Analysis

Open enrollment is under way for the 2023 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 an established component of Part D benefit design.

For 2023:

• 98% of stand-alone Medicare Part D prescription drug plans (PDP) will have a preferred network.

• 52% 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 top companies’ 2023 offerings.

The largest companies made only minor changes to their 2023 stand-alone plans, after streamlining their 2022 plans. I also update our analysis of the prevalence of preferred networks in three different types of MA-PD plans.

In upcoming articles, I’ll investigate what we can deduce from chain and independent pharmacies’ participation in the major 2023 preferred networks.

Today’s guest post comes from Brooks Wildasin, Vice President of Product Management at CareMetx.

Brooks introduces us to CareMetx’s specialty therapy warranty, a specialty patient outcome-based contract model. Download CareMetx’s 2022 Report: The Evolving Landscape of Digital Healthcare Hubs to learn more about digital hub services and CareMetx’s solutions that improve the patient journey.

Read on for Brooks’ insights.

Eeek! Time for my Halloween roundup of wicked Drug Channels’ tales. This month’s tricks and treats:

• Eerie! Mark Cuban tells ghost stories about PBMs.

• Shocking! Walgreens terrifies Wall Street with its 340B losses.

• Vampiric! Sink your fangs into Amgen’s fantastic new report on the biosimilar boom

• Wicked! Physicians think payers cast evil utilization management spells.

Plus, Walgreens launches a refreshing new wellness service.

P.S. Join my more than 33,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 15,400 followers.

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

Megan discusses upcoming specialty medication launches. As she explains, patients will need extra help to overcome the challenges of access, affordability, and adherence.

Click here to learn about CoverMyMeds' patient-centric technology solutions for specialty medications..

Read on for Megan’s insights.

The biosimilar boom for provider-administered drugs continues to accelerate. Net prices in therapeutic classes with biosimilar competition have declined by 60% or more over the past few years. Some major biological reference products have now lost a majority of their unit sales to their biosimilars.

As we explain below, this accelerating adoption also boosts profits for pharmaceutical wholesalers and specialty distributors—particularly when these channel participants can influence which biosimilar version a provider utilizes.

Below, we share our estimates for wholesalers’ gross margins for brand-name, generic, and biosimilar drugs. We then explain the channel dynamics behind biosimilar and generic drugs’ profits. We estimate that for 2022, generics and biosimilars accounted for only about 15% of wholesalers’ U.S. drug distribution revenues, but 77% of total gross profits from U.S. drug distribution.

Read on for the fun financial facts.

Informa Connect’s Trade & Channel Strategies Summit
December 12-14, 2022 in Philadelphia, PA
www.informaconnect.com/trade

Don’t miss Informa Connect's Trade & Channel Strategies Summit, coming up December 12-14, 2022 in Philadelphia! Join your colleagues from across the industry and be part of critical, solution-focused discussions designed to help optimize distribution models and channel strategies driven by market dynamics, product types, site of care and reimbursement, all delivered by an expert speaking faculty.

View the agenda to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/trade for further details and to register. Drug Channels readers will save 10% off when they use code 22DRCH10 and register prior to November 11, 2022.*

You'll attend a Featured Session with Bill Roth, General Manager and Managing Partner, Blue Fin Group, An IntegriChain Company, as he covers Current and Future Trends Impacting Trade and Distribution, a Policy Address, a Wall Street Address, a Partnership Pavilion Panel (3PL, Distribution and Pharmacy), a Distribution Stakeholder Showcase, and an Update from NCPDP.

Additional sessions include coverage on:

• Navigating regulatory reform in the trade & channel space
• Building forward-thinking commercialization and channel strategies for patient affordability
• Maximizing GTN impact
• Future of value-based agreements, measurement, contracting and pull through
• Innovative limited pharmacy networks
• The Drug Supply Chain Security Act
• Emerging distribution trends for a streamlined and efficient model
• Migrating a primary care manufacturer to specialty channel strategies
• Determining the best network for your product - distribution and dispensing partners
• Navigating the payer space for specialty, rare and orphan diseases
• Future of cell therapies and distribution considerations
• The role of distributors in gene therapies
• Current trends and changes impacting biosimilars and specialty generics
• How to tailor a new launch strategy for biosimilars
• And so much more!

Don’t miss the chance to unite with colleagues and master the complexities of pharmacy and distribution models to accelerate patient access!

