Analysis

As many of you know, hospitals and health systems have emerged as significant participants in the specialty pharmacy industry. A new American Society of Hospital Pharmacists (ASHP) survey provides fresh insights into these specialty pharmacies.

Below, I review key findings on the economics and operations of these specialty pharmacies. I then highlight how hospitals steer prescriptions to their internal specialty pharmacies.

As you’ll see, hospitals use network strategies that would make any pharmacy benefit manager (PBM) proud—especially when combined with the prescribing activities of hospital-employed physicians.

Vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels gets most of the attention. But a parallel vertical integration has been occurring among hospitals, specialty pharmacies, and physicians. Manufacturers and payers must adapt to the growing power and market tactics of hospital-owned specialty pharmacies.

Today’s guest post comes from Greg Morris, Chief Strategy Officer at CareMetx.

Greg highlights the value of therapeutic area expertise in enhancing the performance of hub services. He explains how CareMetx's hub used its experience in the retina space to improve a new brand-name product’s launch.

To learn more about the impact of hub service on brand launch success, download CareMetx’s latest report: Patient Service Trends Point the Way to Better Hub/ Provider Partnerships.

Read on for Greg’s insights.

Zoinks! It's time for a super-sized Halloween roundup of wicked Drug Channels’ tales. This month’s tricks and treats:

• Spooky! CVS Health frightens all but one Humira biosimilar maker away from its formulary.

• Creepy! The gross-to-net bubble for anti-obesity GLP-1 drugs walks among us.

• Grotesque! Penn Medicine gorges on the 340B program.

• Vampiric! Rite Aid’s many management missteps finally put a stake in the company’s heart.

• Eerie! Mark Cuban Cost Plus Drug Company conjures a partnership with Alto Pharmacy.

Plus, an epic meetup with two of my favorite drug channel experts.

P.S. For my daily haunting, join the zombie horde who shamble after me on LinkedIn. You can also find my ghostly rantings at @DrugChannels on Twitter/X. (I recommend LinkedIn for maximium scares. Alas, I’m still spooked by Threads.)

thINc’s Value-Based Care Summit
Accelerating Healthcare’s Shift in the Move from Volume to Value
In-Person Event | December 5-6, 2023 in Washington, DC
www.thinc350.com/VBCS

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

View the Agenda Snapshot

As healthcare stakeholders continue to prioritize the move to value-based care and aim to provide equitable access to care for all, health plan, provider, and pharma leaders must develop novel approaches to empower the patient and ensure effective risk-sharing strategies.

The Value-Based Care Summit, produced by The Healthcare Innovation Company (thINc), brings together health care 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 CMMI, ICER (Institute for Clinical and Economic Review), and policy experts on value-based payment models
• Value-Based Digital Solutions: Explore case studies on how to test, design, and scale digital services and ensure technological innovations that support outcomes improvement, preventive care, and cost containment
• 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
• Care Delivery Transformation: Adopt a personalized approach to understand patient needs and implement a value-based care delivery model
• Data and Evidence: Harness real-time patient data and population health metrics to determine medication adherence and identify trends to mitigate major health issues

Must-attend keynotes include:

CEO Keynote Panel: Making Value-Based Care a Reality: Progress, Promise, and the Path Forward

• Eric Gallagher, CEO, Ochsner Health Network (OHN)
• Lee Handke, PharmD, CEO, Nebraska Health Network
• Stacy Meyr DC, President, Saint Alphonsus Health Alliance
• Moderator: Josh Berlin, CEO, rule of three, LLC

Leadership Perspectives to Accelerate the Move to Value Based Healthcare Transformation

• Thomas McGinn MD, MPH, System EVP, Physician Enterprise, CommonSpirit Health
• Rachel Thornton MD, PhD, VP and Enterprise Chief Health Equity Officer, Nemours Children's Health
• Will Shrank, MD, Venture Partner, Andreessen Horowitz
• Mark Steffen MD, MPH, SVP, Medical Management and Chief Medical Officer, Blue Cross and Blue Shield of Minnesota
• Moderator: Ceci Connolly, President and Chief Executive Officer, Alliance of Community Health Plans (ACHP)

