Analysis

With little fanfare, the IMS Institute has just snuck out an interesting report: Emergence and Impact of Pharmacy Deductibles: Implications for Patients in Commercial Health Plans. (free download) The report’s overarching theme is unsurprising: Higher out-of-pocket costs reduce patients’ adherence to drug therapy and increase prescription abandonment rates.

The report’s major contribution, however, links the growth in pharmacy deductibles to manufacturers’ copayment offset programs, which cover a beneficiary’s out-of-pocket costs for a brand-name drug. High deductible plans are shifting costs from payers to consumers and—in many cases—back to manufacturers.

And as the charts below show, pharmaceutical manufacturers end up (perhaps inadvertently) paying full-price for an increasing number of prescriptions for their own products. Ouch.

Read on and then consider whether these results affect your company’s strategy.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, October 20, 2015

Labels: Co-pay Offset Programs, Costs/Reimbursement, Benefit Design, PBMs

eyeforpharma Real World Evidence & Market Access Summit 2015
December 3-4, 2015 | Philadelphia, PA
www.eyeforpharma.com/rwe/

The 4th annual eyeforpharma Real World Evidence & Market Access Summit 2015 is the meeting place 250+ industry leaders in data, HEOR and market access come together to finalize the 2016 evidence strategy.

Drug Channels readers will save $300 off the standard registration rate when they register with discount code 4318DC300.

Latest additions include:

• Geisinger Health System on specialty analytics: Hear from Eric Newman, Vice-Chair of Clinical Innovations, on how Geisinger established a specialty care delivery model through the use of data analytics
• Is there an industrial complex around evidence? Sanofi’s policy leader Joseph Devaney speaks on the risks of dependencies and reveals differences between cost containment-driven quality measures and patient and outcomes-driven quality indicators – one that matters…
• How to engineer the (r)evolution in the evidence hierarchy: Optum Lab’s Paul Wallace, Chief Medical Officer, reveals how alternative models and methods can be applied to support your evidence generation and documentation.
• GSK’s innovative strategies to making all phase III studies pragmatic: Bridge the gap between the evidence being produced by pharma and the type of information that decisions makers want with Rafael Alfonso, Director, Value Evidence Analytics
• Cedars-Sinai on medication adherence: Hear from Pharmacy Director Rita Shane how to assess high risk Medicaid populations with multiple medications
• North Shore on improving clinical outcomes: Frederick Muench, Director, Health Interventions, presents insights on developing streamlined digital assessment and intervention tools to increase engagement

These are just a few of the exciting updates taking place during the program. See all of the latest developments, download the event brochure, and gain front-line insights from AMGA, Novartis, AstraZeneca, Pfizer, Mount Sinai, J&J, Actavis and 50+ others.

Use discount code 4318DC300 to save $300. Register today!

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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.

Posted by Drug Channels Institute, an HMP Global company on Monday, October 19, 2015

Labels: Sponsored Post

It’s time for our annual review of the Kaiser/HRET 2015 Employer Health Benefits Survey, which you can read online for free. The survey delves into employer-sponsored health coverage at 2,000 companies.

Today, I profile the 2015 pharmacy benefit highlights from this well-executed survey. The charts below summarize (1) cost-sharing tier structures, (2), average copayments, by formulary tier, (3) type of cost-sharing (coinsurance and copayment), and (4) new data on specialty drug management strategies.

Bottom line: Employers didn’t make major changes this year, but they continue to shift prescription drug costs to beneficiaries and are focusing on specialty drug management. As I explain below, the plan details won’t give employees a glad expression.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, October 13, 2015

Labels: Specialty Drugs, Costs/Reimbursement, Industry Trends, Benefit Design, PBMs

Data-Driven Strategies for Specialty Product Optimization
December 9, 2015 | Philadelphia, PA
www.cbinet.com/specialtydata

CBI’s December 9th Summit on Data-Driven Strategies for Specialty Product Optimization is the first and only event for the biopharmaceutical industry that is laser-focused on strategies for leveraging third-party data to drive your specialty drug access, uptake, adherence and outcomes.

Benefit from compelling case studies, expert panels and interactive discussions:

• Discover key data insights that support product placement on formulary
• Enhance strategic contracting with key stakeholders
• Gain insight into channel partners ability and willingness to share data sets
• Address performance management and metrics management
• Assess the emergence of specialty pharmacy data within Integrated Healthcare Systems
• Utilize specialty data to enhance care coordination across the patient journey
• Apply data to maximize the impact of business decisions and activities
• Address privacy concerns and risks associated with specialty data

Visit www.cbinet.com/specialtydata for more information. Drug Channels readers will save $200 off of the standard registration rate when they use discount code QMS268.*

*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.

Posted by Drug Channels Institute, an HMP Global company on Monday, October 12, 2015

Labels: Sponsored Post

This week, pharmacy benefit manager (PBM) Express Scripts announced that both of the new PCSK9 inhibitors—Repatha (from Amgen) and Praluent (from Sanofi/Regeneron)—will be on its National Preferred Formulary. Both products will be subject to extensive prior authorization and step therapy. Read the press release.

This formulary approach contrasts sharply with the approach used for the Hepatitis C products. As I explain below, perhaps Express Scripts has learned an important lesson about the business risks of formulary exclusion. AmerisourceBergen, however, may find that it was dealt a losing hand.

As Canadian philosopher Gary Lee Weinrib once opined: "If you choose not to decide, you still have made a choice." Read on and see if you agree.

