Analysis

West Coast Real-Time Benefit Check & ePrior Authorization Summit
October 17-18, 2018 | San Francisco, CA
www.cbinet.com/eBenefit

CBI’s West Coast Real-Time Benefit Check & ePrior Authorization Summit convenes stakeholders, including manufacturers, specialty pharmacies, PBMs, health plans, solution providers and prescribers to discuss and share best practices regarding electronic patient service technology and speed to therapy. With constant innovations in electronic patient services (ePA, FHIR, HL7, RTPBI), the integration and implementation of this technology is imperative to drive patient access to therapy.

Join the conversation and participate in open discussions with your peers to discuss workflow improvements, firsthand experiences with system integration and the latest advancements in ePA and RTBC. Drug Channels readers will save $400 off the standard registration rate when they use discount code SGK838.*

Critical Topics for Peer-To-Peer Benchmarking:

• Discuss clinical and operational factors to consider when implementing portal PA solutions with medical specialty drugs
• Hear how to streamline electronic benefit verifications and prior authorization solutions into a hub model
• Examine how to configure interoperability in a local/regional health setting and recent efforts within the FHIR/HL7 standards
• Understand how to work more efficiently between specialty pharmacies, providers and payers to manage patient therapy
• Discuss alert fatigue, additional clicks, and how to avoid prescriber burnout
• Address considerations for enrollment standards in hubs and specialty pharmacies

Visit www.cbinet.com/eBenefit for more information, or download the full agenda today. Drug Channels readers will save $400 off the standard registration rate when they use discount code SGK838*

*Discount expires October 17, 2018; applies to standard rates only and may not be combined with other offers, category rates, promotions or applied to an existing registration. Offer not valid on workshop only or academic/non-profit registrations.

---

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

Are you ready for a world without rebates?

In June, Alex Azar, Secretary of the U.S. Department of Health & Human Services (HHS), summarized his long-range vision for a new drug channel system:

“[W]e may need to move toward a system without rebates, where PBMs and drug companies just negotiate fixed-price contracts. Such a system’s incentives, detached from artificial list prices, would likely serve patients far better.” (emphasis added)

No one has yet explained what a system without rebates would look like.

To facilitate the discussion, I have sketched out a possible new drug channel system that would:

• Respond to the HHS vision for a “system without rebates”

• Remove/decrease the reliance on list price as a component of intermediary compensation

• Use negotiated discounts as an alternative to the current system of retrospective rebates

• Require manufacturers to negotiate for desirable market access

You can download The Drug Channels Negotiated Discounts Model below.

Please note that I am not advocating for this approach. I am merely exploring one way that a system without rebates could be implemented. I hope you find it helpful for your strategic planning.

As always, I welcome feedback on how to improve and refine this model. Either leave comments below or email me. Enjoy!

The lazy days of summer are here. Take some time off from the gross-to-net bubble and enjoy my curated collection of timely articles. This month:

• A must-read Q&A on Amazon’s healthcare products distribution business

• A new GAO study discovers that more than one in five 340B hospitals provides minimal charity and uncompensated care

• Fresh data from GoodRx about the crazy variability in pharmacies’ prescription prices

Plus, The Wall Street Journal publishes some hard-hitting journalism about the controversial hold music played at CVS pharmacies.

P.S. Join the more than 6,000 people who follow my daily musings and neat links at @DrugChannels on Twitter. Recent tweets have tackled biosimilars, specialty pharmacy, copay accumulators, drug pricing, health policy news, and much more.

CBI’s PAP Legal Update Forum
September 25-26, 2018 | Arlington, VA
www.cbinet.com/papupdate

Join CBI this fall at the PAP Legal Update Forum to delve into the nuances of compliance for patient assistance programs, address new copay card legislation, analyze critical areas of risk within the Anti-Kickback Statute, and explore strategies for effective risk management and compliance monitoring to optimize and ensure patient access.

You can read all about it here.

