Analysis

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

Chris discusses how such copay adjustment programs as accumulators and maximizers impact patients. He also discusses current legal cases that cover prescription medication access.

To learn more, register for ConnectiveRx’s free October online panel discussion with Chris: The Battle Over Accumulators and Maximizers: What You Need to Know for 2024.

Read on for Chris’ insights.

Last week, Anna Matthews of The Wall Street Journal scored a market-moving scoop with her story about Blue Shield of California’s decision to ditch CVS Health’s Caremark pharmacy benefit manager (PBM) in favor of five separate vendors. ICYMI: A Big Health Insurer Is Ripping Up the Playbook on Drug Pricing

I commend Blue Shield of California for undertaking a noble experiment to unbundle the PBM business model. But let’s curb our enthusiasm over any purported “disruption.” The model is intriguing, but less novel than advertised—and retains an unexpected reliance on the largest pharmacy benefit managers (PBMs).

Read on for some industry context and my unanswered questions.

Today’s guest post is from Divya Iyer, Vice President of Strategy & Business Development, Pharma Manufacturer Solutions, at GoodRx.

Divya discusses the challenges patients face in accessing specialty therapies prescribed by their healthcare providers. She suggests how the pharma industry can leverage GoodRx to help patients with access and affordability.

Learn more about GoodRx’s insights and solutions for specialty treatments by downloading their free yellow paper: Access and Affordability Insights: Differences Across Specialties.

Read on for Divya’s insights.

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.

Informa Connect’s Copay, Reimbursement and Access Congress
Hybrid Event | October 2-4 at the Bellevue Hotel in Philadelphia, PA
www.informaconnect.com/copayreimbursement


Copay, Reimbursement and Access Congress is back and we have a lot to talk about! With drug pricing legislation growing more complex, ongoing enforcement actions, accumulator and maximizer programs affecting patients and the rise of PBM cost-shifting strategies, there has never been a more important time for industry to unite. A program driven by marketplace insights and led by industry trailblazers, now is the time to join to drive adherence, access and commercialization forward–It's all happening October 2-4.

Exclusive Offer: View the agenda and register today! Be sure to use your exclusive promo code USAVE10 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 access while also meeting business objectives remains a deep concern and brings about many questions for access professionals.

How are you managing out-of-pocket costs for patients? Do you have clarity on the future of health policy? What is the impact of alternative funding programs on your organization?

In just two-and-a-half 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 navigate marketplace trends and dive into the impact coupons, benefit design, accumulators, maximizers, alternative funding programs and drug pricing legislation have on patient affordability and out-of-pocket costs. This is your chance to gain critical insights on industry standards, forward-thinking strategies to optimize your copay and cost sharing programs and so much more.

Can’t miss content highlights:

• Two Conference Workshops
• Copay and Reimbursement Basics
• Advanced Copay and Reimbursement Strategies
• State of the Industry Keynote: Patient Affordability Challenges
• Luminary Address–Reimbursement and Rebate Marketplace Challenges
• Stakeholder Perspectives: Copay and Reimbursement Marketplace Trends
• Enforcement Update: Exploring Regulatory Actions and Trends
• Build Sustainable Copay Programs While Balancing GTN
• Leveraging Data to Understand the Impacts of Copay Adjustment Programs on Historically Marginalized Communities
• Exploring Formulary Challenges
• And more!

HOW COULD IT GET BETTER?

Enhance Your Conference Experience with Optional Add-On Workshop: Understand the Nuances and Impact of Alternative Funding Programs:

Disrupting the industry, join Dawn Holcombe, MBA FACMPE ACHE, President at DGH Consulting as she leads this workshop, exploring the nuances and complexities of alternative funding programs, the evolution of AFPs and future industry impact these programs will have and what you need to know to fortify your cost-sharing program against AFPs. It may be optional, but with an expert like this, you won’t want to miss it.

Walk away with an understanding of these three main themes:

• The Basics of Alternative Funding Programs
• Industry Impact
• How to Prepare

Exclusive Offer: View the agenda and register today! Be sure to use your exclusive promo code USAVE10 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 Rebecca Cotton, Executive Director of Strategy & Product Innovation at Cardinal Health™ Sonexus™ Access and Patient Support

Rebecca discusses the essential features biopharmaceutical manufacturers should seek in a digital hub that will help patients get their therapies faster. She argues that the most effective hub balances automation with the still-relevant value of human interactions.

Download the Cardinal Health™ Sonexus™ Access and Patient Support case study for more details about how ePA technology can accelerate time to therapy for patients. .

Read on for Rebecca’s insights.

Recently, a bipartisan group of six U.S. senators issued a request for information (RFI) for “input on bipartisan policy solutions that would provide stability and appropriate transparency to ensure the 340B program can continue to achieve its original intent of supporting entities serving eligible patients.” Click here to read the full letter.

I submitted a 14-page letter, which you can read below. I shared my $0.02 on the overall market, explained channel distortions from 340B contract pharmacies, and offered some policy recommendations. How could I not?


Below, I include links to publicly available comments from a diverse range of stakeholders, including 340B Health, the American Hospital Association, Biotechnology Innovation Organization, Community Oncology Alliance, National Association of Community Health Centers, and Pharmaceutical Research and Manufacturers of America. Enjoy!

Today’s guest post comes from Jonas Boli, Chief Product Officer at Phil, Inc.

Jonas describes the challenges patients face when accessing specialty therapies and explains how patient abandonment affects manufacturers over time. He argues that an effective telemedicine program can help patients via an end-to-end digital experience.

To learn more, register for Phil’s free webinar on August 29th at 2 p.m. ET: Your Guide to Building an Exceptional Telemedicine Program.

Read on for Jonas’ insights.

In my most recent video webinar, I explored how plans and PBMs are turning to novel—and highly controversial—benefit design tools that access manufacturers’ patient support spending: copay accumulators, maximizers, and alternative funding programs.

In the video excerpt below, I describe these new approaches that plans offset specialty drug expenses. I then follow the dollar to show how they impact plan, patient, and manufacturer costs when compared with traditional approaches to copay support.

During the full 90-minute webinar, I discussed seven crucial risks that could disrupt this market along with many other aspects of this emerging market. If this clip whets your appetite for more, you can purchase the 90-minute webinar replay and full slide deck here: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

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



Two recent Drug Channels article on these topics:

• Copay Accumulator and Maximizer Update: Adoption Plateaus as Insurers Battle Patients Over Copay Support

• Employers Expand Use of Alternative Funding Programs—But Sustainability in Doubt as Loopholes Close

Errata: The formulary rebate in the mathematical example that begins at 4:40 should be shown as 16.7%, not 20%. We apologize for the error.

Let’s cut through the steamy summer haze with Drug Channels’ refreshing breeze of questions for you to ponder while on your favorite pink beach:

• Why does the biggest PBM need a discount card partner?

• How do copay accumulators affect prescription adherence?

• Do nonprofit hospitals deserve their tax exemption?

Plus, Dr. Glaucomflecken asks: What would happen if UnitedHealthcare hired physicians who practiced evidence-based medicine?

P.S. Join my more than 43,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,600 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. I’m not posting to Threads yet.)