Analysis

Today’s guest post comes from Megan Marchal, Director of Specialty Strategy at CoverMyMeds.

Megan shares the story of Don, a cancer patient who struggled to access and afford his medications. She describes how human care plus an innovative, technology-driven patient support solution can help patients start therapy and get on the road to recovery.

To learn more about CoverMyMeds’ specialty therapy solutions, visit Booth 1519 at Asembia's Specialty Pharmacy Summit in Las Vegas, April 30-May 4, 2023. Additionally, sign up for CoverMyMeds’ on-site recaps from the summit.

Read on for Megan’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, April 28, 2023

Labels: Guest Post, Sponsored Post

Posted by Drug Channels Institute, an HMP Global company on Tuesday, April 25, 2023

Labels: Biosimilars, Alternative Funding Programs (AFPs), Gross-to-Net Bubble, Co-pay Offset Programs, Benefit Design, Pharmacy, Copay Accumulator Adjustment, Specialty Drugs, PBMs

Today’s guest post comes from Ticia Cawley, VP of Client Solutions at ConnectiveRx.

Ticia reviews four interim findings from ConnectiveRx's survey of buy-and-bill prescribers and their support staff. The survey reveals new insights about how practices evaluate automation and digital tools for provider-administered specialty therapies.

To learn more, register for ConnectiveRx’s free online panel discussion on May 17th at 1:00 p.m. ET: Automation and Ease: The Future of Buy-and-Bill. Ticia will be joined by a buy-and-bill brand leader and a medical professional.

Read on for Ticia’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, April 21, 2023

Labels: Guest Post, Sponsored Post

Like it or not, the Centers for Medicare & Medicaid Services (CMS) is barreling ahead with its implementation of the Inflation Reduction Act of 2022 (IRA). Last Friday was the last day to submit comments on CMS's initial guidance on the drug price negotiation program.

The IRA will alter many crucial aspects of the Medicare program and the overall drug channel. To help you anticipate what’s ahead, below I highlight 10 predictions on how the IRA will impact drug prices, demand for prescription drugs, Part D plan strategies, rebates, manufacturers’ revenues, retail pharmacies, and more.

While this is a longer-than usual post, I can still only barely scratch the surface of the many far-reaching effects of this legislation. As always, I encourage you to share your own thoughts in the comments below or on social media.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, April 18, 2023

Labels: Average Manufacturer Price (AMP), Gross-to-Net Bubble, 340B, Costs/Reimbursement, Average Sales Price (ASP), Inflation Reduction Act of 2022, Specialty Drugs, Medicare Part D

Today’s guest post comes from Edward Hensley, Chief Commercial Officer at AssistRx.

Edward discusses how a technology-first approach automates manual processes for therapy initiation. He argues that such an approach can increase patient adherence, speed access to therapy, and improve the healthcare providers’ workflow.

To learn about AssistRx’s technology-first solutions, click here to schedule a meeting at Asembia’s Specialty Pharmacy Summit.

Read on for Edward’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, April 14, 2023

Labels: Guest Post, Sponsored Post

In Drug Channels Institute’s list of the top 15 pharmacies of 2022, we show that central-fill, mail pharmacies operated by large PBMs and health insurers have displaced retail chains as the largest prescription drug dispensers by revenues.

To complement that broader ranking, we rummaged around our DreamHouse to update our exclusive list of the top 15 pharmacies based on specialty drug dispensing revenues in 2022.

For 2022, pharmacy benefits managers (PBMs) and insurers expanded their dominance over specialty dispensing, though both hospitals and physician practices are growing their share of the market. The top three PBM-owned specialty pharmacies accounted for nearly two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. As predicted last year, Walgreens’ specialty pharmacy business has collapsed, which led to a slightly less concentrated industry.

Read on for additional observations about hospitals, independent pharmacies, the dynamics that created this market structure, and why life in plastic is fantastic.

