Drug Channels delivers timely analysis and provocative opinions from Adam J. Fein, Ph.D., the country's foremost expert on pharmaceutical economics and the drug distribution system. Drug Channels reaches an engaged, loyal and growing audience of more than 100,000 subscribers and followers. Learn more...
Today, we examine the seven largest retail chains’ participation in the 12 major 2025 Part D networks that the five largest plan sponsors will offer. As always, we provide you with a handy table for tallying each chain’s participation and changes from 2024 to 2025.
As you’ll see, Albertsons and Publix are the only major retail chains that will be participating in all of the major PDP’s preferred and open pharmacy networks. Walmart and Walgreens will maintain strong participation, while CVS will pull back. Low-income subsidy (LIS) beneficiaries, whose ranks expanded due to the IRA, will continue to have no financial advantage for using a preferred pharmacy.
In a future post, we’ll delve into how smaller pharmacies will participate in the 2025 Part D plans, by examining the pharmacy services administrative organizations (PSAOs).
Today’s guest post comes from Kala Bala, SVP, Enterprise Access & Data Expertise, MMIT, a Norstella company and Dinesh Kabaleeswaran, SVP, Advisory Services at MMIT, a Norstella company.
The authors outline the challenges that manufacturers face when integrating internal and external datasets to build market access and commercialization strategies. They argue that unified datasets and the addition of AI-driven analytics tools can improve decision making throughout a drug’s life cycle.
Uh oh. As I predicted, the stand-alone Medicare Part D prescription drug plans (PDP) market is vanishing.
For 2025, DCI’s exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals that the number of PDPs will drop to a historic low. What’s more, the share of plans with a preferred cost sharing pharmacy network will fall to its lowest rate in more than 10 years. Check out the distressing charts below and our review of the remaining national players (Aetna, Cigna, Humana, UnitedHealthcare, and WellCare).
The destruction of the Part D market marks yet another unintended consequence of the Inflation Reduction Act of 2022 (IRA). The IRA makes PDPs less economically viable and will drive even more seniors into Medicare Advantage Prescription Drug (MA-PD) plans—despite the challenges facing those plans. The 2025 decline will occur even after CMS gifted $7 billion to PDPs to prevent a complete collapse of the 2025 market.
Legislate in haste. Repent in leisure.
What else should you expect for 2025? Find out during my upcoming live video webinar, Drug Channels Outlook 2025, on December 13, 2024, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up. As always, we are offering special discounts if you want to bring your whole team.
Adam J. Fein, Ph.D., president of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for DCI’s new live video webinar:
This post describes the event and explains how to purchase a registration. (Or, just click here to order.) The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.
Join Dr. Fein as he helps you and your team get ready for 2025 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. DCI’s Outlook webinars have proven to be reliable and informative guides to crucial aspects of the ever-evolving healthcare industry.
During the event, Dr. Fein will share his latest thinking and projections on a wide range of topics, including:
Latest predictions for the Inflation Reduction Act
Expectations for the Medicare Part D market in 2025 and beyond
Update on 340B Drug Pricing Program’s controversies
Impact of the new Trump administration and Congress on the drug channel
Vertical integration and consolidation trends—and prospects for dis-integration and de-consolidation
The state of biosimilar markets
What’s next for PBMs’ private label products and GPOs
Retail pharmacy’s future
Prospects for direct-to-patient channels
What’s ahead for discount cards and cash-pay pharmacies
The outlook for state and federal legislation on PBMs and the drug channel
Gross-to-net bubble developments
And much more!
PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last at least 90 minutes to accommodate audience questions.
As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data. He will draw from exclusive information found in DCI's economic reports .
Read on for full details on pricing and registration.
Today’s guest post comes from Chris Dowd, Senior VP of Market Development at ConnectiveRx.
Chris examines three key trends that will affect patient support programs: the Inflation Reduction Act (IRA), legal/regulatory battles over copay adjustment programs, and uncertainties following a national election. He then outlines three actions that should guide manufacturers' preparation.
Here on Drug Channels, we have long highlighted the boom in provider-administered biosimilars. In contrast to the pharmacy market, adoption of these biosimilars is growing, prices are dropping, and formulary barriers continue to fall.
Novel transparency information reveals that this good news doesn’t always translate into savings. Below, we rely on a unique data set from Turquoise Health to examine how much four national commercial health plans—Aetna, Anthem, Cigna, and UnitedHealthcare—paid hospitals for Avastin and its two most significant biosimilar competitors.
As we demonstrate, health plans pay hospitals far above acquisition costs for biosimilars. What’s more, plans can pay hospitals more for a biosimilar than for the higher-cost reference product. The U.S. drug channel system is warping hospitals’ incentives to adopt biosimilars, while simultaneously raising costs for commercial plans.
The namesake of my alma mater once said: “Sunlight is said to be the best of disinfectants.” What would happen if we disinfected the entire channel?
Today’s guest post comes from Kimberley Chiang, Vice President of Biopharma Commercial Solutions at CoverMyMeds
Kimberley highlghts the crucial roles of field reimbursement managers in removing access and reimbursement barriers. She then identifies the keys to successful implementation of field reimbursement services.
Today’s guest post comes from Shabbir Ahmed, Chief Commercial Officer at CareMetx.
