Analysis

World Congress’ Integrate 2019
July 22-23, 2019 | Philadelphia, PA
www.worldcongress.com/integrate

Integrate is a three-track event featuring:

• 6th Annual Specialty Network Design and Channel Optimization Summit
• 6th Annual Patient Support Services and Hub Design Summit
• 3rd Annual Patient Services Compliance Summit

Register with promo code DC200 and save an additional $200 on current early bird rate.

Join your peers across specialty distribution, patient support services and hub design, and patient services compliance to break down silos and strategize best practices for improving support and access from manufacturer to patient, provider and networks.

Our mission is to break down silos between internal colleagues and key stakeholders to help streamline business practices and provide better support and access to patients.

How will you benefit from attending?

• Three Master Classes: Choose from three master classes focused on specialty data strategies, Nurse Educator Programs, and Compliance and Auditing strategies for Patient Support Services
• Legal Roundtable: Hear from the DOJ and industry C-Suite Compliance executives on current and future trends in litigation and regulations around patient support services and foundational partnerships
• Multi-Stakeholder Insights: Hear directly from specialty pharmacies, payers, PBMs, Hubs, government agencies, health systems, and industry leaders to ensure specialty product success
• Access to Three Tracks: Customize your learning experience through free movement between sessions- All for 1 ticket price!

Shouldn’t you be there?

Register with promo code DC200 and save an additional $200 on current early bird rate.

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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.

Today’s guest post comes from Bill Nolan, VP/GM of Access and Adherence at RxCrossroads by McKesson.

Bill discusses the proliferation of co-pay accumulators and the negative effects they can have on patients, particularly those with high-deductible health plans. He offers solutions that biopharma companies can embrace to mitigate the impact, including the adoption of patient-centric support.

To learn more, download McKesson’s white paper: The Impact of Accumulators on Co-pay Programs.

Read on for Bill’s insights.

The gross-to-net bubble—the ever-growing pile of money that sits between a manufacturer’s list price for a drug and the net price after rebates and other reductions—reached another high last year.

Drug Channels Institute developed the term gross-to-net bubble to describe the speed and size of growth in the total value of manufacturers’ gross-to-net reductions.

We estimate that in 2018, the total value of gross-to-net reductions for brand-name drugs was $166 billion. As you will see below, that figure doubled over the preceding six years. Below, I also highlight the various elements that fill the bubble. About two-thirds of total gross-to-net reductions come from rebates paid to third-party payers.

The gross-to-net bubble reflects—and drives—many of the problems with U.S. drug pricing. However, recent movement toward a world without rebates suggests that we may soon hear this bubble pop.

On April 12 at 12:00 p.m. ET, Drug Channels Institute (DCI) will host an exclusive new webinar: Preparing for a World Without Rebates.

Join Dr. Adam J. Fein, CEO of DCI and author of Drug Channels, for this hour long, live event as he helps you understand and get ready for what would be a momentous change to our industry.



The webinar’s benefits include:

• An unlimited number of people may listen on a single phone line. Invite your whole team for an hour of intensive learning and strategic insight. The presentation is sure to spark important internal discussion about the implications for your business.

• Dr. Fein’s slides with marketplace data and analysis. You’ll also receive a downloadable PDF with all of the slides from the webinar.

• An opportunity to ask Dr. Fein questions during the event

• Access via any device with a web browser (computer, iPad, phone)

WHAT YOU WILL LEARN

A serious effort exists to remove or decrease the role of rebates in the drug channel. We will help you and your team master one of the hottest topics in our industry.

Dr. Fein will share his latest thinking on:

• What’s driving the effort to reform the rebate system

• The pros and cons of such alternatives as point-of-sale rebates and negotiated discount models

• The Department of Health & Human Services (HHS) proposed rule to alter the rebate system in federal programs—its timing, implementation, and risks

• Key uncertainties that could affect your scenario planning—including the likelihood of change in commercial markets

• The roles that PBMs, pharmacies, and wholesalers could play in operationalizing a shift to discounts

• What a world without rebates could mean for patients, benefit designs, competition, drug prices, and more

• PLUS: Dr. Fein will take your questions.

HOW TO SIGN UP

The webinar will take place on April 12, 2019, from 12:00 p.m. to 1:00 p.m. ET.