Posted by Drug Channels Institute, an HMP Global company on Wednesday, April 12, 2023

Labels: Pharmacy, Specialty Drugs, Channel Management, PBMs

Today’s guest post comes from Heather Roulston, Market Research Manager at MMIT.

Using MMIT’s proprietary data, Heather demonstrates that contracting for medical benefit drugs is now common for many therapeutic areas. She then highlights how manufacturers and payers are adopting value-based agreements (VBA) for medical benefit products—although VBA usage varies widely across therapeutic area. Heather also shares data on payers’ site-of-care management strategies.

For additional market insights, click here to learn about MMIT’s Biologics & Injectables Index.

Read on for Heather’s insights.

Posted by Drug Channels Institute, an HMP Global company on Friday, April 7, 2023

Labels: Guest Post, Sponsored Post

Time for Drug Channels Institute’s annual update on the gross-to-net bubble—the ever-growing dollar gap between sales at brand-name drugs' list prices and their sales at net prices after rebates and other reductions.

We estimate that the gross-to-net bubble reached $223 billion for patent-protected brand-name drugs in 2022. If we include brand-name drugs that have lost patent protection and face competition from generic equivalents, the bubble was even higher, at $256 billion. Our latest data appear below.

Four crucial trends will deflate the gross-to-net bubble—thereby disrupting market access strategies, altering pharmacy benefit manager (PBM) profit models, and changing plan sponsor benefit designs. Perhaps it’s time to get ready for the day when SpongeBob SquarePants will depart from Drug Channels.

Posted by Drug Channels Institute, an HMP Global company on Tuesday, April 4, 2023

Labels: Average Manufacturer Price (AMP), Gross-to-Net Bubble, Benefit Design, Inflation Reduction Act of 2022, PBMs, Medicare Part D

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook.

Click here to see the original post and comments from January 2023.

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Time for the Drug Channels annual reality check on drug pricing. The data once again tell a different story than you might read in your favorite politician’s Twitter feed or misleading news reports.

For 2022, brand-name drugs’ net prices dropped for an unprecedented fifth consecutive year. What’s more, after adjusting for overall inflation, brand-name drug net prices plunged by almost 9%.

The factors behind declining drug prices will remain in the coming years—and become even stronger due to forthcoming changes in Medicare and Medicaid. Employers, health plans, and PBMs will determine whether patients will share in this ongoing deflation.

Read on for details and make up your own mind. And please pass the news along to the drug pricing flat earthers (#DPFE) who refuse to accept that brand-name drug prices are falling—or that prescription drug spending is a small and stable portion of overall U.S. healthcare expenditures.

Even a purple gorilla professor understands these facts.

Posted by Drug Channels Institute, an HMP Global company on Friday, March 31, 2023

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

This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook.

So far, it appears that PBMs are neither preferring Amgen's Humira biosimilar nor embracing the low-list/low-rebate version. In February, AbbVie stated that U.S. Humira sales would be decline by about 37% in 2023—which is at the lower end of its previous erosion projection of 35% to 55%. Much more to come. Click here to see the original post and comments from February 2023.

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As you've surely heard, Amgen has just launched Amjevita, the first non-interchangeable biosimilar of Humira. Our crazy drug channel led Amgen to launch both a high-list/high-rebate and a low-list/low-rebate version of the drug. Its strategy echoes the pricing of the first interchangeable insulin biosimilars—as I predicted in 2021.

Unfortunately, we should expect most PBMs and plan sponsors to embrace the high-list/high-rebate version. The plans that adopt the higher-priced biosimilar will get bigger rebates, while patients with coinsurance and deductibles end up paying more out-of-pocket.

As Mark Twain said: “History doesn’t repeat itself—but it often rhymes.” So, below, I revisit the surprising market dynamics for the interchangeable insulin biosimilars and highlight Amgen’s experience lowering the list price of its PCSK9i product. The story is more complex than you might expect, so perhaps there is hope that low-list-price versions will connect.

Posted by Drug Channels Institute, an HMP Global company on Thursday, March 30, 2023

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