Analysis

sPCMA Business Forum
March 16 & 17, 2020
Hilton Bonnet Creek | Orlando, FL

The sPCMA Business Forum brings together senior executives and decision makers from PBMs, health plans, and specialty pharmacy to collaborate with biopharmaceutical manufacturers and other key business partners.

Conference sessions will cover pressing business issues such as the pharmacy value transformation, total cost of care, the evolution of retail healthcare, 2020 Medicare Part D changes, and more.

Contact PCMA

Please contact Kayla Firriolo (kfirriolo@pcmanet.org) with questions or to request further information.

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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.

Our high-list-price/high-rebate system remains a fundamental source of warped incentives and cascading problems within the Medicare Part D program.

For proof, check out the previously unpublished data below on market share for products that treat hepatitis C. Despite manufacturers offering products with lower list prices, Medicare Part D plans have rejected the therapeutically identical but lower-priced versions of these drugs.

List prices significantly affect seniors’ out of-pocket costs, so Part D plans are needlessly costing many of them thousands of dollars. The federal government's Medicare spending is also unnecessarily higher.

Anyone concerned about drug prices should pay close attention to this situation. Part D plans and seniors who don’t need specialty medications are benefiting, while seniors who need treatment with specialty medications are ripped off. Just another day inside the gross-to-net bubble!

PAP 2020 - 21st Annual Patient Assistance & Access Programs
March 23-25, 2020 | Baltimore, MD
www.cbinet.com/pap

PAP 2020, the industry’s highly anticipated annual program, convenes over 450 passionate leaders to discuss how to break through barriers to accelerate prescription access and affordability, manage compliance risk and gain operational efficiencies. 2020 features powerful programming and compelling content and brings you the opportunity to exchange techniques for successful partnering, gain key industry trends in PAPs and connect personal and professional goals to accelerate success.

Visit www.cbinet.com/pap for further details and to register. Drug Channels readers from life science manufacturers will save $200 off the standard rate when they use code RAR664 and register prior to February 7th.*
The 2020 agenda features coverage on topics that matter most to you in the year ahead. Conference features include:

• Featured Keynote Kick-off Speaker — Ezekiel J. Emanuel, Vice Provost for Global Initiatives, the Diane v.S. Levy and Robert M. Levy University Professor, and Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, addresses how pending health policy changes may impact patient access and affordability
• Three Tailored Strategy Streams —Technology to Automate PAPs * Compliance Risk Management * Collaborations to Expedite Access
• Patient Spotlight Sessions — Patient Q&A sessions highlight current challenges and successes along the patient journey
• OIG Compliance Review on PAPs and Copay Programs — Hear key insights on where the OIG focus may extend to next from former special agent and senior counsel with the OIG
• Benchmarking Survey Results — Gain insight into exclusive intelligence around the state of patient assistance

Download the complete agenda and speaker list to get the full picture of what to expect in March.

Visit www.cbinet.com/pap for further details and to register. Drug Channels readers from life science manufacturers will save $200 off the standard rate when they use code RAR664 and register prior to February 7th.*

CBI will see you there!

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates, clinic/hospital rates, non-profit rates other offers. 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.

For 2020, the two largest pharmacy benefit managers (PBMs)—Express Scripts and the Caremark business of CVS Health—have again increased the number of drugs they have excluded from their standard formularies. The 2020 formulary exclusion lists are available below for your downloading pleasure.

Below, I highlight my key takeaways from the 2020 lists:

• The number of exclusions

• Management of specialty drugs

• Indication-based formularies

• The slow adoption of biosimilars

• The PBMs’ patient-unfriendly exclusions in the hepatitis C category

Formulary exclusions have emerged as a powerful tool for PBMs to gain additional negotiating leverage against manufacturers. The prospect of exclusion leads manufacturers to offer deeper rebates to avoid being cut from the formulary. Exclusions are therefore a key factor behind falling brand-name net drug prices.

Read on for a look at this year’s exclusions along with some closing thoughts on what exclusions mean for patients.

PBMI’s 25th Annual National Conference
March 2-4, 2020 | Rosen Shingle Creek Hotel | Orlando, Florida
www.pbmi.com/AC20

You’re invited to join PBMI for their 25th Annual National Conference. This conference is considered one of the most insightful conferences addressing the challenges of managing drug benefits – and the robust agenda offers education to help employers, health plans, PBMs and other industry stakeholders effectively manage drug benefits for the year ahead.


