This week, the two largest pharmacy benefit managers (PBMs)—Express Scripts and the CVS/caremark business of CVS Health—released updates to their 2018 formulary exclusion lists. They are available below for your downloading pleasure.

For 2018, Express Scripts was more aggressive, expanding its list to 159 excluded products. At CVS Health, however, the total number of excluded remained steady. The Prime Therapeutics list won’t be available until September, but it will apparently exclude more drugs that either of its PBM peers.

Read on for my 2018 head-to-head comparison, including comments on inflammatory conditions, multiple sclerosis, epinephrine, biosimilars, and more. I also review the reported savings from formulary exclusions. I conclude with some questions about patients. Remember them?

If I have missed anything important, please comment below.

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The Medicare Payment Advisory Commission (MedPAC), the independent agency that advises Congress on the Medicare program, recently released its June 2017 Data Book: Health Care Spending and the Medicare Program. The report is a 201-page wonktastic data dump. Chapter 10 focuses on prescription drugs.

In 2015, the most recent year available, Part B spending on drugs reached $25.7 billion. Hospital outpatient sites now constitute more than one-third of Medicare spending and have been crowding out physician offices. Part B payments to physician practices are growing much more slowly than payments to hospitals.

For some time, I have been tracking the evolution of the buy-and-bill system for provider-administered drugs. These new data confirm my predictions that physician offices’ will account for a declining share of the buy-and-bill market. Still unknown: Is this good or bad for patients?

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CBI’s 5th Annual Coupon and Copay

September 14-15, 2017 | Philadelphia, PA

www.cbinet.com/CouponAndCopay

In the midst of a turbulent healthcare system, with drug prices continuing to escalate, patient affordability and access programs have become more critical than ever. Coupon and copay programs are one of the most effective tools for life sciences manufacturers to minimize patient out of pocket costs, while driving access and adherence.

As such, CBI’s flagship Coupon and Copay conference, taking place September 14-15 in Philadelphia, PA, serves as the life sciences industry’s foremost event devoted exclusively to manufacturer-driven coupon and copay programs. Join the best of the best in life sciences and discover pioneering strategies to maximize ROI by leveraging these powerful discount opportunities.

The 2017 agenda boasts a diverse, experienced faculty from Otsuka Pharmaceuticals, United Healthcare Pharmacy, Healthwell Foundation, Coherus Biosciences, BioPlus Specialty Pharmacy, Community Health Network, UVA Cancer Center and many more!

Don’t miss your chance to unite with leading innovators in copay design to discuss the future of patient assistance and access:

• Hear multi-stakeholder perspectives on the future of assistance and access for patients needing high-cost specialty therapies
• Discuss key analyses (abandonment, redemption, competitive offerings) used to improve the value of copay programs
• Identify new challenges in an evolving environment including deductible reset, LOE, real-time measurement for launches, distribution channel, OIG risk, denial conversion and e-coupons
• Navigate the OIG modifications on contributions to charitable patient programs
• Learn more about copayment assistance funds for Medicare patients
• Alignment of offer strategy with contracting efforts to avoid “double-dipping” of rebate and copay offerings
• Consider strategies for fast tracking prior authorization and copay assistance for specialty prescriptions to increase speed to therapy

*Discount offer valid through 8/25/2017; applies to standard rates only and may not be combined with other offers, categories, 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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Cut through the steamy summer haze with our refreshing selection of articles and insights. In this issue:

• CVS drugstores aim for a healthier look

• Anthem dissects specialty pharmacy management

• Takeaways from an Insys employee’s guilty plea over prior authorization

• Profiling pharmacies inside supermarkets and mass merchants

Plus, The Onion reports on the launch of generic internets following patent loss. Scary!

P.S. Follow @DrugChannels on Twitter for my daily curated selection of news and commentary.

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Let’s revisit the Walgreens Boots Alliance—Rite Aid deal. Instead of an acquisition, the revised transaction calls for Walgreens Boots Alliance (WBA) to buy 2,186 Rite Aid stores and three distribution centers for $5.2 billion. WBA will also pay a $325 million termination fee to Rite Aid.

If the deal receives regulatory approval, Rite Aid will shrink to a multi-regional pharmacy chain with about half as many stores. It will, however, hold onto EnvisionRx, the pharmacy benefit manager (PBM) that it acquired in 2015.

Unfortunately, EnvisionRx remains a small, struggling regional PBM with limited growth. Its revenues in 2017 have been declining. There also appears to be no material synergies between Rite Aid’s retail pharmacy business and its Envision PBM.

Last week, Rite Aid disclosed that it will use $4.9 billion of its $5.5 billion windfall to repay debt. (Pro forma financials below.) Given the performance troubles that I outline below, I wonder whether investors will trust the current management team to spend the cash wisely.

