Analysis

Time for DCI’s annual update on the channels for provider-administered drugs. Below, I review the latest data on 2024 trends and compare them to the pre-pandemic figures.

For 2024, payers report that specialty pharmacies—via white and clear bagging—have displaced buy-and-bill for a meaningful share of commercial covered lives utilizing provider-administered oncology drugs. However, provider pushback has limited specialty pharmacies' share gains, so that buy-and-bill remains the most common channel for these products.

Payers’ adoption of white bagging—and provider’s push back—reflect the ongoing battle for oncology margin in U.S. drug channels. Let’s hope that patients don’t get caught in the crossfire.

P.S. Today’s article is adapted from Chapter 3 of DCI’s forthcoming 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, which will be available to preorder next week at special introductory pricing.

I am pleased to announce the full agenda for the inaugural Drug Channels Leadership Forum, which will be held from March 17 to 19, 2025, at the Turnberry Resort and Spa in Miami. Everyone here at Drug Channels Institute (DCI) is excited to bring this novel event to the drug channels community.

I personally assembled the agenda. As you can see, it’s filled with senior industry executives who will participate in fireside chats with me as well as topical panel discussions moderated by a diverse set of subject matter experts.

• Check out our fantastic lineup of speakers

• View the full Drug Channels Leadership Forum agenda

I am also pleased to announce an excellent addition to the agenda. David Joyner, Executive Vice President, CVS Health, and President, CVS Caremark, and Prem Shah, Executive Vice President and Chief Pharmacy Officer, CVS Health and President, Pharmacy and Consumer Wellness, will be joining me for a fireside chat.


To maximize the value of networking and learning, the event will have fewer than 450 participants. If you haven’t done so yet, click here to request an invitation. DCI will carefully review all submissions to include participants from a broad range of industry organizations. DCI will begin extending invitations on a rolling basis starting on September 23, 2024. Once you receive your invitation, you will have 15 business days to accept and complete the registration by paying the registration fee.

Please note that the number of attendees from technology companies, business services, and other industry vendors will be strictly limited to the number of badges included with their chosen sponsorship level. There will be no exhibit hall and no media. Click here to learn more about available sponsorship opportunities.

Visit the event website for more information on the registration process and our policies.

Read on for the full press release. I hope you can join us!

Today’s guest post comes from H. John Beardsley, Senior Vice President of Corporate Strategy at CoverMyMeds

John discusses how the new maximum fair prices (MFPs) published by the Centers for Medicaid & Medicare Services (CMS) will affect medication affordability, formulary negotiations, evidence-based strategies, and other aspects of the market.

To learn more, register for CoverMyMeds' October 10, 2024, webinar: The Inflation Reduction Act: What to Watch Following the First Round of Negotiations.

Read on for John’s Insights.

The Humira biosimilar market just took another step forward—but remains far from its ideal state.

Last week, Cigna’s Express Scripts announced that it that will follow CVS Health’s CVS Caremark business and remove Humira from its largest commercial formulary in favor of multiple biosimilars.

Below, we review the 20 products competing with Humira—including four private-label products marketed by in-house subsidiaries owned by CVS Health and Cigna.

As you will see below, CVS Health’s formulary actions led to rapid uptake of a low-list-price biosimilar. Express Scripts’ 2025 strategy will also drive biosimilar adoption, although its pricing strategy is more problematic.

But what’s really going to bake your noodle later: Would the largest PBMs have popped the gross-to-net bubble for Humira if they hadn’t been able to profit from the switch?

The Healthcare Innovation Company's Value-Based Care Summit
In-Person Event | October 28 - 29, 2024 in Washington, DC

Use promo code VBCDC to save $100. Register Today.

Download the brochure.

The Value-Based Care Summit, produced by The Healthcare Innovation Company (thINc), brings together healthcare providers, health plans, pharmaceutical companies/manufacturers, and regulatory and legislative leaders to discuss novel approaches, innovative models, and mutually beneficial partnerships that drive care delivery transformation and accelerate the transition to value-based care.

