ICYMI: Rep. Doug Collins (R-GA) led a 60 minute rant against pharmacy benefit managers (PBMs) in the U.S. House of Representatives. Joining him were congressmen Brian Babin (R-TX), Buddy Carter (R-GA), John J. Duncan, Jr. (R-TN), Dave Loebsack (D-IA), and Austin Scott (R-GA). It’s an enlightening tour through the usual grievances and conspiracy theories about PBMs.

Regular readers know that I have called out PBMs for the potentially warped incentives embedded in rebate practices and the gross-to-net bubble. See, for example, this article and this one.

But the overheated rhetoric on the House floor was truly jaw dropping. Example: Rep. Collins kicked things off in style by claiming that PBMs engage in “monopolistic, terrorist kind of ways that they are dealing with our community pharmacies and independent pharmacies.”

Terrorists? Really?!? I wonder how ISIS feels about this comparison.

Video, transcript, and additional observations below. Enjoy!

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The Centers for Medicare & Medicaid Services (CMS) recently released its updated forecasts for national health expenditures. See the Health Affairs article: National Health Expenditure Projections, 2016–25: Price Increases, Aging Push Sector To 20 Percent Of Economy. (Available for free to subscribers and to others for purchase.)

These new data don’t account for any changes in policy or the law, such a repeal of the Affordable Care Act (ACA). They do, however, show drug spending growth below that of CMS’s July 2016 projections. The updated forecasts predict that through 2025, drug spending will grow at roughly the same rate as will total U.S. healthcare spending.

By 2025, the U.S. is expected to have spent about $597 billion annually on outpatient prescription drugs. Just seven months ago, the 2025 figure was projected to $615 billion. Below, I also review drug spending projections by payer. CMS expects that drug spending will account for a stable share of private insurance, but a bigger part of Medicare spending.

Note that these projections will be revised when the law changes. For now, we have only CMS’s vision. Reality will render its own opinion soon.

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Our mild winter is almost over! Celebrate the imminent return of spring with our selection of noteworthy news stories. In this issue:

• Business trends for specialty pharmacy owners

• The new Specialty Pharmacy Patient Choice Award

• Pharmacy benefit managers find a powerful friend

Plus, some droll health insurance humor! (Is there any other kind?)

P.S. Remember to follow me on Twitter @DrugChannels for daily tweets on cool and intriguing stuff.

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eyeforpharma Oncology Market Access & Pricing 2017

June 15-16, 2017

Le Meridien | Philadelphia, PA

In an increasingly complex and fragmented healthcare space, isn’t it time for true innovators to take control?

Against the back drop of increased pricing pressure, the next few years in Oncology will be volatile. But with volatility comes great opportunity- especially for Pharmaceutical companies ready to step from the periphery to the centre of the healthcare stage. Pharma can- and should lead stakeholders towards mutually beneficial outcomes and drive the decision making processes that will both outline oncology’s future and redefine the healthcare system.

The shift from volume to value has brought the adoption of alternative payment models, increased payer involvement, increased spending on oncology therapeutics, a shift in drug distribution, integrated delivery systems… the list is endless. Meeting the needs of cancer patients is now down to successful navigation of a complex, fast-evolving market place.

The answer to this existential crisis is multi-stakeholder buy-in, but with pharma firmly at the helm. We need to embrace more collaboration, transparency and payer/patient engagement. eyeforpharma’s Oncology Market Access & Pricing Summit will show you how. Download the full agenda here.

In June, after the dust from ASCO has settled, with expert insights from Julie Locklear, VP, EMD Serono; Kevin Fitzpatrick, CEO, CancerLinQ; Bryon Wornson, VP, Pfizer; Ariella Evenzahav, Head, Takeda; Lou Sanquini, VP, Healthagen Aetna and many more…eyeforpharma will be addressing the key strategic points in more detail, including:

• Expert insights on how to move value from theory to reality
• Ways to change market place dynamics and develop stronger patient, payer and HCP partnerships
• Guidance on how to connect reimbursement with value and win over your stakeholders

Join eyeforpharma at a provocative and complete gathering for commercialization, market access and pricing leaders in Oncology to find out how Pharma can deliver leadership-based value, satisfy payers and drive better outcomes across the board.

Access the full agenda here.

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 2016, specialty drugs became an even bigger part of the pharmacy industry. We estimate that in 2016, retail, mail, long-term care, and specialty pharmacies dispensed about $115 billion in specialty pharmaceuticals. Specialty drugs accounted for 28% of the pharmacy industry’s prescription dispensing revenues.

Below is our exclusive list of the 15 largest pharmacies, ranked by estimated revenues from dispensing specialty pharmaceuticals. This year’s expanded list includes specialty pharmacies owned by pharmacy benefit managers (PBMs), health plans, retail chains, and wholesalers. A further five pharmacies are independent companies—for now.