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PBMI 2017 Specialty Rx Forum

September 12, 2017

Hyatt Regency Hotel | Downtown Chicago

You’re invited to join PBMI for its first regional Specialty Rx Forum in downtown Chicago at the Hyatt Regency Hotel. This one-day meeting is focused on discussing what’s keeping plan sponsors up at night—specialty drug trend.

PBMI has gathered speakers representing different perspectives on the specialty drug industry including senior leaders from the largest PBMs, national employers, specialty drug manufacturers, and specialty pharmacies.

For more information about the Forum and sponsorship opportunities, please contact Linda DeChant at ldechant@pbmi.com.

PBMI looks forward to seeing you!

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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Drug Store News (DSN) has just released its latest rundown of the top pharmacy retailers in the mightily-titled PoweRx 50. (Links below.)

I recommend the PoweRx list to anyone who competes with, sells to, or otherwise interacts with retail pharmacy chains. This useful resource also provides brief profiles of most organizations.

Below, I show DSN's top 25 retailers. This year, CVS Health tops the DSN list, with $60.8 billion in retail prescription sales. Colorado-based chain Pharmaca Integrative Pharmacy is no. 50, with $73 million in prescription sales—0.1% of CVS Health’s retail revenues.

Note that the DSN list is not a complete look at the U.S. pharmacy industry. It excludes many large mail and specialty pharmacies. It also inconsistently (and IMHO, inaccurately) aggregates independently-owned pharmacies by wholesaler and buying group. I highlight how the list differs from our broader but shorter list shown in The Top 15 U.S. Pharmacies of 2016.

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Last Thursday, the Centers for Medicare & Medicaid Services (CMS) shocked everyone with a proposal altering a small part of the 340B Drug Pricing Program. CMS proposed reducing reimbursement for certain Medicare Part B drugs purchased by 340B-eligible hospitals: from Average Sales Price (ASP) plus 6% to ASP minus 22.5%. Hospitals will also have to identify 340B claims with a new modifier.

Below, I highlight the most important 13 pages of CMS’s 664-page proposal. I also offer some observations and commentary on the proposal.

For context, I also include the new background memo for today’s House Energy and Commerce Committee hearing: Examining HRSA’s Oversight of the 340B Drug Pricing Program. The memo highlights the many negative findings from government watchdog agencies.

Like it or not, change may finally be coming to the out-of-control 340B program. Let’s hope Congress can get the program refocused on genuine safety-net providers and financially needy patients.

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CBI’s Life Sciences Outcomes-Based Contracting Summit

October 3-4, 2017 | Philadelphia, PA

www.cbinet.com/OutcomesContracting

CBI’s 2nd Annual Life Sciences Outcomes-Based Contracting Summit provides critical strategies into the process of outlining, structuring and negotiating risk-sharing agreements between bio/pharma manufacturers and payers.

This timely event will address the continuous challenges the industry faces to lower drug costs and increase patient access, all while demonstrating the value of their drugs to insurers by providing best practices and key insights from thought-leaders regarding the nuances surrounding outcomes-based contracting.

Join us for Solutions-Oriented Sessions, Powerful Payer Insights and Illuminating Case Studies:

• Gain an understanding of the risk-sharing challenges from the payers perspective, featuring Michael Sherman, MD, Sr. Vice President and Chief Medical Officer of Harvard Pilgrim Health Care
• Bridge the gap between real-world evidence and health economics outcomes research
• Manage legal, compliance and regulatory concerns surrounding value-based contracts
• Examine the benefits and challenges of outcomes-based contracts for target population (orphan/rare disease) therapies
• Translate successful European managed entry agreements into actionable opportunities for the U.S. marketplace
• Discuss the challenges and rewards of co-developing drugs and diagnostics for enhanced outcomes
• And more!

Be the first to view the complete agenda, then register today using promo code DCR400 for this limited time savings of $400* off.

*Discount offer valid through 8/14/17; applies to standard rates only and may not be combined with other offers, category rates, promotions or applied to existing registration. Offer not valid on workshops only or academic/non-profit 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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For a follow-up to The Booming 340B Contract Pharmacy Profits of Walgreens, CVS, Rite Aid, and Walmart, let’s examine covered entities’ contract pharmacy networks in the 340B Drug Pricing Program.

Many covered entities have relatively small 340B contract pharmacy networks. However, some have built large networks seemingly designed not to help needy and uninsured patients, but to enrich hospitals and pharmacies.

The top 10 hospitals, listed below, have built mega-networks averaging 277 pharmacies. The largest retail chains and pharmacy benefit managers (PBMs) are active participants in these networks. That’s right: PBMs have joined the 340B party!

Yesterday, the House Energy and Commerce Committee announced a July 18 hearing: Examining HRSA’s Oversight of the 340B Drug Pricing Program. Also below, I pose four questions that committee members should consider about 340B contract pharmacy mega-networks.

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