Analysis

The latest Drug Channels commentary — PBMs, 340B, specialty pharmacy, and the contracts that move the money.

Showing 311–320 of 2721

Friday, April 5, 2024

  • Tales of the Unsurprised: U.S. Brand-Name Drug Prices Fell for an Unprecedented Sixth Consecutive Year—And Will Fall Further in 2024 (rerun)

    This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.

    One important update: In the article below, I suggested that the IRA will make high-list/high-rebate products less attractive to Medicare plans. But this appears not be accurate, as I explain in Surprise! Thanks to the IRA, Part D Plans Will Prefer High-List, High-Rebate Drugs.

    Click here to see the original post from January 2024.


    It's time for Drug Channels’ annual reality check on U.S. drug pricing.

    For 2023, brand-name drugs’ list prices again grew at mid-single-digit rates. However, net prices dropped for an unprecedented sixth consecutive year. What’s more, after adjusting for overall inflation, brand-name drug net prices plunged by more than 7%. Details below.

    Employers, health plans, and PBMs determine whether patients share in this ongoing deflation. Meanwhile, these data challenge drug pricing flat earthers (#DPFE) who remain committed to a false narrative of “skyrocketing” drug prices.

    As I discuss below, manufacturers will face ongoing pressure on net prices from both commercial and government payers. They will also have new incentives to limit growth in list prices—and will even reduce list prices on certain drugs (as some are already doing).

    Perhaps these factors will finally start to deflate the gross-to-bubble and reduce its negative effect on patients and public policy discussions. Hope has to triumph over experience eventually, doesn’t it?

    Posted by Drug Channels Institute, an HMP Global company on Friday, April 5, 2024

    Labels: Gross-to-Net Bubble, Industry Trends, Costs/Reimbursement, PBMs

Thursday, April 4, 2024

Wednesday, April 3, 2024

  • The Big Three PBMs’ 2024 Formulary Exclusions: Biosimilar Humira Battles, CVS Health’s Weird Strategy, and the Insulin Shakeup (rerun)

    This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.

    The 2024 formularies described below should boost biosimilar adoption. As a new Biosimilar Council report shows, Humira retained 99% of market share in late 2023, despite being more expensive than its biosimilars.

    Click here to see the original post from January 2024.


    For 2024, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again each excluded 600 or more drugs from their standard formularies. You can find our updated counting below.

    This year, Humira and its 14 biosimilars will provide the most intriguing formulary drama. Unfortunately, the gross-to-net bubble will remain a fixture for this category, despite a price war led by almost half of the biosimilars. CVS Health will lean into the craziness with an unusual Humira strategy.*

    There are also unusual formulary developments for insulin products, many of which experienced massive list price cuts for 2024.

    Read on for my deep dive into these two therapeutic categories. I also highlight recent research that raises troubling questions about the patient impact of these ever-growing exclusion lists. As always, I welcome your comments below or on LinkedIn.

    Posted by Drug Channels Institute, an HMP Global company on Wednesday, April 3, 2024

    Labels: Biosimilars, Gross-to-Net Bubble, Benefit Design, Specialty Drugs, PBMs

Tuesday, April 2, 2024

  • What CVS Pharmacy’s New Cost-Plus Reimbursement Approach Means for PBMs, Pharmacies, Plan Sponsors, and Prescription Prices (rerun)

    This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.

    For more on acquisition cost reimbursement for pharmacies, see Sections 8.4. and 12.3.4. of our new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

    Click here to see the original post from December 2023.


    Is the world ready for new ways to price pharmacy and pharmacy benefit manager (PBM) services? CVS Health thinks so, as evidenced by two new initiatives that it announced yesterday. Below you'll find details and links to source documents.

    I commend CVS Health for attempting to address key economic challenges facing the retail pharmacy industry and for tackling the hidden complexities of PBM pricing models. As I explain, a shift to cost-based pharmacy reimbursement could stabilize CVS Health’s retail business by improving its dispensing profits.

    Nonetheless, CVS Pharmacy’s cost-plus model has some notable shortcomings for plan sponsors and is far less “disruptive” than the company would like us to believe. Mark Cuban should be flattered—but not fearful.

    What's more, other large pharmacies will likely follow CVS with attempts to force payers and PBMs to accept some form of cost-plus reimbursement. (Et tu, Walgreens?) If that happens, expect higher prescriptions prices, less efficiency, and a slowdown in the inevitable retail pharmacy shakeout.

    Posted by Drug Channels Institute, an HMP Global company on Tuesday, April 2, 2024

    Labels: Average Acquisition Cost (AAC), Costs/Reimbursement, Discount Cards, Pharmacy, PBMs, Pharmacy Economics

Monday, April 1, 2024

Thursday, March 28, 2024

Tuesday, March 26, 2024

Friday, March 22, 2024

Thursday, March 21, 2024

Tuesday, March 19, 2024