Can't miss content highlights including:

• Risk-Sharing and Value-Based Contracting: Examine outcomes-based strategies and innovations in value-based contracting arrangements
• Policy and Regulations: Understand key updates from policy experts including HHS and CMS on value-based payment models
• Value-Based Digital Solutions: Explore case studies on how to test, design, and scale digital services
• Cross-Stakeholder Partnerships: Foster stakeholder partnerships to optimize patient support and care delivery
• Population Health and Value-Based Care: Leverage real-world data and understand social determinants of health to build predictive value-based care solutions for populations

Must-attend sessions include:

Enhancing Value-Driven Care through Patient Engagement, Customer Experience, and Quality Measurement

• Jennifer Norton, SVP of US Patient and Market Access (PAMA), Takeda Pharmaceuticals

Leadership Roundtable: Transformational Leadership Strategies for Driving Value

• Lee J. Handke, PharmD, MBA, CEO, Nebraska Health Network
• Conrad Vial, MD, SVP, Sutter Health and President, Sutter Health Network
• Moderator: Josh Berlin, JD, CEO, rule of three, LLC

Key Strategies from the Value-Based Care Playbook

• Mollie Gelburd, JD, Senior Director, Delivery System & Payment Transformation, America's Health Insurance Plans (AHIP)
• Aisha Pittman, MHP, SVP of Government Affairs, National Association of ACOs (NAACOS)
• Jeff Micklos, Executive Director, Healthcare Transformation Task Force
• Carol Vargo, VP, Physician Practice Sustainability, The American Medical Association (AMA)
• Moderator: Debbie Welle-Powell, MPA, Adjunct Professor, University of Colorado Business School; Past Chair, National Association of ACOs (NAACOS); CEO, DWP Advisors

PLUS! Two Dedicated Tracks for Your Focus Area:

• Data Analytics and Technology
• Strategy and Operations

View the current Speaker Faculty and register today.

Bonus content for Pharma and Life Sciences executives: You can attend the Specialty Networks and Patient Support Services Summit, October 29-30 in the same venue.

*All registrations subject to review by the thINc team. Promo codes are only applicable to NEW registrations and not applicable for vendors/solutions providers.

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The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@DrugChannels.net).

Today’s guest post comes from Nasir Ali, Chief Product Officer at CareMetx.

Nasir reviews the cumbersome processes that affect providers’ preferences when prescribing a specialty drug to their patients. He believes that embedding the specialty drug initiation process into the provider’s workflow will benefit both patients and prescribers.

Learn more by downloading CareMetx’s new 2024 Patient Services Report: Revealing Manufacturer Priorities: Patients Naturally Take Center Stage.

Read on for Nasir’s Insights.

Another news-laden summer is ending. Time to pack away your bathing suit, send the kids back to school, and cherish these curated curiosities that I combed from the Jersey shore:

• Some uncomfortable realities of the Inflation Reduction Act’s (IRA’s) first set of 10 prices

• Amazon goes after retail pharmacies with an amusing lack of self-awareness

• A health system-backed start-up pharmacy benefit manager (PBM) will somehow deliver massive drug costs savings

• An intriguing solution for fixing the 340B program

Plus, Mark Cuban unloads on the healthcare system during an entertaining interview.

P.S. Join my nearly 58,000 LinkedIn followers for daily links to neat stuff along with thoughtful and provocative commentary from the DCI community.

Have you requested an invite to the inaugural Drug Channels Leadership Forum? Attendance will be highly limited, so apply now. Full agenda coming soon!

Today’s guest post comes from Benjamin Hinton II, Senior Market Access Solutions Analyst at MMIT.

Benjamin reviews the growing trend of PBMs vertically integrating into the production of biosimilars. He shares data from an MMIT survey of 20 large national payers, independent plans, Blues affiliates and PBMs (excluding participants). The findings shed light on payers' view of biosimilar conpetition, contracting challenges, and other issues.

Click here to learn more about MMIT’s Custom Market Research offering for biosimilar manufacturers.

Read on for Benjamin’s insights.

Last fall, poor ol’ Rite Aid finally succumbed to bankruptcy. It was pretty much the definition of an expected surprise.

To get a comprehensive look at the company’s ever-declining fortunes, DCI rummaged around the compnay's numerous bankruptcy filings. Below, you’ll find our review of Rite Aid’s current financial situation, shrinking store footprint, changing relationship with key wholesaler McKesson, surprisingly optimistic projections, and more.

Drug Channels has been tracking retail pharmacies’ economic and business challenges—and Rite Aid’s troubles—for many years. Consider this article to be an opportunity for some fact-based analysis to replace your schadenfreude.

Today’s guest post comes from Chris Dowd, Senior VP of Market Development at ConnectiveRx.

Chris reviews recent developments for the Inflation Reduction Act of 2022 (IRA). He then recommends four IRA-related adjustments that manufacturers should make to their patient support programs.

To learn more, register for ConnectiveRx’s free webinar on September 17: IRA Reality Check: Adapting Hub and Copay Programs to Ensure Patient Access and Affordability.

Read on for Chris’s insights.