• At least 48 hours before the event, you will receive an email with a toll-free dial-in number and a unique PIN for your location. You will also receive an email on the morning of the event.

• Invite your entire field team to listen from multiple sites around the country. Contact Paula Fein (paula@drugchannelsinstitute.com) to get special pricing for 10 or more locations.

• If you purchase access for multiple sites, we will contact you for the names and email addresses of a contact person at each location.

• Pembroke Consulting clients receive free access to the webinar. Contact Tamra Feldman (admin@drugchannels.net) for details.

Spring has finally reached our worldwide headquarters here in lovely downtown Philadelphia. (See photo at right.) Before your allergies kick in, please inhale this month’s selection of noteworthy news stories:

• Eli Lilly discloses the bonkers gross-to-net economics for Humalog insulin

• John O’Brien of HHS blasts the current drug pricing system

• The Community Access National Network’s 340B Commission releases an excellent new report—and you can read my testimony, too!

Plus, a compelling new HBO documentary delves further into the sordid tale of Elizabeth Holmes and Theranos.

P.S. Join the more than 7,200 people who follow my comments and links at @DrugChannels on Twitter.

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SAVE THE DATE: Drug Channels Institute will hold a special live, interactive webinar titled Preparing for a World Without Rebates on April 12, 2019, at 12 PM ET. Details and registration information will be announced on Monday.

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The econowonks at the Centers for Medicare & Medicaid Services (CMS) have recently published new projections for U.S. National Health Expenditures (NHE). You’ll find links and my data analysis below.

As you will see, total U.S. spending on healthcare is projected to grow, from $3.5 trillion in 2017 to $4.8 trillion in 2023. Spending on hospitals and professional services is expected to grow by a combined $750 billion—about 59% of CMS’s projected $1.3 trillion increase in U.S. healthcare spending.

CMS also projects that spending on outpatient prescription drugs will account for only 9% of the total increase in U.S. healthcare spending. What’s more, total growth in spending on healthcare administration by the government and insurance companies is roughly equivalent to the growth in total spending on outpatient prescription drugs. Guess which of these categories will contribute more to patients’ well-being!

These sobering figures put the debate about drug spending in context. To say that slashing drug spending would solve the healthcare spending problem is like saying you can afford a New York City penthouse by making fewer trips to Starbucks.

CBI’s 21st Annual Medicaid and Government Pricing Congress
May 20-22, 2019 | Orlando, FL
www.cbinet.com/medicaid


As our healthcare system proves to be more turbulent than ever, with a slew of regulatory and political announcements, hearings, the never-ending drug pricing debate, and most recently, FDA Commissioner Scott Gottlieb announcing his resignation and talks of doing away with rebates and/or PBMs, the time has never been more opportune to convene with industry colleagues at the 21st Annual Medicaid and GP Congress this Spring in Orlando.

The 2019 agenda boasts 55+ speakers, 30+ customizable sessions and 7 hours of dedicated networking time. Bio/pharma, regulatory and government experts representing Johnson & Johnson, OIG, Sunovion, Pfizer, Ingenus, Chiesi, AstraZeneca, Amneal, Hikma, CMS, Bristol-Myers Squibb, Apotex, Fresenius Medical Care, UCB, Alvogen, PhRMA, Jazz Pharmaceuticals, Insmed, Arbor Pharmaceuticals, Eisai, Goldwater Institute, Amicus Therapeutics and many others are set to drive the dialogue.

Stay on the pulse with timely, up-to-the-minute insights on the political and regulatory landscape, industry hot topics and best practices:

• Political and Legislative Trends
• 340B Guidance
• State and Federal Transparency Regulations
• Civil Monetary Penalties
• Value-Based Frameworks
• State Invoicing and Disputes
• Contracting with PBMs
• Changes to Medicare
• Bona Fide Service Fees
• GTN and Accruals
• And many other critical topics. Download the complete agenda.

Drug Channels Readers – Register today with promo code MDCDC5 and save $500.*

*Discount offer valid through 4/5/2019; applies to standard rates only and may not be combined with other offers, categories, promotions or applied to an existing registration. Offer not valid on workshop-only or non-profit registrations.

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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.

Two years ago on Drug Channels, I wrote about a shift from rebates to discounts as a black swan event—a massively important yet unexpected break from current practice.

