Analysis

Autumn is almost here! Curl up with your favorite extra hot skim grande Pumpkin Spice blog and savor our latest seasonal harvest of Drug Channels news:

• Walgreens Specialty Pharmacy tells us a teeny bit about its business

• Dispensing oncology practices battle PBM CVS Caremark

• The uncertain forecast for drug spending and gross-to-net pricing

• A fascinating peek behind the downfall of Elizabeth Holmes and Theranos

Plus, Jimmy Kimmel tells an EpiPen pricing joke at the Emmys. Can’t wait for him to riff on AMP!

P.S. Join our nearly 3,000 @DrugChannels followers on Twitter for my daily tweets about intriguing and insightful stuff from the interwebs.

Time for our annual review of the latest Inc. 5000 list, the magazine’s annual ranking of the fastest-growing private companies in the United States. The list offers a valuable snapshot of the dynamic specialty pharmacy industry.

We have identified 12 specialty pharmacies on the 2016 list, which is based upon revenue growth from 2012 to 2015. Annual revenues range from $17 million to $1 billion. The pharmacies and key stats are listed below. Average revenues in 2015 sped ahead by an eye-popping 63%.

Given specialty pharmacies’ growth prospects, there’s a fast and furious market for the buying and selling of specialty pharmacy companies. Two companies below are prime targets. Investment bankers: Start your engines!

P.S. Today's post will help you get tuned up for next week’s National Association of Specialty Pharmacy (NASP) annual meeting. I’ll be there—wearing my black muscle t-shirt, of course!

CBI’s 8th Federal Pricing and Reporting – VA * DoD * PHS
November 16-17, 2016 | Philadelphia, PA

At the 8th Federal Pricing and Reporting Summit, gain strategies to achieve contracting excellence and compliance with the “Big Four” federal programs. Join the hundreds who have benefited over the years and gain invaluable learnings to stay profitable in this low-margin, highly complex market.

New this year, customize your conference experience by choosing from breakout sessions:

• Federal Supply Schedule Pricing, Calculations and Program Intricacies
• Acquisitions and Divestitures - Buyer and Seller Requirements and Considerations
• Dual Pricing vs. Single Pricing - Understand When to Use and How to Implement
• TRICARE Dispute Resolution, Calculations and Refund Management

This meeting features a dynamic group of speakers with government updates from the Department of Veteran Affairs, VA Office of Inspector General, DoD DLA Troop Support, and Former DoD Pharmacoeconomic Center. Plus! Practical strategies and guidance from Acorda Therapeutics, Amneal Pharmaceuticals, Bayer Healthcare, Chiesi, Eisai, Eli Lilly, Genentech, Horizon Pharmaceuticals, Pfizer, King & Spalding, Sidley Austin and Dave Rice Group.

For more information, please download the complete agenda or visit www.cbinet.com/fedpricing. Drug Channels readers will save $400 off of the standard registration rate when they use discount code DTB637.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates. Other restrictions may apply.

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

For better or worse, Mylan’s EpiPen controversy has started an intriguing dialogue about my favorite subject: the economics of U.S. drug channels. Many news stories have tried to explain how a prescription drug’s list price differs from the ultimate net price paid by insurers and the government. A few brave souls have even dug into the role of such intermediaries as pharmacy benefit managers (PBMs), wholesalers, and pharmacies.

Below, I highlight aspects of the EpiPen story that raise crucial questions about our healthcare system, including: Who benefits from big gross-to-net spreads in drug prices? How do benefit design and payer decisions alter channel economics? Are patients benefiting from manufacturer’s rebates to PBMs? How (if at all) should manufacturers alter their pricing strategies?

And I wonder: Will we look back on the EpiPen incident as the beginning of the end for manufacturers’ gross-to-net drug pricing models and PBMs’ traditional role in the flow of rebates?

Pharmaceutical Strategies for Value-Based Contracting Summit
Managing Customer Expectations When Designing Outcome-Based Contracts
October 24 - 25, 2016 • Alexandria, VA • Westin Alexandria

Customers continue to evolve traditional contracting structures and strategies as the health care market dynamics shift towards value-based care. World Congress’s Pharmaceutical Strategies for Value-Based Contracting Summit convenes executives within pharmaceutical and biotechnology companies to discuss best practices and tactical solutions in contracting with customers in today’s value-based system. Executives will hear the “How” from their peers as well as customers including payers, PBMs, providers, and manufacturers on leveraging partnerships and technology to develop contracts based on transparency and accountability.

This year’s summit brings you an exclusive contracting workshop dedicated to giving you practical take-aways for establishing your value proposition and determining what measures and metrics should be monitored to ensure optimal contract performance. Learn innovative approaches and strategies that will allow you to meet customer expectations and minimize risk.


Please visit www.worldcongress.com/valuebased to register or for more information. Those who register will receive a $300 savings when they use promo code DC300.

2016 Topics Discussions Include:

• Examine how new market dynamics, delivery systems, and customers have changed traditional contracting structures and strategies
• Determine what measures and metrics should be monitored after executing a contract to ensure optimal contract performance from both parties
• Hear about the implication of the new MACRA regulations for all health care stakeholders
• Understand how new value-based payment models for payers and providers are impacting the way manufacturers need to approach pricing and contracting with their customers
• Identify emerging data metrics payers are seeking when contracting with manufacturers
• Analyze new business models manufacturers are implementing to get a seat at the table and successfully interact with a value-based health care delivery system
• Discuss considerations taken into account when designing an outcome-based contract
• Hear payers’ definitions of an “overpriced drug” and how that impacts contract negotiations
• Explore what extent of risk partners are expecting manufacturers to take
• Examine the implications of indication-based pricing models on the design of a value-based contract
• Evaluate the nuances of contracting with a PBM vs. another type of payer
• Learn how physicians’ and administrators’ influence on prescriptions impact formulary access across different patient care points within an IDN

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

ICYMI: Last week, Walgreens Boots Alliance (WBA) and Prime Therapeutics rolled out a highly innovative partnership. It could have wide-ranging implications for the drug channel’s next phase.

