Analysis

In yesterday’s post, I highlighted the largest pharmacy chains that will participate in the 2023 Medicare Part D prescription drug plans (PDP).

Today, I update our annual analyses of how smaller pharmacies will participate as preferred cost sharing pharmacies via the pharmacy services administrative organizations (PSAOs) that represent them in negotiations with plans.

As you will see below, the largest PSAOs will move further away from preferred networks in 2023. What's more, plans from Aetna, Humana, WellCare, and UnitedHealthcare will not have any independent pharmacies participating via PSAOs as preferred pharmacies.

Below we provide details about the PSAOs owned by the three major wholesalers—AmerisourceBergen, Cardinal Health, and McKesson—along with information about AlignRx, the largest independent PSAO. There are some differences in strategy, as you will see from our handy scorecard below. However, smaller pharmacies’ near-total rejection of preferred networks shows that the more the PBMs talk, the less independents can take.

What else is ahead for 2023? Find out during my upcoming live video webinar, Drug Channels Outlook 2023, on December 16, 2022, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

In Preferred Pharmacy Networks in 2023’s Medicare Part D Plans: Cigna, CVS Health, Humana, UnitedHealthcare, WellCare, and More, I highlighted how those networks have taken over the world of stand-alone Medicare Part D prescription drug plans (PDP) and become a major presence in Medicare Advantage prescription drug (MA-PD) plans.

Today, I examine the seven largest retail chains’ 2023 participation in the 22 major 2023 Part D preferred networks that the eight largest plan sponsors will offer. As always, I offer you a handy table for scoring each chain’s participation and changes from 2022 to 2023.

As you’ll see, Kroger’s decision to exit Express Scripts commercial pharmacy networks has had negative ramifications for its Part D position. Kroger will be out-of-network—not just non-preferred—in the major Part D networks for which Express Scripts acts as the PBM. That will be a key factor behind its $1+ billion revenue hit.

Speaking of 2023, please join me for my upcoming live video webinar, Drug Channels Outlook 2023, on December 16, 2022, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Today’s guest post comes from Deepak Thomas, Founder and CEO of PHIL Inc.

Deepak explains how a manufacturer’s net revenues are affected when that manufacturer helps patients access, afford, and adhere to medication therapy. He provides three suggestions for building a channel strategy to optimize gross-to-net while also improving clinical, financial, and operational outcomes.

Click here to learn about PHIL’s access and commercialization solutions.

Read on for Deepak’s insights.

I hope everyone enjoyed the Thanksgiving holiday! Now that you’ve stretched your stomach, stretch your mind with some food for thought. In this issue:

• Mark Cuban schools Elon Musk on PBMs

• Market access lessons from Semglee

• Gen Z rejects the pharmacy career path

• A potent call for 340B transparency

Plus, get ready to love the ‘90s again!

P.S. Join my more than 34,000 LinkedIn followers for daily links to neat stuff. If you haven't quit Twitter, you can also find my daily posts at @DrugChannels on Twitter, where I have more than 15,500 followers.

Please join me for my upcoming live video webinar, Drug Channels Outlook 2023, on December 16, 2022, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Today’s guest post comes from Bansi Nagji, President of Healthcare at GoodRx.

Bansi explains how GoodRx Provider Mode delivers a prescription savings flow that offers health care professionals (HCPs) efficient access to the information they need at critical moments of care.

Click here to learn how GoodRx Provider Mode can help manufacturers reach and engage HCPs.

Read on for Bansi’s insights.

Last week, GoodRx announced that it would become the exclusive prescription discount card provider for the commercial beneficiaries of Cigna’s Express Scripts. Links below.

The rise of discount card pricing within pharmacy benefit plans is a positive development. Patients get access to market prices that can be lower than their PBM’s contracted rate. All out-of-pocket spending with a discount card counts toward a patient's deductibles, and all prescription activity gets captured.

However, I suspect few people understand that placing discount cards within the pharmacy benefit enables a PBM to monetize a new fee stream from the card vendor. Below, I walk through this booming business and highlight some of the conflicts and contradictions underneath the coconuts.

I’ll cover what’s next for PBMs and discount cards during my upcoming live video webinar, Drug Channels Outlook 2023, on December 16, 2022, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Today’s guest post comes from Lung-I Cheng, Vice President of Cell & Gene Therapy at AmerisourceBergen.

Lung-I discusses advancements in cell and gene therapy and explains how to tackle the challenges facing manufacturers, providers, and patients.

Click here to learn about AmerisourceBergen’s Cell and Gene Therapy solutions for biopharma companies, providers, and patients.

Read on for Lung-I’s insights.

Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for a new live video webinar:

Drug Channels Outlook 2023
Friday, December 16, 2022
12:00 p.m. to 1:30 p.m. ET.

This page describes the event and explains how to purchase a registration to the live event. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

WHAT YOU WILL LEARN

Join Dr. Fein as he helps you and your team get ready for 2023 by outlining key issues and uncertainties that will surely affect your planning. This event can be both a capstone of your annual learning and a touchpoint for the future. Dr. Fein will draw from exclusive information found in DCI’s industry economic reports.

During the event, Dr. Fein will share his latest thinking on a wide range of topics, including:

• Update on the retail pharmact market

• The Medicare Part D Redesign

• What's next for the Inflation Reduction Act of 2022

• Vertical integration and consolidation trends

• PBM industry developments and government actions

• Disruption from discount cards and cash-pay pharmacies

• Predictions for biosimilar Humira competition

• The latest on copay accumulators and maximizers

• Likely 340B Drug Pricing Program developments

• Hospitals and health systems in the pharmacy channel

• The primary care M&A boom

• And more!

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data. PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last 90 minutes to accommodate audience questions.

After the event, every registrant will receive a link to download the complete slide deck and have an opportunity to watch a replay of the live event.

Read on for full details on pricing and registration.

I recently joined Julie Yoo on Bio Eats World, a podcast from legendary venture capital firm Andreessen Horowitz (also known as "a16z"). Julie is a General Partner at Andreessen Horowitz.

We chatted about the current state of the U.S. drug channel, the roles and controversies around pharmacy benefit managers (PBMs), GoodRx, Mark Cuban’s cost-plus pharmacy, the 340B Drug Pricing Program, and much more. I also shared some thoughts on opportunities for entrepreneurs in such a consolidated space. The episode is about 36 minutes long.

The podcast audio is embedded below, along with links to the episode on major podcast platforms.

Enjoy!

P.S. Let me know if you’d like to see more audio/podcast content on Drug Channels.

Today’s guest post comes from Matthew Balogh, Head of Digital Marketing at Melinta Therapeutics.

Matt discusses the ongoing global problem of antimicrobial resistance (AMR). He suggests that lessons learned from the COVID-19 pandemic can inform both innovation in AMR therapies and our understanding of AMR.

To learn more about the global challenge of AMR and brainstorm solutions, request an invitation to Innovate4Outcomes^®. This virtual event is presented by OptimizeRx in collaboration with Melina Therapeutics.

Read on for Matt’s insights.