Posted by Drug Channels Institute, an HMP Global company on Thursday, October 8, 2015

Labels: Specialty Drugs, Wholesalers, PBMs, Benefit Design

I am pleased to announce the availability of our new report: the 2015-16 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. We’re offering special discounts if you order before October 24, 2015.

This year’s report—our sixth edition—has been updated, revised, reorganized, and expanded. It contains the latest industry and financial data, along with detailed information about the strategies and market positions of the largest public companies: AmerisourceBergen, McKesson, and Cardinal Health. It also includes many new elements.

• Click here to download a free report overview

• Click here to review the Table of Contents.

• Click here to review the List of Exhibits

The 2015-16 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors is the most comprehensive, non-partisan tool for building deep business acumen about the economic and business realities of U.S. pharmaceutical distribution.

I've worked hard to make it an essential tool for pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, benefit managers, managed care executives, healthcare policy analysts, investors, consultants—anyone who wants to understand and benefit from this ever-changing industry.

Alas, the report has no corny jokes and 0.0% pop culture references. I recognize that some Drug Channels readers may consider these omissions to be value-enhancing features.

If you have any questions (before or after reading the report), please email me. Enjoy!

Posted by Drug Channels Institute, an HMP Global company on Tuesday, October 6, 2015

Labels: Industry Trends, Wholesalers

CBI’s 11th Life Sciences Trade and Channel Strategies
December 9-10, 2015 | Philadelphia, PA

Are you ready for some drug channel strategy?

Then join me at CBI’s 11th Trade and Channel Strategies conference, being held this December in Philadelphia. CBI’s annual event is the life science industry’s premier event focused on bio/pharma trade, channel, and account management. Use discount code AKE367 to save $200.

Adam J. Fein, Ph.D., of Pembroke Consulting, will kick things off with a keynote address called Drug Channels Update—Things to Watch in 2016. Dr. Fein will update everyone on hot topics and identify key strategic issues for the year ahead.

Day one will end with the renowned Trade Throwdown: Battle of the Experts. This year, Dr. Fein will be joined by Bill Roth of Blue Fin Group and Allen Dunehew of Rx Sourcing Strategies. Come prepared with your most vexing questions and watch them compete in CBI’s XTreme Trade Battle Cage™. Three consultants will enter…but only three will leave!

Other new features for 2015 include:

• A Trailblazer Address from Kaiser Permanente Colorado on Optimizing Care and Quality in Our Health System.
• A Manufacturer Strategic Viewpoint Panel featuring industry speakers discussing network design and forward-thinking product-specific strategies for optimized distribution.
• A Wall Street Panel, where you'll learn how the drug channel is changing and what they are forecasting for the future.
• A Trade Think Tank, where you can identify trailblazing trends by benchmarking with your peers utilizing interactive and anonymous live polling.

Visit www.cbinet.com/trade for more information. Drug Channels readers will save $200 off of the standard registration rate when they use code AKE367.*

*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.

Posted by Drug Channels Institute, an HMP Global company on Monday, October 5, 2015

Labels: Sponsored Post

The Centers for Medicaid & Medicare Services (CMS) just released data on 2016's Medicare Part D plans. Our exclusive, warp speed analysis reveals that 85% of Medicare Part D regional prescription drug plans (PDP) will have a preferred cost sharing network in 2016. That’s comparable to the 2015 figures, and signals that these plans are here to stay.

Preferred network plans are controversial (and generally disliked) by pharmacy owners. That’s because reduced pharmacy profits are the biggest source of cost savings from these networks. Despite ongoing complaints, it's still full speed ahead for preferred networks.

Read on for a look at the top plans. I'll review pharmacy network participation in a future article.

Posted by Drug Channels Institute, an HMP Global company on Friday, October 2, 2015

Labels: Health Care Policy, Benefit Design, Pharmacy, Narrow Networks, PBMs, Medicare Part D

Rejoice, fans of medical billing codes. It’s ICD-10 Compliance Day!

As you may know, the International Classification of Diseases (ICD) will expand the number of medical service codes for doctors and hospitals, from 18,000 in the ICD-9 to more than 140,000 in the ICD-10. Click here for a good background article from The Wall Street Journal. The Centers for Medicare & Medicaid Services (CMS) has been counting down to today's launch.

So, today is a perfect time to revisit the Find-A-Code YouTube channel, where you can see a gaggle of semi-wacky video clips illustrating legitimate ICD-10 codes.

I picked out a few choice ones below, including my personal favorite V95.44 ("Spacecraft accident injuring occupant”). And that's only one of an astounding 21 spacecraft-related ICD-10 codes.

Click here to search the database and discover your own lucky code.

Posted by Drug Channels Institute, an HMP Global company on Thursday, October 1, 2015

Labels: Hospitals, Fun Stuff, Health Care Policy, Physicians

Fall is here! Curl up with your extra hot grande Pumpkin Spice Whatever and check out this cornucopia of stories harvested from the Drug Channels crop:

• A neat profile of Helena Foulkes, president of CVS/pharmacy (and future CEO of CVS Health?)

• An interesting interview with AmerisourceBergen CEO Steve Collis

• The other NCPA deconstructs the supply chain factors behind generic drug inflation

Plus, The Onion reports on a highly innovative new health benefit plan.

P.S. For my daily harvest of interesting news stories, follow @DrugChannels on Twitter.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, September 29, 2015

Labels: Generic Drugs, Wholesalers, Costs/Reimbursement, Pharmacy