The keynote for this year is Mr. Barry Meier, author and former Pulitzer-winning reporter for The New York Times and two-time winner of the prestigious George Polk Award for Investigative Reporting. He has authored several books, including Pain Killer, which chronicles the rise of the multi-billion-dollar pain management industry and lays bare its excesses and abuses. Mr. Meier’s keynote will dive into the opioid crisis in America today.

Here are some highlights of the event:

• Earn CE credit for sessions identified with a CE icon*
• Get the latest, state-of-the-industry news and trends directly from providers, industry organizations, analysts, and consultants
• Learn about new technologies shaping the industry
• Hear what some of the nation’s leading PBMs, health plans, and pharmacies are doing to manage drug costs
• Network with peers facing the same challenges as you

*CE credit available for pharmacists.

You can learn more about the program here. For more information about the conference click here.

Drug Channels readers can enter discount code PEM20 to receive $200 off conference registration rates. Register today!

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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.

Manufacturers recently announced list price increases for many brand-name drugs. The typical increase was about 5%. Judging by recent history, these moderately higher list prices will translate into another year of falling brand-name drug prices in 2020.

This surprising conclusion comes from our analysis of SSR Health data on prices for more than 1,000 drugs. Details below.

SSR Health data reveal that list prices for brand-name drugs rose by about 5% in 2019. However, net prices (after rebates and discounts) decreased by -3.1%. Drug makers discounted their brand-name drug list prices by an average of 45%.

Too many journalists and politicians remain committed to the false narrative of “skyrocketing drug prices.” In 2020, Congress may again take up drug price legislation. Let’s all hope that our country builds its public policies based upon accurate facts and reliable data. Hope has to triumph over experience eventually.

Just before the holidays, Cigna’s Express Scripts business announced a market-changing deal with Prime Therapeutics. Click here to read the press release.

There's been very little written about this transaction, though it has potentially major implications. Below, I share my thoughts on the following topics arising from the deal:

• Implications for manufacturers and pharmacies

• The role of the secretive Ascent Health Services

• What this all means for Walgreens

• Why the Federal Trade Commission won’t challenge the deal

A few weeks ago, I explained why integrated insurer / PBM / specialty pharmacy / provider organizations are poised to restructure U.S. drug channels. The Express Scripts / Prime deal signals that the channel will continue its amazing pace of reinvention.

The scale, scope, and interconnectedness of today’s market participants make the system increasingly resistant to massive disruption from either external players like Amazon or a government takeover. Like it or not, the channel will continue to gain power and extract profit. Read on and see if you agree.

CBI’s 16th Annual Life Sciences Accounting & Reporting Congress
March 16-19, 2020 | Loews Hotel | Philadelphia, PA
www.cbinet.com/accounting

Regulatory reforms, increased complexity and materiality of rebate/discount agreements, continued M&A deals and a dynamic risk environment have leaders in Finance and Accounting on the front lines of critical business decisions and external reporting.

CBI’s 16th Annual Life Sciences Accounting & Reporting Congress, an important event for finance, accounting and business leaders within life sciences, provides in-depth CPE education and networking with nearly 600 professionals.

Visit www.cbinet.com/accounting for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code RJF938 and register prior to January 31st.*

Hot topics include SEC reporting, R&D financing, product pricing and contracting, critical audit matters, GTN, robotic process automation, valuation, collaborations and licensing, capital creation and allocation, SOX compliance, M&A, corporate tax, new product commercialization, FP&A, cybersecurity and data privacy, carve-outs and divestitures, revenue recognition, forecasting and financial planning, leases, and third-party oversight. You’ll return to the office ready to advance your organization to stay ahead in 2020.

Here’s a snapshot of what to expect, and don’t forget to download the latest agenda here.

EXTENSIVE INDUSTRY KNOWLEDGE SHARING AND BENCHMARKING FROM OVER 100 EXPERTS, INCLUDING:

• Chad Cohen, CFO, Adaptive Biotechnologies Corp
• Gina Consylman, CFO, Ironwood Pharmaceuticals
• Patrick Coyle, CFO, Eisai
• Gisele Dion, Chief Accounting Officer, Takeda
• Rita Karachun, Senior VP and Global Controller, Merck
• Kevin Mackay, VP, Controller and Chief Accounting Officer, Pfizer
• Steve Rivera, VP, Global Technical Accounting Advisory Services & Policy, J&J
• Gary Sender, CFO, Nabriva Therapeutics

