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In a previous analysis (Employer Pharmacy Benefits in 2017: More Cost-Shifting to Patients As Tiers and Coinsurance Expand), I examined the structure of employers’ 2017 pharmacy benefit plans.

Today, I examine the growing role of deductibles. The growth of separate prescription deductibles has become a significant change in patient cost sharing for prescription drugs.

For 2017, about 8 out of 10 U.S. workers must meet a general annual deductible before their plan pays for most healthcare services. Prescriptions are typically excluded from the deductible.

However, this year’s survey shows that one-third of workers in high-deductible plans now faces a separate prescription drug deductible. These plans shift 100% of the prescription cost to the patient until the deductible is met.

After reviewing the latest data, I offer some observations on how deductibles are altering the pharmaceutical and pharmacy industries. The bottom line: Patients who must cover the costs of their drugs shop for better deals and cheaper pharmacies. Get ready for the consumerization of the pharmacy industry!

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It’s time for our annual analysis of the Kaiser/HRET 2017 Employer Health Benefits Survey, which you can read online for free. The survey delves into employer-sponsored health coverage at more than 2,000 companies.

In the charts below, I summarize employers’ 2017 pharmacy benefits by examining (1) cost sharing tier structures, (2) average copayments, by formulary tier, (3) type of cost sharing (coinsurance and copayment), and (4) coinsurance structures. I’ll investigate the growing role of deductibles in a follow-up article.

This year’s results show massive cost-shifting for specialty drugs. For the first time, a majority of plans have four tiers. Economically-debilitating coinsurance—in some cases with no limit on out-of-pocket expenses—is common.

When people complain about “drug costs,” they are actually thinking about the share of costs that they pay. Last week, I highlighted Prime Therapeutics’ data showing very slow growth in post-rebate drug spending. Given the new Kaiser/HRET survey, it looks like patients may not always be getting the benefit of lower costs.

Read on for my analysis along with another annual Drug Channels tradition: tiers/tears puns!

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CBI’s 15th Specialty Therapies – A Forum for Payers

January 25-26, 2018 | Las Vegas, NV

www.cbinet.com/specialtytherapies

CBI announces that registration is open for the Specialty Therapies Forum!

Join stakeholders from across the healthcare industry – health plans, PBMs, pharmacies, and drug manufacturers – to take a deep dive into managing cost, expanding access and improving patient services and care delivery for specialty therapies.

Exchange ideas on:

• Latest trends for conquering diseases that were once considered untreatable
• Addressing the challenges of controlling costs
• Providing access for new therapies
• And more!

Sign up to receive the agenda here. Visit www.cbinet.com/specialtytherapies for further details and to register.

CBI will see you there!

“Class act!” – Director of Specialty Pharmacy Programs, Blue Cross Blue Shield South Carolina

“I found the program to be well-designed and stimulating, well worth my time.” -Executive Director, MidAtlantic Business Group on Health

“The specialty pharmacy arena is constantly evolving. Quality Conferences like CBI’s Specialty Therapies Forum for Payers allows payers and industry alike to hear from KOL’s and prepare for the challenges that they are currently dealing with or will be facing in the near future.” -Director, Clinical Pharmacy, Blue Cross Blue Shield of Tennessee

“The conference provided a unique insight into the payer viewpoint and allowed attendees to observe complex discussions between interested parties.” -Manager of Specialty Clinical Services, Fairview Specialty Pharmacy

*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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Speculation about Amazon’s intentions for the drug channel has reached a new high. Below, I briefly review the recent news and hype.

Amid the hubbub, you may have missed intriguing comments from Tim Wentworth, president and CEO of the pharmacy benefit manager (PBM) Express Scripts. On an earnings call last week, he explained how Amazon could partner with the largest (for now) PBM via Inside Rx, the Express Scripts-GoodRx drug discount partnership. I explain the economic logic for both companies below.

Amazon will reportedly decide on its pharmacy and/or PBM strategy by Thanksgiving. We’ll see if I have been talking turkey or am just full of stuffing.

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Eeek! Time for my Halloween roundup of Drug Channels news stories. In this issue:

• Spooktakular! An FTC competition workshop will include a terrifying panel on pharmacy benefit managers (PBMs)

• Scary! The pros and cons of frightful high-deductible health plans

• Creepy! JPMorgan Chase conjures up surprising new data on consumer out-pocket costs

• Spooky! Ghastly hospital markups on outpatient drugs

Plus, the FDA treats us to a new educational campaign on biosimilar drugs—complete with groovy shareable GIFs for millennials.

P.S. For a daily haunting, join the zombie horde who shamble after me here: @DrugChannels on Twitter. (ICYMI: Over the past week, I have sent multiple tweets with my $0.02 on Amazon and CVS-Aetna.)

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CBI’s Drug Pricing Transparency Congress

December 5, 2017 | Philadelphia, PA

www.cbinet.com/drugpricing

With numerous states across the country ramping up on introducing and passing laws aimed at drug pricing transparency and reporting, is your organization prepared to act? And fast? The recent passage of California’s drug pricing bill and a number of other states passing laws earlier in 2017 leaves many unanswered questions and the opportunity to steer the course is now.

Exclusive Offer for Drug Channels Readers: Save $300 when you use discount code DCP125 and register by November 17, 2017.

CBI’s one-day Drug Pricing Transparency Congress, taking place December 5th in Philadelphia, convenes stakeholders across the healthcare ecosystem, including state and federal government regulators, manufacturers, health plans, PBMs, associations and other industry experts to learn how the future of drug pricing transparency regulation impacts commercialization, reimbursement and drug pricing models with a focus on state pricing and transparency regulation.

This monumental shift will undoubtedly impact so many functions across the healthcare system. If your responsibilities touch any facet of your organization’s pricing, transparency or commercialization efforts, you’ll need to be on the pulse of the rapid developments and this conference will serve as an unparalleled uniting place for the industry to assess the future landscape and gain clarity on the many unanswered questions from industry experts and regulators.

Don’t be left out of the critical conversation.

Exclusive Offer for Drug Channels Readers: Save $300 when you use discount code DCP125 and register by November 17, 2017.

*Offer expires November 17, 2017; applies to standard rates only and may not be combined with other offers, category rates, and promotions or applied to an existing registration.

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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In a previous analysis (CVS Bets Big: Our Exclusive Analysis of Pharmacy Chain Participation in 2018's Part D Preferred Pharmacy Networks), I highlighted how the largest pharmacy chains will participate in next year’s Medicare Part D prescription drug plans (PDP).

Today, I examine independent pharmacies’ participation in 22 major 2018 Part D preferred networks. Our analysis focuses on the pharmacy services administration organizations (PSAOs) that represent these pharmacies in negotiations with plans.

As you will see below, the profit pressures from narrow networks have made smaller pharmacies much choosier about contracting for preferred status. For three of the four largest PSAOs, smaller pharmacies will have preferred status in fewer than half of the major plans. By contrast, members of AmerisourceBergen’s Elevate PSAO will not have preferred status in the largest plans, although they will be preferred in some smaller plans.

I wonder: Will 2018’s surprising pharmacy participation patterns trigger a rethink of preferred networks in Medicare Part D?

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