Participate in compelling discussions led by expert speakers:

• Examine the Impact of Legal Actions and Developments Related to Patient Assistance Programs
• Analyze PAP Critical Risk Areas within the Anti-Kickback Statute (AKS), False Claims Act (FCA) and Other Key Laws
• Redefine Relationships between Manufacturers and 501(c)3 Foundations
• Dissect Evolving State Copay Card Legislation in California, Massachusetts and Rhode Island
• Tackle Critical Challenges in Providing Assistance for Rare Disease and Specialty Therapeutics Patients
• Build Effective Strategies to Balance Patient Centricity and Compliance in Patient Access
• Implement Robust Compliance Monitoring Programs for PAPs

Visit www.cbinet.com/papupdate for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code YHX639 and register prior to August 24th.*

CBI looks forward to seeing 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.

Today, drug wholesalers make money from distribution in a straightforward manner: Buy low, sell high, collect early, and pay late. They also profit as brand-name list prices increase. Like other drug channel intermediaries, wholesalers have warped incentives to prefer ever-higher list prices.

But what happens to their business model if list prices don’t rise—or even if they decrease?

This question is no longer theoretical. Many drug makers—Pfizer, Roche, Novartis, Novo Nordisk, Sanofi, and others—have announced an intention not to raise list prices for 2018 or have rescinded planned increases. Merck has gone further and become the first major manufacturer to reduce the list price of a brand-name, patent protected product, albeit for a product with minimal sales. And for the first time, there is a serious attempt to pop the gross-to-net bubble and build a system without rebates.

Below, I analyze what this could mean for the Big Three drug wholesalers—AmerisourceBergen, Cardinal Health, and McKesson. I explain some of the problems that arise when wholesalers are compensated based on a brand-name drug’s list price. I then suggest an alternative approach that would reshape wholesalers’ economics. It appears that even the wholesalers’ trade association supports some sort of new model.

Given what’s happening, it’s clearly time for some ch-ch-ch-ch-changes.

CBI’s 11th Hub and SPP Model Optimization
September 12-13, 2018 | San Diego, CA
www.cbinet.com/hubswest

In order to keep up with the escalating challenges associated with rebooting or maintaining your hub model, your organization requires novel and innovative strategies for customizing your products and services. CBI has once again gathered the pioneers in the industry to share practical strategies for advancing patient services, enhancing program effectiveness and driving speed to therapy.

Join CBI in San Diego, CA for the 11th installment of the Hub and SPP Model Optimization Summit on September 12-13. You can read all about it here.

Visit www.cbinet.com/hubswest for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code TJC549 and register prior to August 17th.*

Conference Highlights Include:

• Discover how to best streamline the information generated by the hub back to the manufacturer
• Review the overall end-to-end experience from the physician and patient perspective in e-prescribing, prior authorization and dispensing workflows
• Discuss the impact of DIR Fees on practice-based pharmacies
• Examine best practices on the development and administration of a third-party monitoring and oversight program
• Understand the consequences of narrow channel medication distribution on patient adherence in post-acute care
• Gain an understanding for how to consolidate specialty distribution data
• Use EHR technologies to determine formulary, launch electronic prior authorizations and streamline fills at retail pharmacies and through mail-away hubs

PLUS! Don't miss the heart-wrenching Keynote Address from former NFL great Rolf Benirschke, current CEO of Legacy Health Strategies.

Visit www.cbinet.com/hubswest for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code TJC549 and register prior to August 17th.*

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.

In two recent Drug Channels articles, I have documented the phenomenal growth in pharmacies participating in the 340B Drug Pricing Program and the superior profits that pharmacies earn from the program.

Today, I turn to the less well-known role of specialty pharmacies and pharmacy benefit managers, which are now significant participants as 340B contract pharmacies. Below, we present our first exclusive analysis of how independent and PBM-owned specialty pharmacies have deepened their relationships with hospitals and other 340B covered entities.

We estimate that nearly 10% of all specialty prescriptions are dispensed by 340B contract pharmacies, which makes this channel one of the fastest-growing components within the 340B program. Despite this growth, pharmaceutical manufacturers have limited transparency into the behavior of these 340B contract pharmacies. Drug makers therefore pay 340B discounts on prescriptions for which they also pay commercial, Medicare Part D, and managed Medicaid rebates.

