Analysis

Today’s guest post comes from Kylanne Green, President and CEO of URAC. Kylanne shares an interesting perspective on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). She explains how the transition from fee-for-service to value-based payment will impact various stakeholders, including pharmacists. And, she offers suggestions for success.

Visit www.info.urac.org to learn how URAC’s Specialty Pharmacy and Community Pharmacy accreditation programs can help you establish benchmarks, standards, and goals to prove the quality of your pharmacy practice.

Read on for Kylanne’s thoughts.

Last week, Walgreens Boots Alliance (WBA) provided a small but notable boost to Valeant Pharmaceuticals.

WBA co-COO Alex Gourlay said that the company was “satisfied” with its Valeant relationship. That’s no surprise, given the favorable economics for Walgreens. Gourlay went further, stating that WBA would be “very willing to help them in a positive way.” Hmmm.

WBA also gave a brief update on its planned Rite Aid acquisition, which it still expects to complete later this year. And the company still expects to divest only 500 stores to get the deal done.

Reach for the sky with my analysis and commentary on these topics below.

Government rules and regulations affect every department at a pharmaceutical company. However, few areas are as directly-and as frequently-affected as the government programs, pricing, and reimbursement space.

Due to the highly anticipated release of the AMP Final Rule, 340B Mega Guidance and Proposed Rule, HRSA's Rule on Dispute Resolution, and the recent release of CMS' Proposed Medicaid Managed Care Regulation, your day-to-day operations will fundamentally change.

Join IIR in Chicago this September 20-22 at IIR's Medicaid Drug Rebate Program (MDRP) Summit is a leading event for insights into the implications of these inevitable changes. It’s the longest running and the largest MDRP event where more than 600 industry, state, and federal government professionals come to get questions answered, gain clarity, and remain compliant.


Ensure you have the most comprehensive educational experience over three days with unparalleled access to government officials creating regulatory rules, the industry leaders interpreting them, and the pharmaceutical executives implementing them.

Collaborate with your peers and benchmark best industry practices to:

• Navigate Regulatory Hurdles
• Address the implications of AMP Final Rule, 340B Guidance, along with State Policy changes
  
• Critical legal trends affecting Pharma Manufacturers
  
• Get updates directly from 4 key government agencies: CMS, HRSA, OIG, and VA
  

• Benchmark Best Practices
• Develop strategies to streamline pricing and reporting
• Hear from the industry's leading service providers as they showcase new technologies and products to improve operations

• Optimize Accounting & Gross-to-Net
• Calculate liability and improve accuracy and accountability
• Discover the latest in Automation & Customization of finance systems

• EXCLUSIVE! Meet Face to Face with 13+ States in One-on-One Dispute Resolution Meetings where you can recoup or save millions of dollars in rebates and reimbursements

Stay ahead of the curve by getting the best networking, education, and technology at IIR's MDRP Summit this September. There is no other MDRP event built like it.

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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 while I'm on vacation. Click here to see the original post and comments from February 2016. P.S. This is one of my most frequently viewed articles!

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I received a bunch of emails asking about the channel flows chart that appears in yesterday’s blog post. That version had numbers corresponding to chapters in our new 2016 Economic Report on Retail, Mail, and Specialty Pharmacies.

Below is the full version of the chart without the chapter numbers. I also provide a PDF version and some additional background. Feel free to use this chart to help others understand how money and product flow in the U.S. pharmacy distribution and reimbursement system for patient-administered, outpatient prescription drugs.

And tip your hat to Mr. Goldberg for dreaming up this system. Details below.

This week, I’m rerunning some popular posts while I'm on vacation. Click here to see the original post and comments from April 2016.

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On Drug Channels, I highlight the two primary reasons pharmaceutical manufacturers’ list prices don’t represent what third-party payers actually spend for drugs: (1) channel intermediaries add markups that account for the costs, profits, and value of the channel's services, and (2) manufacturers provide rebates and discounts to third-party payers.

The new 2015 Medical Pharmacy Trend Report (free download), from Magellan Rx Management, documents just how outrageous a channel’s markups can be.

As I show below, the reimbursement approaches that commercial payers use permit hospitals to get paid two to three times as much as physician offices—and to inflate drug costs by thousands of dollars per claim. Naturally, the 340B program plays a part in this sordid tale.

A few prominent hospital-based physicians have become very public critics of pharmaceutical list prices. It may come as no surprise that these physicians neglect the pricing behavior of their own employers, ignore the hospital-related factors affecting payers’ spending, and fail to examine drugs’ true net costs. I guess that when the media spotlight is shining, it’s better to take the money and run than be intellectually honest.

This week, I’m rerunning some popular posts while I'm on vacation. Click here to see the original post and comments from March 2016.

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Last week, Express Scripts released its new 2015 Drug Trend Report. Click here to download the complete report. (Free download.) You should also read the press release, which offers additional information that is inexplicably excluded from the full report.

