Analysis

PBMI 21st Annual Drug Benefit Conference
February 29 - March 2, 2016 | Palm Springs, CA
Location: The Westin Mission Hills Golf Resort & Spa Hotel

PBMI invites you to join them next year for our 21st Annual Drug Benefit Conference.


The event will hit the ground running with an innovative opening keynote by Dr. Daniel Kraft. Dr. Kraft, a progressive physician, will examine rapidly emerging, game changing, and convergent technology trends and how they are and will be leveraged to change the face of health care and the practice of medicine in the next decade.

With more than 20 sessions, you’ll gain insight into practical and proven strategies for effectively managing the drug benefit. The conference will include three educational tracks. Check out the conference program to see who will be there.

Conference attendees can also maximize their learning experience by selecting one of two pre-conference workshops to attend. Both workshops are free of charge and will be held February 29 from 10:30 am to 12:00 pm (lunch included).

Workshop A: The Total Medical Costs of the Hepatitis C Virus in Commercial and Managed Medicaid Populations

Sponsored by Primrose Healthcare

Workshop B: Delivering the Right Information to the Point of Care

Sponsored by Surescripts

Note: You must be registered for the conference to attend a workshop.

For more Information: Contact Linda DeChant at ldechant@pbmi.com.

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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.

Ronny Gal, a Senior Analyst at investment bank Sanford C. Bernstein & Co., just published an excellent analysis of the latest formulary exclusion moves by the biggest pharmacy benefit managers (PBMs).

Ronny and his team found that four more companies—OptumRx, Aetna, Cigna, and Prime Therapeutics—will introduce or significantly expand formulary exclusions in 2016. Combined with the actions of Express and Caremark, they estimate that more than 50% of the commercial market will have access to exclusion lists.

Below is their summary of 2016 exclusion lists, by therapeutic area. Their analysis confirms my view that exclusions are the new normal. Expect continued growth in these lists, as payers scrutinize manufacturers’ copay card strategies in a post-Valeant market.

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.

Specialty Therapies 2016
January 28-29, 2016 | Planet Hollywood | Las Vegas, NV

Join healthcare and pharma thought leaders on January 28-29 in Las Vegas for Specialty Therapies 2016 – the highly acclaimed meeting that brings about critical discussions on balancing costs, access, and quality for management of specialty drugs.

DIALOGUE LED BY KEY THOUGHT LEADERS:

Avella Specialty Pharmacy | Blue Cross Blue Shield of Massachusetts | Blue Cross and Blue Shield of Minnesota | Blue Cross and Blue Shield of North Carolina | Denver Health Medical Plan | Fairview Specialty Pharmacy | Florida Blue | Gorman Health Group | Horizon Blue Cross Blue Shield New Jersey | Independent Health | NSHOA Cancer Centers in NY | Rutgers RWJ Medical School | Walgreens | Walmart | Widener University

DISCUSSIONS ON SPECIALTY THERAPY INDUSTRY HOT TOPICS:

Specialty Product Market Trends | Value-Based Reimbursement Programs | Patient Support Services for Limited Distribution Drugs | Therapy Usage Management | Plan Coordination with 340B Pharmacies | Medicaid and Medicare Updates | Specialty Pharmacy Cost Containment | Biosimilars | Oral Oncolytics | Specialty Pipeline Management | And More!

For more information, please download the complete agenda or visit www.cbinet.com/specialtytherapies. Drug Channels readers will save $200 off of the standard registration rate when they use code TAT246.*

*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.

I want to know what you think of Drug Channels Institute's (DCI) economic reports and how I can improve them.


What's in it for you? Well, just answer a few brief questions—the survey should take 5 to 10 minutes, tops—and you could win a free Drug Channels Institute report.

You can answer anonymously. But if you provide an email address, you'll be entered in a drawing to win a free corporate license of our forthcoming 2015-16 Economic Report on Retail, Mail, and Specialty Pharmacies, which will be released in February 2016. If you win, you'll be one of the first people to get this new report!

Any information you provide will be held in the strictest confidence. Per Drug Channels' long-standing policy, I never publish, release, or disclose any personal data without your permission.

Thanks in advance for helping me help you. I read EVERY response, so don't be shy.

P.S. Have a Happy Thanksgiving!

I hope you enjoy time with your family...along with a traditional meal of toast, popcorn, pretzels, and jelly beans!

Expanded Access Programs 2016
February 23-24, 2016 | Washington, DC
www.cbinet.com/expandedaccess

Current legislation is quickly paving the path for easier patient access to experimental, unapproved drugs. CBI’s Expanded Access Programs is the industry’s leading event dedicated to the nuances and complexities of designing and implementing early access programs. This multi-stakeholder event is focused on U.S. and global models for a variety of access management programs, including, but not limited to:

Expanded Access Programs, Early Access Programs, Compassionate Use Programs, Named Patient Programs and Managed Access Programs.