Below, we explain why manufacturers should have access to the prescription-level data that would permit the identification of 340B claims. Playing Where’s Waldo? for 340B claims is no way for this multi-billion dollar program to operate.

CBI’s 6th Annual Coupon and Copay Summit
October 2-3, 2018 | Philadelphia, PA
www.cbinet.com/coupon

CBI’s Coupon and Copay Summit begins with their Chairman, Chris Dowd, Executive Vice President, Market and Product Development of ConnectiveRx addressing the state of the marketplace – accumulator programs, drug rebates, rising out-of-pocket costs and the drug pricing debate.

This two-day summit is filled with key issues:

• Assessing the Impact of Industry Consolidations and Cost Shifts
• Understanding Key Trends Affecting Market Access, Patient Affordability and the Future of the Drug Pricing Ecosystem
• Identifying Challenges in Copay Access and Reimbursement from Patient Advocacy, Pharmacy and Manufacturer Perspectives

As the healthcare marketplace continues to evolve, CBI’s Coupon and Copay Summit convenes an exceptional group of industry experts to discuss key market factors affecting the future of copay assistance and copay program design.

Here’s a snapshot of the experts you’ll meet and with whom you’ll benchmark best practices:

• Chris Boneham, Executive Director, Managed Markets, Aralez Pharmaceuticals
• Fred Brownfield, Former Director, Pharma Innovative Contracting, Humana
• David Eskew, Deputy Chief, Criminal Division, United States Attorney’s Office, District of New Jersey
• Dina Inverso, Strategy Leader, Patient Engagement and Reimbursement, CSL Behring
• Joseph Mack, Senior Compliance Counsel, U.S. Office of Compliance, Bayer U.S.
• Philip W. McCreary, Pharm.D., MBA, Medication Access Program Director, Vanderbilt University Medical Center
• Dennis Murphy, Pharm.D., Manager, Commercial Strategy, Radius Health
• Peter J. Pitts, Former Associate Commissioner, FDA; President, Center for Medicine in the Public Interest

And much more …

Please visit CBI’s site for more information. Register by August 10th 2018 and receive $500 off the standard rate with the discount code DCC500 (an additional $100 off the Advantage Pricing!).

*Discount expires 08/10/2018 and may not be combined with other offers, category rates, promotions, or applied towards an existing registration. Offer not valid on workshop only or academic/nonprofit registrations. 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.

Today’s guest post comes from Jean-Francois Denault, CEO and Owner of Impacts.CA. He discusses the Trump Administration’s Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. He outlines potential changes and their impact on pharmaceutical manufacturers.

Knect365’s 23rd Annual Summit on the Medicaid Drug Rebate Program (MDRP) in Chicago will provide an opportunity to learn more about the administration’s drug pricing plans and such other topics as government pricing, rebates, and regulation. This event is notable for including many government officials along with over 500 industry participants.

Register by July 27 to save up to $400 off the regular registration fee. Visit medicaiddrugrebates.com for more information.

Read on for Jean-Francois’s insights.

Pharmacies continue to profit from the 340B Drug Pricing Program’s explosive growth.

Our latest exclusive analysis finds that about 21,600 pharmacy locations now act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. The total number of locations has grown by 9% over the past 12 months. The five largest retail pharmacy chains—Walgreens, CVS, Walmart, Albertsons/Rite Aid, and Kroger—account for two-thirds of 340B contract pharmacy locations.

This growth is unsurprising. The U.S. Government Accountability Office (GAO) has now documented the tremendous profits available to 340B contract pharmacies. See GAO Confirms It: 340B Hospitals and Contract Pharmacies Profit from Low-Income, Uninsured Patients.

Does Congress really want the 340B program to provide outsize financial benefits to a handful of large, multi-billion-dollar, for-profit pharmacy chains? Should investors be concerned about how much pharmacies are earning from this embattled program?