For the first time, the Express Scripts data account for rebates—a meaningful and welcome improvement in reporting methodology. After accounting for rebates, the 2015 report reveals that drug spending growth is comparable to growth in other parts of the healthcare system. For some payers, utilization (script growth) was a bigger driver of spending than drug prices.

So much for the myth of exploding drug costs! Our politicians may not believe it, but Martin Shkreli et al. are the exception in the pharmaceutical industry. Below, I review the four key highlights about traditional and specialty drug spending, trend patterns for different payers, and a red flag from upcoming biosimilar launches.

Plus, diving into the numbers is more fun than contemplating the Anthem-Express Scripts kerfuffle and the meaning of such ill-defined terms as "competitive benchmark pricing."

NASP 2016 Annual Meeting & Expo
September 26-28, 2016 | Omni Shoreham Hotel | Washington, D.C.

There is still time to register for the 2016 NASP Annual Meeting & Expo, the comprehensive national meeting for all stakeholders in the industry. Join industry leaders of specialty pharmacy as they gather for the 2016 NASP Annual Meeting, September 26-28, at the Omni Shoreham Hotel in Washington, DC.

In addition, NASP’s first Specialty Pharmacy Law Conference, will be held on September 26 at the same location. This is a unique, one-day conference for attorneys and others concerned with legal and regulatory aspects of managing and operating a specialty pharmacy. Sessions will offer CLE credit.

The NASP’s Specialty Pharmacy Law Conference is intended for general counsel and in-house counsel for national and regional specialty pharmacies, practicing attorneys in health care law, compliance officers or executives in specialty pharmacies or other settings concerned with the legal and regulatory aspects of operating a specialty pharmacy.

The program for the 2016 NASP Annual Meeting begins on September 27. This year’s NASP meeting has an expanded education program with more than 30 sessions including a look at specialty pharmacy from the patient’s perspective, biosimilars, 340B, best practices in specialty pharmacy, value-based reimbursement, employer perspectives on specialty pharmacy, the coming impact of developments in genomics, specialty pharmacy in health systems, a perspective on how the upcoming presidential election will affect specialty pharmacy, and clinical sessions on immuno-oncology, multiple sclerosis, and NASH.

Registration is open and the fee for the Specialty Pharmacy Law Conference may be applied toward registration for the 2016 NASP Annual Meeting & Expo, which is that same week at the same location.

Register today for these singular specialty pharmacy events that can offer significant insights and have influential and positive impacts on your business.

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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.

Brexit, schmexit. It’s time for us to celebrate our independence—and not just by rapping like founding fathers Alexander Hamilton and George Washington.

Before you celebrate our country’s birthday, please enjoy these Drug Channels fireworks:

• The bizarre PBM practice of copayment clawbacks

• Entrepreneurial reinvention at Ritzman Pharmacy

• Drug wholesaler Frank W. Kerr closes its doors forever

• A fascinating peek behind Valeant’s collapse

Plus, a very droll takedown of insufferably pompous TED talks...or perhaps your secret guide to thought leadership?

P.S. Join the nearly 2,800 people who follow @DrugChannels for my Twittertastic daily links to valuable news and insights.

Patient Journey Mapping – From Diagnosis to Treatment
August 15-16, 2016 | Philadelphia, PA

CBI’s Patient Journey Mapping Summit is the industry’s key event that dives into the key challenges surrounding time to fill from a multi-stakeholder perspective.

Delays in getting medications to patients continues to be a hindrance for not only the patient but for manufacturers as well. Work with professionals that have a hand in the time to fill process to better navigate a road towards quicker speed to therapy and formulate strategies that will avoid or lessen bumps in the road to shorten patient wait time.

The Summit provides expert analysis and insight to:

• Understand the impact of the changing payer landscape on time to fill
• Examine the effect of the patient protection and Affordable Care Act on the patient journey
• Optimize e-Prescribing to benefit the patient and decrease time to fill while integrating with HUBs
• Improve speed to therapy for specialty products
• Identify bottlenecks in the speed to therapy process and how to lessen delays
• Improve the prior authorization process
• Examine the multiple myeloma patient journey including patient preferences and needs
• Overcome out of network pharmacy challenges

For more information, please download the complete agenda or visit www.cbinet.com/patientjourney. Drug Channels readers will save $500 off of the standard registration rate when they use code MHB926.*

*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.

Today’s guest post comes from Katie Lapins, Principal/CEO of Government Pricing Specialists. Katie discusses five key challenges facing drug manufacturers as they attempt to comply with the Average Manufacturer Price (AMP) Final Rule.

To learn more about these topics, join Katie at IIR’s 21st Annual Summit on the Medicaid Drug Rebate Program (MDRP). Register before July 1 and save $400 off the regular registration fee.

Read on for Katie's thoughts.