The FDA and a broad array of key stakeholders are coming together for an in-depth and meaningful discussion on Expanded Access Programs where the implications, prevailing policies and current industry approaches are discussed in detail. Don’t miss the opportunity to join your peers and share best practices around providing investigational, pre-launch or end-of-lifecycle drugs to patients for treatment purposes.

Visit www.cbinet.com/expandedaccess for more information.

Speakers Include Representatives from:

FDA | National Organization for Rare Disorders (NORD) | Pfizer | Dyax Corporation |Prothena Biosciences, Inc. | King & Spalding LLP | Idis Managed Access | AstraZeneca | Biotechnology Industry Organization (BIO) | Ultragenyx Pharmaceutical | Max Cure Foundation, Inc. | Ax-S Pharma | ALS Emergency Treatment Fund | Halozyme Therapeutics, Inc. | Amgen | Canadian Organization for Rare Diseases (CORD)

Drug Channels readers will save $400 off of the standard registration rate when they use code SNH248.*

*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.

The initial fallout from the Valeant-Philidor kerfuffle has hit the pharmacy industry. Over the past few weeks, the major pharmacy benefit managers (PBMs) have begun dropping pharmacies from their networks. Some PBMs are also reminding retail pharmacies that they are prohibited from acting as mail pharmacies.

Below, I highlight the high-profile network pruning by the top three PBMs—Express Scripts, the Caremark PBM business of CVS Health, and the OptumRx business of UnitedHealthcare. I also speculate on the factors that would lead a PBM to clash with a pharmacy in its network.

An as-yet-unanswered question: If PBMs routinely monitor their networks, why did it take a highly publicized pharmacy meltdown before PBMs finally cracked down?

Time for my annual look at independent pharmacy owners’ business economics, drawn from the recently released 2015 National Community Pharmacists Association (NCPA) Digest, Sponsored by Cardinal Health. Here's the press release: NCPA Digest: Adherence, Diversified Revenue Critical for Community Pharmacies.

The data reveal that independent pharmacy owners are doing better than you might expect. In 2014, the average pharmacist owning a single pharmacy earned about $228,000. The number of independent pharmacies continues to hold steady.

In the NCPA Digest sample, average per-prescription revenue declined, which reduced gross profits and average prescription revenues. On the other hand, IMS Health data imply independents' revenue and prescriptions are growing, not declining. Hmmm.

As always, I welcome your constructive and civil comments. Please remember our Drug Channels philosophy, courtesy of the late senator Daniel Patrick Moynihan: "Everyone is entitled to his own opinion, but not his own facts."

A MESSAGE FROM sPCMA

Connect with Specialty Pharmacy’s Most Influential Leaders

The sPCMA Business Forum attracts the highest number of executives and decision makers from PBMs and the nation's largest specialty pharmacies of any industry conference. The sPCMA Business Forum is a networking and educational conference designed for professionals of all levels engaged in the business of specialty pharmacy and pharmaceutical care.

Register now!

2016 sPCMA Business Forum

February 8 & 9, 2016

JW Marriott Orlando, Grande Lakes | Orlando, FL

Conference features include:

• Presentations by C-suite and other senior PBM, specialty pharmacy and pharma executives;
• Timely and thought-provoking CPE sessions;
• Dedicated time and facilities for private meetings;
• Pre-conference networking through PCMA-Connect; and
• Networking receptions with members and conference sponsors.

Who Should Attend
Anyone interested in attending is welcome. The 1,300 attendees will range from C-suite executives to mid-level professionals tasked with all aspects of the business of specialty pharmacy. Companies in attendance will include specialty pharmacies of all sizes and composition, PBMs, manufacturers, wholesalers and distributors, consultants, vendors, and other specialty pharmacy stakeholders.

Contact PCMA

Please contact Jenny Dawson with questions or to request information about the Affiliate Program or conference sponsorships.

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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.

Here’s a Drug Channels Zen koan for you: When does a price increase not increase the price?

This riddle came to me while reviewing the excellent new Pharmaceutical Research and Manufacturers of America (PhRMA) slide deck called Prescription Medicines: Costs in Context. (Free download.) The slides argue—persuasively, I believe—that pharmaceuticals have been undervalued as a source of health benefits and unfairly maligned as the key driver of costs.

One important slide, reproduced below, is definitely worth your time. Despite the growth in drug list prices, manufacturers are experiencing limited growth in net revenues, which deduct payer rebates. As the data show, this difference has grown sharply over the past two years. I also present data from a separate Medicaid analysis, which tells a similar story.

Meanwhile, drug list price increases are boosting revenues at drug channels companies—pharmacies, wholesalers, and PBMs. These intermediaries are still compensated on gross (not net) revenues. I wonder: Will the growing gross-to-net disparity make current channel economic arrangements unsustainable for wholesalers and pharmacies?