Lace up and get ready to slug it out with our latest update on the booming specialty market.

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Specialty Pharmacy Summit 2017

April 30 – May 3, 2017

Wynn & Encore | Las Vegas

Please join me at Asembia's  Specialty Pharmacy Summit 2017, which will take place from April 30 to May 3, 2017, at the wonderful Wynn & Encore Las Vegas.

This year, I will help kick things off with an opening Featured Session titled Specialty Pharmaceuticals and Pharmacy: Today, Tomorrow and Beyond. I'll be joined by Doug Long from QuintilesIMS and Eric Percher from Barclays Capital.

The Summit attracts an impressive diversity of pharmacies, manufacturers, health plans, wholesalers, hospital systems, pharmacy benefit managers, patient advocacy groups, and more. View the agenda and check out the list of speakers.

Here's my review of last year's Summit: The State of Specialty Pharmacy in 2016: Reflections from #Asembia16.

Read on for more details about this great specialty pharmacy event and register now. See you in Vegas!

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Retail clinics focus on convenient care for simple acute conditions. They exemplify how drugstores and other retail outlets are broadening their services to emphasize non-dispensing revenues.

As I predicted last year, clinic growth stalled in 2016. From 2010 to 2015, the number of retail clinics grew by nearly 70%, to more than 2,000 locations. As of January 2017, the number of retail clinics was unchanged compared from the 2016 figure.

Below, I update our analysis of the chains with the biggest clinic market share: CVS Health, HEB, Kroger, Rite Aid, Walgreens, and Walmart. As you will see, strategies and growth rates differ.

FYI, this post is adapted from Section 1.4.1. of our 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. Friendly reminder: Discounted pricing for the report ends tomorrow!

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Last week, Express Scripts released its 2016 Drug Trend Report for the commercial market. (Free download. Download the two separate documents titled “Executive Summary” and “Commercially Insured” for the full story.)

Kudos to Express Scripts for continuing to publish these insightful data. Too bad that its PBM peers have stopped releasing comparable data or devolved into publishing only the briefest of marketing pamphlets.

For 2016, drug trend—the year-over-year change in spending—was a mere 3.8% for Express Scripts’ commercial plan sponsor customers. The Express Scripts data also highlight how drug prices were only part of the reason behind moderating drug spend. Contrary to the public rhetoric, increased utilization was a bigger influence than higher prices for both specialty and traditional drugs.

Tough benefit management enabled one-third of plan sponsors to lower spending from 2015 to 2016. Will Medicare and Medicaid really be willing to limit access to medicines and pharmacies? I wonder how many Americans would say “Be Mine” to aggressive utilization management tactics.

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CBI’s Formulary, Co-Pay and Access Summit

April 11-12, 2017 | San Francisco, CA

www.cbinet.com/formulary

CBI’s Formulary, Co-Pay and Access Summit is coming up April 11-12 at the Hyatt Centric Fisherman’s Wharf in San Francisco. For 2017, this annual meeting focuses on overcoming patient affordability barriers and navigating increased efforts from health plans to limit reimbursement of high cost therapeutics. There’s also a focus on the hot button issues impacting the pharma/bio industry today, including formulary exclusions, high deductible plans, changes in benefit design, NDC blocks and step therapy programs.

Interactive Discussions on Critical Topics Affecting Patient Access and Discount Programs:

• Formulary Breakthroughs – Moving Beyond Co-Pay Programs to Encourage Collaboration and Improve Patient Outcomes
• Survey Data Review – Explore Physician Perspectives on Prior Authorization and Formulary Issues
• Buy and Bill, Physician Administered Specialty Drugs – Managing Complexities while Ensuring Compliance
• May the Field Force Be With You – Managing Field Representatives to Execute Co-Pay Programs

New for 2017!

• Tech Talk – SEO Optimization to Promote Co-Pay Cards
• Stefani Klaskow, Head of Industry, Healthcare, Google

For more information, please download the complete agenda or visit www.cbinet.com/formulary. Drug Channels readers will save $400 off of the standard registration rate when they use discount code MPD934.*

*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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I am pleased to announce our new The 2017 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, available for purchase and immediate download.

• Click here to download a free report overview (including the Table of Contents and a List of Exhibits)

• Click here to read the press release (which highlights some key findings about specialty drugs, revenues, and profits)

We’re offering special discounted pricing if you order before February 17, 2017!

With more than 140 proprietary charts, exhibits, and data tables, it offers the only complete examination of the pharmacy and PBM industries’ prescription economics, reimbursement models, market structure, growth rates, forces of change, and interactions within the U.S. healthcare system.

See below for more info and some behind-the-scenes tidbits. Happy reading!

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