Analysis

As regular readers know, the biosimilar boom for provider-administered drugs has been accelerating. Prices are dropping while adoption accelerates. In many therapeutic areas, biosimilars’ market share is approaching 80%. In the video below, I review these developments and discuss lessons from the launch of Semglee, the first interchangeable insulin.

I also offer some thoughts on 2023 and 2024. That’s when Humira, the best-selling drug in the U.S., will face multiple biosimilar competitors. Some—but likely not all—of these products will have interchangeability with Humira.

The video is excerpted from last month’s Specialty Drugs Update: Trends, Controversies, and Outlook video webinar. During the webinar, I speculated that net prices in the Humira category will be 70% or more below today’s prices. If you missed the live event, you can register to watch a replay and download the full slide deck.

Despite these positive recent developments, the just-passed Inflation Reduction Act (IRA) seems likely to disrupt the biosimilar market by altering launch strategies. However, the IRA won’t affect the coming Humira price war.

Enjoy!

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

Chris discusses the benefits of using in-electronic health record (EHR) messaging to communicate formulary information to both healthcare providers and patients during the patient encounter. Click here to learn more about ConnectiveRx’s in-EHR messaging

You can also register for Your Brand Just Got Added to a Must-Have Payer Formulary, Now What?, a free webinar on September 29th at 1:00 P.M. ET.

Read on for Chris’ insights.

Our news-laden summer is coming to an end. Time to pack away your bathing suit, send the kids back to school, and cherish these curated curiosities that I combed from the Drug Channels coastline:

• Howard Dean attacks patient-unfriendly cost shifting

• Cancer patients’ views of copay assistance

• My $0.02 on key specialty pharmacy trends

• Evidence for biosimilar-to-biosimilar switching

Plus, Dr. Glaucomflecken takes on PBMs!

P.S. Join my more than 31,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 15,000 followers.

Informa Connect’s Copay, Reimbursement and Access Congress
Hybrid Event | October 12-14 in Philadelphia, PA
www.informaconnect.com/copay

Exclusive Offer: Be sure to use your exclusive promo COPAYDC to save 10% off* of your registration

An important event for all aspects cost sharing, Copay, Reimbursement and Access Congress is back and better than ever! This year's event features a brand new look with the same great content, dedicated tracks, diverse and robust speaking faculty and greater networking opportunities. Now is the time to join to drive patient assistance, adherence and access forward—it’s all happening October 12-14.

Exclusive Offer: View the agenda and register today. Be sure to use your exclusive promo COPAYDC to save 10% off* of your registration.

Why should you attend this pivotal event?

Copay and cost sharing programs are growing continuously more complex. The recent enforcement actions surrounding cost sharing programs are evidence that the shifting market dynamics remain a deep concern and bring about many questions for access professionals.

How are you managing out-of-pocket costs for patients? Do you have clarity on the further of health policy? What is the impact of accumulator and maximizer program utilization 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. You would be remiss not to join seasoned leaders, your peers and leading solution providers as they navigate marketplace trends and dive into the impact coupons, accumulators, maximizers, benefit design, innovation and drug pricing legislation have on patient affordability and out-of-pocket costs and provide critical insights on industry standards, forward-thinking strategies to optimize copay and cost sharing programs to accelerate access and commercialization and so much more.

Can’t miss content highlights:

• Two Pre-Conference Workshops
• Copay 101 Workshop
• Product Launch and Commercialization Summit
• Marketplace Trends Opening Panel
• Advocacy Insights and Furthering Access to Care
• Government Enforcement Trends Impacting Copay Assistance
• Analyze the Effect, Impact and Utilization of Accumulator and Maximizer Programs
• And more!

PLUS! Two Dedicated Tracks for Your Focus Area:

Innovative Copay Program Design and Utilization Management

• Implementing Innovation to Drive Next Generation Copay Design

Legal Implications and Compliance for Copay Programs

Utilizing Copay Data to Drive Program Decisions and Product

And more!

Reimbursement Strategies and Contracting

• Value-Based Contracting Frameworks and Considerations
• HEOR, RWE and Their Roles in Reimbursement
• Rebates and Reimbursement—Breaking Down the Pricing Strategy
• And more!