Given recent developments, I believe that we are moving ever closer to a world without rebates. Yet there are many unanswered questions were such a radical shift to occur.

As I see it, a world without rebates would force manufacturers to use net price as a competitive weapon. If PBMs and payers behave logically, then drug prices would drop as manufacturers are forced to compete more aggressively for prescriptions.

These conclusions are based on the predictions about market changes that I describe below. Other key implications include:

• Winner-take-all auctions and narrow formularies for categories with therapeutically comparable products

• Broader formularies to encourage indication-based price competition for other therapeutic categories

• Faster patient access to new drugs with superior efficacy for certain subgroups of patients

• Fewer pharmacy benefit tiers and a greater ability for physicians and patients to make cost/value tradeoffs

• The popping of the gross-to-net bubble and declines in brand-name list prices

• Slower growth in drug prices

This is a longer-than-average post, but I still only scratch the surface in speculating how our world could change. If the black swan continues to spread its wings, I’ll expand in future posts on implications for drug makers, pharmacy benefit managers (PBMs), wholesalers, pharmacies, health plans, and patients. As always, I encourage you to leave your comments and ideas below.

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SAVE THE DATE: Drug Channels Institute will hold a special live, interactive webinar titled Preparing for a World Without Rebates on April 12, 2019, at 12 PM ET. Details and registration information will be announced in the first week of April.

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CBI’s Real-Time Benefit Check & ePrior Authorization Summit
May 14-15, 2019 | Philadelphia, PA
www.cbinet.com/eprior

CBI’s Real-Time Benefit Check & ePrior Authorization Summit is your chance to stay on the pulse of groundbreaking advancements and innovations in real-time benefit verification and prior authorizations in this evolving and complex healthcare environment. Convene with industry stakeholders from bio/pharma, PBMs, payers, health systems, prescribers and system solution providers to discuss the latest in standards, adoption and best practices to enable streamlined healthcare team workflow and quicker access to therapy to improve patient outcomes.

Visit www.cbinet.com/eprior for further details and to register. Drug Channels readers will save $300 off the standard rate when they use promo code ANS268 and register prior to April 5th. *

Download the agenda here and see in-depth coverage on critical issues, such as:

• Real-Time Prescription Benefit and ePrior Authorization
• New Regulations from CMS on Medicare Part D and RTBT
• Implementing Medical Specialty Drug ePA
• eBV and ePA Frameworks for the Future of the Medical Benefit
• Reducing Friction in the Prescribing Process
• Fixing ePrior from a Prescriber Perspective
• Collaborating to Improve Patient Outcomes
• Low Utilization of RTBC and ePA Among Stakeholders
• Turnaround Time for Accelerated Patient Access to Therapy
• Real-Time Benefit Data at the Point of Prescription
• HL7 Da Vinci Project for Value-Based Care Interactions between Payers and Providers

Featured Sessions:

• Trailblazer Talk- Hear Updates on Industry Scorecard
• Melissa Paige, Oncology/Infusion Patient Access Principal Coordinator, University of Virginia
• Eric Weidmann, M.D., Chief Medical Officer, eMDs
• Evan Grossman, Vice President, Integration Services, athenahealth
• Working Group for Specialty Pharmacy Advancements and Standard Updates in Real-Time Prescription Benefit and ePrior Authorization
• John Klimek, R.Ph., Senior Vice President, Standards and Industry Information Technology, NCPDP

Visit www.cbinet.com/eprior for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code ANS268 and register prior to April 5th. *

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.

The likelihood of a radical restructuring of the U.S. drug channel has never been greater. A serious effort exists to remove or decrease the role of rebates.

Today, we shed light on one crucial aspect of the current rebate system: how employer-sponsored health plans access the billions of dollars in manufacturer rebates that are negotiated by their pharmacy benefit managers (PBMs). For this analysis, we rely on the Pharmacy Benefit Management Institute’s (PBMI) excellent new reports.

As you will see, employers are receiving an increasing share of the rebate money collected by pharmacy benefit managers. However, employers’ rebate agreements with PBMs vary widely. Important differences also exist in rebate arrangements for traditional vs. specialty drugs.

Despite these data, we still don’t know how much of these rebates offset out-of-pocket costs for the patients whose prescriptions generated the rebate funds. As I warned last August: The focus of rebate reform will turn from PBMs to the plan sponsors that are absorbing rebate dollars.