Align Incentives to Strengthen Payer-Provider Partnerships and Contract Arrangements

• Josh Patten, Executive Director, National Value Based Development, Aetna, CVS Health Company
• Janet Pogar, Market Leader, SW Florida, Florida Blue
• Elisa Wetherbee, CEO, IPA; VP, Clinically Integrated Network, Rose Medical Group and HealthONE Physician Partnership; VP, Population Health, UCHealth
• Moderator: Debbie Welle-Powell, CEO, DWP Advisors; Adjunct Faculty, Denver Business School, University of Colorado

PLUS! Two Dedicated Tracks for Your Focus Area:

• Value-Based Contracting Strategies for Manufacturers
• Contracting and Networking Design Strategies for Health Plans and Providers

View the current Speaker Faculty and register today.

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

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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. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

Today’s guest post is from Dorothy Gemmell, Chief Commercial Officer at GoodRx.

Dorothy explains the innovative new collaboration between GoodRx and Sanofi. Under the program, the out-of-pocket cost for Sanofi's Lantus will be capped at $35 at any pharmacy that accepts GoodRx. This program will increase affordabiliy and broaden access for people living with diabetes.

Click here to learn more about GoodRx access and affordability solutions like GoodRx Assist, a point-of-sale (POS) rebate program that attracts cash-paying patients who require additional financial assistance to start and stay on medication.

Read on for Dorothy’s insights.

Open enrollment is under way for the 2024 Medicare Part D plans. Our exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals that preferred cost sharing pharmacy networks will maintain their dominance as a component of Part D benefit design.

For 2024:

• 94% of stand-alone Medicare Part D prescription drug plans (PDP) will have a preferred network.

• 51% of Medicare Advantage prescription drug (MA-PD) plans will have a preferred network.

Below, I provide historical data on preferred networks’ growth and update the seven top companies’ 2024 offerings. I also update our analysis of the prevalence of preferred networks in three different types of MA-PD plans. In upcoming articles, I’ll delve into chain and independent pharmacies’ participation in the major 2024 preferred networks.

The 2024 data provide early evidence of a shrinking PDP market. Chalk it up to yet another unintended consequence of the Inflation Reduction Act of 2022 (IRA), which will make PDPs less economically viable and drive even more seniors into Medicare Advantage plans.

Informa Connect’s Trade and Channel Strategies
December 11-13, 2023
DoubleTree By Hilton | Philadelphia, PA

Exclusive Offer–Be sure to use your exclusive promo code 23DC10 to save 10% off* of your registration.

Trade and Channel Strategies is back and we have a lot to talk about! With regulation and policy changes, specifically surrounding the DCSCA, IRA and serialization, the loss of exclusivity wave, adoption of low-WAC products affecting GTN and the rise of alternative distribution models, there has never been a more important time for industry to unite. A program driven by market dynamics and led by champions of channel strategy, join now to master the complexities of pharmacy and distribution models to accelerate market access –It's all happening December 11-13, 2023.

Exclusive Offer–Download the agenda and register today–Be sure to use your exclusive promo code 23DC10 to save 10% off* of your registration.

Why should you attend this pivotal event?

The challenges of keeping up with shifting market dynamics in the midst of maximizing market access while also meeting business objectives remains a deep concern and brings about many questions for trade and channel professionals.

Have you properly prepared for the DSCSA to take effect and what should you expect post implementation? How is health policy affecting the distribution channel? How are product archetypes and market expansion influencing the physical channel and what does that mean for your organization?

In just three days, walk away with answers to these questions and more from experts from across the industry. Do not miss your chance to join seasoned leaders, your peers and leading solution providers as they dive into the top trends for innovative distribution, integrated pharmacy models and the future of trade.

What can you expect?