View the agenda to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/trade for further details and to register. Drug Channels readers will save 10% off when they use code 22DRCH10 and register prior to November 11, 2022.*

*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.

---

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 Steve Callahan, Senior Manager of Market Research at MMIT.

Steve walks us through the expected Humira biosimilars launches and discusses potential responses from payers.

To learn more, check out MMIT’s Strategic Launch Report & Evaluate Forecast solution.

Read on for Steve’s insights.

I conservatively estimate that I’ve created about 1,374,613 slides during my career. But there are two slides that people seem to appreciate the most.

One is my chart showing the key channel flows within the entire U.S. pharmaceutical distribution, payment, and reimbursement system.

The other is my mapping of the insurer/PBM/specialty pharmacy/provider organizations that now dominate U.S. drug channels. Below, I provide an updated version of this second chart that reflects some recent transactions and name changes. About half of all U.S. healthcare spending flows through the seven companies shown below.

These organizations are poised to exert greater control over patient access, sites of care/dispensing, and pricing. But as I note below, Federal Trade Commission chair Lina M. Khan has other ideas about these companies.

I am pleased to announce our new 2022–23 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, available for purchase and immediate download.

• Click here to download a free report overview (including a summary of industry trends, the Table of Contents, and a List of Exhibits)

• New Drug Channels Institute Study: U.S. Drug Distribution Industry Expands as COVID-19 Disruption Fades and Biosimilars Boom (press release)

We’re offering special discounted pricing if you order before October 21, 2022!

The 2022–23 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors—our 13th edition— remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry.

This 2022-23 edition contains the most current financial and industry data along with detailed information about the strategies and market positions of the largest companies: AmerisourceBergen, Cardinal Health, and McKesson. It updates our annual analysis of each wholesaler’s business segments and underlying business profitability, based upon our proprietary economic models.

The notable new material in this 2022-23 edition includes three new sections:

• Section 3.4.1. contains new data on hospital acquisitions and consolidation activity.

• Section 6.1.6. examines how the Inflation Reduction Act could ultimately impact pharmaceutical wholesalers’ customers and business outlook.

• We have updated our financial analyses based on the new reporting segments introduced by AmerisourceBergen and McKesson.

We also update sections that were introduced in recent editions, such as our estimates of wholesalers' profits from provider-administered biosimilar drugs.
If you would like to pay by corporate purchase order or check, please email Tamra Feldman. If you preordered the report, you should have already received an email with download instructions. Please contact us if you did not receive the email.

WHAT’S GOING ON

Twice a year, I spend my evenings and weekends writing two comprehensive, fact-based, and nonpartisan reports on drug channel economics. In some small way, I try to make the world a better and smarter place.

Licenses for our DCI reports are regularly purchased by nearly every company involved in the drug channel: pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospitals, buyers, benefit managers, managed care executives, policy analysts, investors, lawyers, consultants, and more. So, you can find out what your customers, partners, and competitors are reading.

The 2022–23 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors is the only resource of its kind available anywhere. It offers 142 proprietary charts, exhibits, and data tables.

FOUR FUN FACTS

• The 9 chapters are self-contained and do not need to be read in order. (Really!) There are loads of internal hyperlinks to help you navigate the document and customize it to your specific interests and priorities.

• We are offering the option to download an additional PowerPoint file with images of all 150 exhibits. This popular option helps you share the insights and data with others in your organization. (The exhibits appear in all license versions. The PowerPoint file option is available only with the purchase of a corporate license.)

• There are nearly 600 endnotes, most of which have hyperlinks to original source materials. These source materials offer a handy way to build your knowledge base beyond what’s included in the full report.

• As usual, I have reluctantly stripped out the corny jokes and pop culture references.

If you have any questions (before or after reading the report), please email me.

Enjoy!

Today’s guest post comes from Jon Lanznar, Chief Strategy Officer at vitaCare Prescription Services from GoodRx.

Jon discusses vitaCare, a pharmacy services platform acquired by GoodRx earlier this year. vitaCare helps patients understand coverage, identifies available savings opportunities, and facilitates communications between providers and payers. It also offers a path for filling a prescription, primarily through their network of third-party pharmacies.

Click here to learn more about vitaCare’s access and adherence solutions.

Read on for Jon’s insights.