Analysis

My recent Drug Channels Outlook 2024 webinar covered 12 key trends that will shape the commercial environment this year. The video excerpt below highlights my commentary on trend #2: the rapid growth of anti-obesity GLP-1 agonist drugs.

As I explain, this growth will challenge payer and channel economics, while boosting profits for patient reimbursement hub businesses and pharmacy benefit managers (PBMs).

The widespread use of these products will also lead to greater scrutiny of utilization management—the tools that PBMs use to influence and manage prescription costs.

If this clip whets your appetite for more, register to watch a replay of the full 100 minute Drug Channels Outlook 2024 video webinar.

Click here to sign up for The Drug Channels 2024 Video Webinar Series. My first webinar will be on April 5, 2024.

Click here if you can’t see the video above.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, January 16, 2024

Labels: Benefit Design, Video, PBMs

Today’s guest post comes from Maria Kirsch, President, Patient Services, Krista Pinto, President, Deployment Solutions, and Mike Scott, Senior Vice President, Specialty Consulting at EVERSANA.

Maria, Krista, and Mike discuss the key reasons why patients abandon drug therapy. They then describe EVERSANA’s approach for helping manufacturers and healthcare providers improve adherence and health outcomes.

Learn more about EVERSANA’s solutions from this complimentary whitepaper: Repairing the Patient Journey: How Pharma Can Fix the Obvious–and Not So Obvious–Breaking Points of Nonadherence.

Read on for the authors’ insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, January 12, 2024

Labels: Guest Post, Sponsored Post

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 Tuesday, January 9, 2024

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

Paula and I have some exciting news to share with you: Drug Channels Institute is joining the HMP Global family! HMP is a leading omnichannel healthcare education, events, and market insights company. It’s a great fit for DCI.

Here’s the press release: HMP Global Expands Market Reach with Strategic Acquisition of Drug Channels Institute; Launches Market Intelligence Unit

Paula and I will continue to lead DCI as part of HMP. We love bringing you great content, and plan to continue doing so. HMP will be making significant investments to help us grow. Stay tuned for some exciting announcements!

Thank you all for your support and encouragement over the years. Please enjoy our special video message to the Drug Channels community:

Click here if you can’t see the video.

Posted by Drug Channels Institute, an HMP Global company on Thursday, January 4, 2024

Labels: Blog Administration

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 Wednesday, January 3, 2024

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

Happy New Year, everyone! It has been another wild year for our ever-evolving healthcare system.

Thank you, dear readers, for welcoming Drug Channels into your inboxes, browsers, and apps. I’m proud of the diverse and thoughtful audience who follows and comments on our unique content. The Drug Channels community now encompasses 50,000+ LinkedIn followers, 25,000+ email subscribers, and 17,000+ Twitter/X followers.

We’ve had a blast bringing you our perspectives and curated links in 2023 and hope that you had fun engaging with it. Stay tuned for some exciting announcements in 2024!

Wishing you and your family health and happiness,
Adam and the Drug Channels team

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In this issue:

• Say hello to AVERON, CVS Health’s latest group purchasing organization

• States continue to carve PBMs out of Medicaid programs

• Seniors and taxpayers fund a growing share of 340B profits

Plus, George Barrett, former CEO of Cardinal Health and current cool dude, re-launches his music career.

Posted by Drug Channels Institute, an HMP Global company on Wednesday, December 20, 2023

Labels: Group Purchasing Organizations (GPOs), 340B, Health Care Policy, Medicaid, PBMs, Medicare Part D

This week, I’m rerunning some popular posts while I prepare for today’s Drug Channels Outlook 2024 live video webinar. My topic #9 for 2024: The Battle Over 340B Gets Even Messier.

Click here to see the original post from September 2023.

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Drug Channels has just obtained new details on the size of the 340B Drug Pricing Program. I couldn’t wait to share the news, hence this special Sunday post.

For 2022, discounted purchases under the 340B program reached a record $53.7 billion—an astonishing $9.8 billion (+22.3%) higher than its 2021 counterpart. The difference between list prices and discounted 340B purchases also grew, to $52.3 billion (+$2.6 billion).

Hospitals accounted for 87% of 340B purchases for 2022. Every 340B covered entity type experienced double-digit growth, despite drug prices that grew more slowly than overall inflation.

Another surprise: HRSA estimated that manufacturers' contract pharmacy restrictions reduced 340B purchases by only $470 million—or less than 1% of 2022's total purchases. That's far below the figure quoted by 340B lobbyists.