Exclusive Offer: View the agenda and register today. Be sure to use your exclusive promo COPAYDC 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 H. John Beardsley, Senior Vice President of Corporate Strategy at CoverMyMeds.

John discusses how a patient-centric technology solution can increase access and affordability for patients. He goes on to describe how human contact and support helps patients understand their disease and their treatment plan, thus increasing adherence.

Click here to learn how CoverMyMeds’ technology interventions help patients.

Read on for John’s insights.

Here’s a summer surprise for fans of the 340B Drug Pricing Program: Drug Channels has just obtained the 2021 figures from the Health Resources and Services Administration (HRSA)! Even better, my Freedom of Information Act (FOIA) request was able to pry out detailed purchases by covered entity type.

The data tell a familiar story. For 2021, discounted purchases under the 340B program reached a record $43.9 billion—an astonishing $5.9 billion (+15.6%) higher than its 2020 counterpart. Hospitals accounted for 87% of these skyrocketing 340B purchases.

What’s more, the difference between list prices and discounted 340B purchases also grew, to $49.7 billion (+$7.0 billion). This figure approximates the money collected by 340B covered entities.

340B advocates have been screaming that “drug companies are cutting 340B,” but the data tell a very different story. Only in the U.S. healthcare system can billions more in payments and spreads be considered a cut.

Read on for full details and analysis, including the opportunity to download your very own copy of the raw data from HRSA.

Today’s guest post comes from Divya Iyer, VP, Strategy and Business Development, Pharma Manufacturer Solutions at GoodRx.

Divya highlights new GoodRx research on the out-of-pocket cost gap between brand-name and generic prescriptions. She discusses the challenges that providers face when having real-time discussions with patients about out-of-pocket costs. Divya then explains how GoodRx partners with pharmaceutical companies to improve cost transparency and communication between patients and providers.

Click here to learn more about how GoodRx helps brand teams engage providers in specific specialties.

Read on for Divya’s insights.

Over the weekend, the U.S. Senate passed a massive overhaul of the Medicare Part D program. If passed into law, these changes will have many unintended consequences, but will not address the warped incentives baked into our current rebate system.

This makes it a good time to review the murky, little-seen economics of how commercial plan sponsors and payers access the billions of dollars in manufacturer rebates and fee that are negotiated by their pharmacy benefit managers (PBMs).

Our analyses of new Texas-mandated PBM disclosures reveal that plan sponsors receive most of the rebates, fees, and other payments from manufacturers. However, PBMs retain an unexpectedly large share of these payments—while the patients whose prescriptions generated these funds get almost nothing.

In other words, plans spread around manufacturers’ rebates and fees to offset premiums for all beneficiaries, rather than lower out-of-pocket costs for drugs that plans buy at a discounted price. Perhaps Congress will someday get around to corralling these funds.

Today’s guest post comes from Karina Castagna, SVP of Access and Adherence at OptimizeRx.

Karina discusses the challenges health care providers and patients face in their quest to secure prior authorizations from payers. She argues that manufacturers adopt an electronic health record-based solution to facilitate access to therapies, from the point of prescription through the point of dispensing at the pharmacy.

To test the efficacy of your market access digital strategy against industry best practices, take the OptimizeRx Market Access Strategy Quiz.

Read on for Karina’s insights.

Watch out! Plan sponsors are getting even bolder in their attempts to grab financial support intended for patients. The latest scam is called a specialty carve-out.

Here’s the game: A commercial plan eliminates coverage for all specialty drugs. Beneficiaries are then shunted over to a charitable foundation, because they are now disguised as uninsured—at least for specialty drugs. Naturally, the vendor skims a healthy share of the charity’s money.

In addition to the ethical and compliance issues, some vendors raise safety risks by sourcing prescriptions from non-U.S. pharmacies as a backup.

The Orwellian euphemism for this “benefit” design: alternative funding program.

A new survey reveals that an astounding four out of 10 commercial plans are already using, or exploring the use of, these specialty carve-out programs. Yikes.

Read on for an overview of these shady programs—and the many problems they are creating.