Shabbir explains the barriers that providers face when dealing with branded portals for multiple products. He then maintains that patients can access new therapies more quickly when the manufacturer relies on a brand-agnostic hub connected to a large network of providers and integrated with the systems those providers use daily.
Reality has again failed to support the spin surrounding the 340B Drug Pricing Program.
For 2023, discounted purchases under the 340B program reached a record $66.3 billion—an astounding $12.6 billion (+23.4%) higher than its 2022 counterpart. The gross-to-net difference between list prices and discounted 340B purchases also grew, to $57.8 billion (+$5.5 billion). 340B purchases are now almost 40% larger than Medicaid’s prescription drug purchases.
Hospitals again accounted for 87% of 340B purchases for 2023. Purchases at every 340B covered entity type grew, despite drug prices that grew more slowly than overall inflation.
Lobbyists claim that manufacturers’ 340B contract pharmacy changes are “stripping billions of dollars from the healthcare safety net.” But every year, 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 our analysis, along with fresh details of troubling behavior by the Health Resources and Services Administration (HRSA).
Pharmacy and distribution models are growing increasingly complex. Stop running in circles—It’s time to unlock proven strategies to propel market access.
What is the secret to success? Trade and Channel Strategies is bringing together industry experts to deliver specific strategies and talk best practices in tackling the latest industry challenges.
As the landscape rapidly evolves, there are only two choices—Adapt or risk falling behind. With policy changes and market fluctuations, specifically surrounding the DSCSA and IRA, the loss of exclusivity wave, adoption of low-WAC products affecting GTN and the rise of innovations within the pharmacy sector, there has never been a more important time for industry to unite. A program driven by market dynamics and led by champions of channel strategy, join your peers now to master the complexities of pharmacy and distribution models to accelerate market access—It's all happening December 10-12.
Why do trade and channel professionals choose this pivotal event?
The challenge of staying viable among shifting market dynamics while meeting business objectives is heavy. Professionals are left with many questions, including:
How will the new administration affect the distribution channel?
Is my organization haemorrhaging money to stay afloat with the shift to alternative distribution and pharmacy models?
Does the DSCSA deadline change affect my organization? Am I still prepared?
Join the experts for three dedicated days of collaborative discussions that will give you the answers to these questions and so many more. Leaders in the landscape are uniting and will dive into the top trends for innovative distribution, integrated pharmacy models and talk the truth about the future of trade.
WHAT CAN YOU EXPECT?
Vital insights from industry’s leading pharmacy and distribution experts, including:
Bill Roth, Senior Vice President of Consulting, Blue Fin Group, An IntegriChain Company
Patrick Lupo Group Vice President, Pharmacy Trade and Specialty, Walgreens
Eliane Maalouf, Director Trade and Fulfillment, Mass General Brigham Specialty Pharmacy
Stephanie Wirkes, Head of Distribution and Strategy Execution, Bayer
John Harlow, Chief Commercial Officer, Melinta Therapeutics
Aria Cohen, Vice President, Head of Market Access, Alkeus Pharmaceuticals, Inc.
Elizabeth Cherry, Program Director for Trade Relations, Vanderbilt Specialty Pharmacy
Danielle Bryan, PharmD, CSP, Program Director, Specialty Pharmacy Trade Relations, Vanderbilt University Medical Center
Thomas Scalone, Director, Trade Strategy and Operations, Bristol Myers Squibb
Dina Lynch, VP, Market Access and Reimbursement, Renibus Therapeutics
And more!
Tackle the hottest topics facing industry right now, including:
Keynote Address: Access and Channel 2024 In-Review and Preview of 2025
Pharmacy Evolved—Aligning Commercialization to the Changing Pharmacy Channel
Advanced Trade Leaders Executive Session
Navigate and Operationalize the IRA
Focused Multi-Track Offerings:
Supply Chain, Distribution and Logistics
Pharmacy Models and Reimbursement Strategies
Data, Innovation and Analytics
Health Systems and Pharma Partnering Symposium
Balancing the GTN Bubble with Market Access Priorities
What’s Happening in Retail—Brick and Morter, Home Delivery and Cash Pay Pharmacies
Navigating Post Deadline Challenges—DSCSA Compliance and Serialization Updates
Four Roundtable Breakout Discussions:
What Good Looks Like in a 3PL/Manufacturer Partnership
Optimizing Healthcare Partnerships
Women in Trade
GLP-1s and New Product Archetypes
Actions Needed to Mitigate and Prevent Drug Shortages
Case Study: Master Your Organization Chart—Ensuring Higher Cross Functional Interactions
Three Interactive Workshops:
Trade 101
Advanced Trade Leaders Executive Session
Health Systems Fundamentals
And more!
Exclusive Offer—Download the agenda and register today—Be sure to use your exclusive promo 24DC10 to save 10% off* of your registration.
See you there!
* Cannot be combined with other offers, promotions or applied to an existing registration. Other restrictions may apply.
The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, 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 Greg Skalicky, President, EVERSANA and Faruk Abdullah, President, Professional Services & Chief Business Officer, EVERSANA
Greg and Faruk walk through the marketplace pressures driving Direct-to-Patient commercialization models. They argue that a technology-enabled infrastructure, combined with clinical and reimbursement support specialists, can improve patients' access to new therapies, shorten the time to therapy, and enable better overall clinical outcomes.
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