Once again, the data demonstrate that 340B advocates are wrong when they claim that manufacturers are “stripping critical resources from the nation’s health care safety net.” As I noted last year, only in the U.S. healthcare system can billions more in payments and spreads be considered a cut.

Read on for full details and analysis, including the opportunity to download your own copy of the raw data from HRSA.

Posted by Drug Channels Institute, an HMP Global company on Friday, December 15, 2023

Labels: Gross-to-Net Bubble, Hospitals, 340B, Health Care Policy, Industry Trends, Pharmacy, PBMs

This week, I’m rerunning some popular posts while I prepare for tomorrow’s Drug Channels Outlook 2024 live video webinar. Click here to see the original post from October 2023.

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In case you haven’t noticed, private equity firms have displaced hospitals and health systems as the major acquirers of community oncology practices. These financial firms have assembled significant oncology practice management companies that are primed for purchase by drug channel participants.

Below, I review recent M&A trends and then examine the strategic objectives behind the acquisition of private-equity-backed OneOncology by AmerisourceBergen (Cencora) and another financial buyer. As I explain, AmerisourceBergen (Cencora) gains significant strategic advantage from this transaction, which echoes a historical McKesson deal.

The Federal Trade Commission’s (FTC) has a newfound interest in the roll-up transactions that are creating practice management companies. Nonetheless, I expect this consolidation activity to continue—enabling a new round of vertical integration in the drug channel.

FYI: Today’s article is adapted from Section 6.3. (Future Trends for Buy-and-Bill Channels) of our new our 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, now available to download at special launch pricing.

Posted by Drug Channels Institute, an HMP Global company on Thursday, December 14, 2023

Labels: Mergers and Acquisitions, Physicians, Specialty Drugs, Wholesalers, Buy-and-Bill, Channel Management

This week, I’m rerunning some popular posts while I prepare for Friday's Drug Channels Outlook 2024 live video webinar. Click here to see the original post from September 2023.

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Time for our annual update on the channels for provider-administered drugs.

For 2023, specialty pharmacies—via white, brown, and clear bagging—retained a meaningful share of the distribution channels for provider-administered oncology drugs. Despite the concerted efforts of insurers such as UnitedHealthcare and Elevance Health, however, buy-and-bill remains the most common channel for these products. Below, I review the latest data on trends over the past five years.

Strategies for white and brown bagging reflect the broader battle over oncology margins—and plans’ attempts to shift costs to providers, patients, and manufacturers. The persistence of buy-and-bill reflects this channel’s legacy infrastructure as well as providers’ push back on white bagging mandates. But perhaps patients and manufacturers will start paying more attention to the higher costs from white bagging.

FYI: The material in today’s article is adapted from Chapter 3 of our forthcoming 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, now available to preorder at special introductory pricing.

Posted by Drug Channels Institute, an HMP Global company on Wednesday, December 13, 2023

Labels: Hospitals, Physicians, Specialty Drugs, Buy-and-Bill, Channel Management, PBMs

This week, I’m rerunning some popular posts while I prepare for Friday’s Drug Channels Outlook 2024 live video webinar. Click here to see the original post from August 2023.

Something to consider while you review today's rerun: The Lower Costs, More Transparency Act (H.R. 5378), which the U.S. House of Representatives passed yesterday, contains new PBM rebate disclosure requirements, but no mandates for rebate pass-through.

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Hi, Barbie! The likelihood of major national legislation over the pharmacy benefit management (PBM) industry has never been greater. A serious effort exists to require greater transparency into PBMs’ activities and mandate full pass-through of rebates to plan sponsors.

Today, I review some surprising new data on a crucial aspect of the drug channel: how employer-sponsored health plans access the billions of dollars in manufacturer rebates that are negotiated by their PBMs.

As Barbie learned, the real world isn’t what you thought it was. Only about 60% of employers report that their PBM passes through all rebates on traditional and specialty drugs. What's more, one-third of employers choose spread pricing for their pharmacy network.

These data seem to contradict public statements by PBM executives, while also undermining the purpose of legislation that mandates rebate pass-through to plan sponsors. Notably, most of the proposed legislation fails to mandate pass-through to the patients whose prescriptions generated the rebates.

Read on for the details. Although when you find out that PBM reform isn’t about horses, you may lose interest.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, December 12, 2023

Labels: Health Care Policy, Benefit Design, Specialty Drugs, PBMs