Vital insights from some of the industry’s leading pharmacy and distribution experts, including:

• Bill Roth, General Manager and Managing Partner, Blue Fin Group, An IntegriChain Company
• Jeff Henderson, Vice President, Head of Global Market Access, Reimbursement and Distribution, VectivBio
• David T. Foell, Director, Specialty Channel Operations, Ultragenyx
• Chris Rocco, Senior Director, Market Access Data, Reporting and Analytics, GSK
• Spencer Miller, Director, Market Access, National Accounts, Trade & Distribution, Bayer
• Dana Dickens, Senior Director, Trade, Gilead Sciences
• Rena Goins, Executive Director, Global Distribution, Regeneron Pharmaceuticals, Inc.
• Eduardo De La Calle, Director of Regional Supply, AstraZeneca
• Shefali Shah, Global VP, Market Value and Commercial Effectiveness, MindMaze
• And more!

Tackle the hottest topics facing industry right now, including:

• Keynote: The State of the Channel — Overview of Current and Future Trends Impacting the Channel
• Wall Street Insights — Analyze Market Dynamics and Key Investments in the Healthcare Ecosystem
• Focused Multi-Track Offerings:
• Supply Chain and Distribution Operations
• Pharmacy Model Strategies and Management
• Data, Innovation and Analytics
• Supply in Crisis—How Can We Better Prepare
• How to Maximize GTN Impact for Channel Strategy
• Diversity, Equity and Inclusion Summit
• Interactive Working Groups Based on Product Type:
• Branded Products
• Specialty, Orphan and Rare
• Generics and Biosimilars
• The Flavors of Retail Pharmacy—Exploring Various Models in the Marketplace
• The State of the IRA and Navigating What Comes Next
• Thought-Provoking Workshops by Role Type:
• Trade 101 for Existing Products
• Portfolio Management and Launch Strategy
• Executive Trade Directors Exchange
• Distribution for Digital Therapeutics
• And more!

Exclusive Offer–Download the agenda and register today–Be sure to use your exclusive promo code 23DC10 to save 10% off* of your registration.

Informa Connect will see you there!

*Cannot be combined with other offers, promotions or applied to an existing registration. 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. 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 Melanie Christie, VP of Product Management at CoverMyMeds.

Melanie discusses how the nationwide shortage of pharmacy technicians affects pharmacists. She argues that centralized prescription fulfillment can provide pharmacists with more time to care for patients while also reducing medication errors and accelerating time-to-treatment. Melanie explains how such fulfillment tools also increase a pharmacy’s revenues and lowers its costs.

Click here to learn about CoverMyMeds’ automated central fill solutions.

Read on for Melanie’s insights.

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.

Informa Connect’s PBM Contracting Summit
December 5-6, 2023 in Chicago, IL
Drug Channels readers save 10% with code 23DRCH10*

Join your peers for a unique opportunity to navigate the complex PBM landscape and gain unparalleled strategies to improve patient care and manage costs. The PBM Contracting Summit December 5-6, 2023 in Chicago, focuses on innovative and practical contracting strategies, improving patient care management and rising costs, the current legislative issues impacting contract negotiations and so much more. If you can’t attend in-person, there are virtual registration options available, too!

View the agenda the 2023 PBM Contracting Summit to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pbm-contracting for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to November 10, 2023.*

Sessions include coverage on multiple hot topics, including:

• A regulatory update on the changing legal environment in healthcare
• The latest on the 340B drug pricing program
• A review of the AMP Cap removal project in relation to insulin and rebates
• Understand copay maximizer and patient assistance programs in relation to PBM contracting
• Combatting spread pricing with optimal PBM contracting and pricing
• Take a deep dive into financial acceptance and consequences of biosimilars and specialty therapeutics
• Strengthen the PBM-Payer partnership and strategize cost management
• Develop an understanding of vertical integration and the consolidation of PBMs and the impact of offshore rebate aggregation entities
• Hear about measuring value-based care and contracting, patient access priorities and PBM relationship, the expanding role of data, healthcare M&A, market access and pricing strategies and more!

View the agenda the 2023 PBM Contracting Summit to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pbm-contracting for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to November 10, 2023.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates or other offers. 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. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).