This novel union aligns a pharmacy benefit manager (PBM), retail pharmacy chain, and health plans via joint ownership of a new mail and specialty pharmacy company. If executed properly, it will be a best-of-breed business model that could reshape the PBM and pharmacy industries. For manufacturers, organized customer management just got even more complicated.

The new business could also pose a serious challenge to pure-play PBMs that lack a health insurer partner or an economically-aligned retail dispensing channel. Below, I compare the capabilities of the new business those of the four largest PBMs.

Jim DuCharme, president and CEO of Prime Therapeutics, told me: “The PBM business model needs transforming. Prime wants to have a significant influence on transforming the PBM business before others try to fix it.” I am normally immune to hype, but he could be right. Read on and see if you agree.

CBI’s Outcomes-Based Contracting Summit
October 17-18, 2016 | Philadelphia, PA
www.cbinet.com/outcomescontracting

Are you prepared to navigate the intricacies of value-based contracting? Mark your calendar for CBI’s Outcomes-Based Contracting Summit for Life Sciences on October 17-18th, 2016 where you will examine how performance- and value-based contracts are structured and negotiated. You won’t find a better platform to discuss value optimization and price alignment with health outcomes data.

Join our expert faculty to:

• Learn how to draft and negotiate win-win RSAs with payers
• Examine the pros and cons of outcomes-based contracts for specialty and rare disease therapies
• Bridge the gap between real-world evidence and health economics outcomes research
• Translate successful European managed entry agreements into actionable opportunities for the U.S marketplace
• Manage legal, compliance and regulatory concerns surrounding value-based contracts

The faculty members tackling the hard-hitting topics in our agenda include:

Eli Lilly, Sunovion Pharmaceuticals, Rite Aid Corporation, EMD Serono, Aetna, Daiichi Sankyo, AstraZeneca, Novo Nordisk and many others!

PLUS! CLE & CPE Credits Available (pending approval)!

Visit www.cbinet.com/outcomescontracting for more information. Drug Channels readers will save $300 off of the standard registration rate when they use discount code EZQ567.

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates. Other restrictions may apply.

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

This week, I’m rerunning some popular posts, so I can finish the forthcoming 2016-17 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from March 2016.

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For 2015, retail, mail, and specialty pharmacies dispensed about $98 billion in specialty pharmaceuticals. Though market share was concentrated among the top companies, even I can’t count the total number of pharmacies dispensing specialty drugs, since any pharmacy can designate itself a “specialty pharmacy.”

A useful proxy for the number of active specialty pharmacies comes from our exclusive analysis of the two primary pharmacy accreditation organizations. We found nearly 400 pharmacy locations than had specialty pharmacy accreditation. As the second chart below shows, the number of accredited specialty pharmacies is still booming.

Specialty pharmacy accreditation is becoming the promised land for pharmacies that want to participate in the networks developed by manufacturers and third-party payers. As more pharmacies can prove that they are special, will that mean that no one is?

This week, I’m rerunning some popular posts, so I can finish the forthcoming 2016-17 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from December 2015.

For our most current estimates of 340B market size, see Reality Check: 340B is 4% (not 2%) of the U.S. Drug Market—And Growing Quickly.

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The Office of Inspector General (OIG) has just released another eye-opening report on the 340B drug discount program: Part B Payments For 340B-Purchased Drugs. (Free download)

The report documents how 340B-eligible hospital outpatient departments earn tremendous profits from the Medicare Part B program. Physician offices, which also receive Part B reimbursements, are not as fortunate.

The OIG focuses on how the Medicare program could save money by sharing in these mega-profits. But as my summary chart below shows, Medicare appears to be providing incentives for shifts in cancer care treatment locations.

As usual, we don’t know if needy patients are benefiting from hospitals’ excess Medicare 340B profits. The OIG even reminds us three times in its report: “The 340B statute does not restrict how covered entities may use these funds.” Unfortunately, the Health Resources and Services Administration’s recent Omnibus Guidance didn’t bother to require that hospitals use 340B funds help the neediest patients access valuable medicines. Money, so they say, is the root of all evil today.

This week, I’m rerunning some popular posts, so I finish the forthcoming 2016-17 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from June 2016. It's another timely rerun given the past week's discussions over drug channel profits.

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Time for my annual review of the new Fortune 500 list. Every year, this is one of my favorite posts, because its helps us to “follow the dollar” and understand how drug channel intermediaries make money.

The 2016 list contains seven drug channels companies—AmerisourceBergen, Cardinal Health, CVS Health, Express Scripts, McKesson, Rite Aid, and Walgreens. Assuming the Rite Aid-Walgreens deal happens, it will be six companies next year.

Using the Fortune data, I explore the profitability and shareholder returns of the largest public drug wholesalers, chain pharmacies, and pharmacy benefit managers (PBMs). I compare these companies with the Fortune 500’s 11 pharmaceutical manufacturers and a separate survey of independent pharmacies.

It’s politically fashionable to bash drug makers. These data remind us that many other multi-billion dollar businesses make some gold as drugs move through the U.S. reimbursement and distribution system.