VALUABLE NETWORKING AND CAREER DEVELOPMENT:

• 14+ hours of specially designed networking events and receptions
• Industry-Only Controllers Roundtable
• Talent Planning, Diversity, Culture & Inclusion Summit
• 12 Acuity Activities and Topic Intensive Workshops
  
• Four company-specific tracks for:
1. Mid-Large Pharma
2. Commercial-Stage Biotech
3. Clinical-Stage Innovators
4. Device and Diagnostic

INFLUENTIAL INSIGHTS FROM REGULATORS AND AUDIT FIRMS:

• John Vanosdall, Deputy Chief Accountant, U.S. SEC
• Kevin Vaugh, Accounting Branch Chief, Office of Life Sciences U.S. SEC
• Russ Golden, Chairman, FASB
• PwC, Deloitte, Ernst & Young, KPMG, CFGI and more!

Visit www.cbinet.com/accounting for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code RJF938 and register prior to January 31st.* CBI will see you there! *Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rate or non-profit rates. 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.

This week, I’m rerunning some popular posts before the holidays. Click here to see the original post and comments from October 2019. Commercial strategies for the new cell and gene therapies will be a hot topic in the coming years. Revisit this article for a look at how one major insurer / PBM / specialty pharmacy is attempting to pre-disrupt the channel.

Express Scripts is on a roll. ICYMI, it will be taking over Prime Therapeutics' formulary contracting and pharmacy network management. Manufacturer rebates will grow, pharmacy margins will be under more pressure, and the gross-to-net bubble will inflate.

Get ready for more volatility with the DRUG CHANNELS OUTLOOK: WHAT YOU NEED TO WATCH IN 2020. During last week's event, I even discussed PBM consolidation scenarios for sub-scale players like Prime. Click here to hear what you missed and download the slides.

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Cell and gene therapies are poised to transform the treatment of many serious and previously untreatable conditions.

As this new market develops, payers and PBMs are laying the groundwork for disruptive channel models. Below, I examine how Cigna’s Express Scripts business has begun to shape this channel’s development. Its new models show the promise of private market innovation for the financing and commercialization of novel therapies.

These approaches will also shake up existing channels. If payers rub this magic lamp, these innovative channel models would: 1) enhance the role of the vertically-integrated insurer/PBM/pharmacy companies, 2) reduce or eliminate buy-and-bill by providers, and 3) minimize the role of the largest wholesalers. Consider the examples below to be early warnings of change.

FYI: Today’s post is an excerpt from Chapter 6 of our new 2019–20 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

This week, I’m rerunning some popular posts before the holidays. Click here to see the original post and comments from September 2019. It’s a timely rerun, given rumors that the Senate Finance Committee's Prescription Drug Pricing Reduction Act may add a provision requiring rebates on insulin to be passed along to seniors at the pharmacy counter. Until then, the gross-to-net bubble is alive and well.

P.S. Yesterday, I posted my $0.02 on the new importation guidance and proposal on @DrugChannels. You can read them here, here, and here.

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Did you miss our DRUG CHANNELS OUTLOOK: WHAT YOU NEED TO WATCH IN 2020 webinar? Click here to watch a replay of my 75-minute webinar (including the Q&A). You will also be able to download the slides.

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Third-party payers' benefit designs remain a significant barrier to addressing drug costs. Many continue to use the ever-growing rebate dollars of the gross-to-net bubble to offset overall plan costs rather than reducing patient’s out-of-pocket spending.

Point-of-sale (POS) rebates are one possible benefit design solution. POS rebates directly share with patients the discounts that PBMs negotiate with manufacturers.

A recent survey of large employers by the National Business Group on Health (NBGH) suggests this change may be coming. The survey found that about one in five large employers is using point-of-sale (POS) rebates in their pharmacy benefit plans. The survey found that a further 40% of employers are considering POS rebates for 2021 and 2022.

Pharmaceuticals are the only part of the U.S. healthcare system where the difference between list and net prices is monetized as rebates and redistributed by intermediaries to payers. But we’ve seen that moving to a world without rebates may not be possible, given the drug channel’s entrenched interests and payers’ established economics.

POS rebates may therefore be our most realistic chance for addressing the drug costs of patients trapped in the gross-to-net bubble. Commercial payers and Congress (for Medicare Part D) should get started ASAP with POS rebates for insulin—a highly rebated and massively distorted therapeutic category.