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’s guest post is from Dorothy Gemmell, Chief Commercial Officer and President, Manufacturer Solutions, at GoodRx.
Dorothy highlights five trends to watch in 2025. She then describes how GoodRx's Cash Point-of-Sale Solution can help brands improve gross-to-net (GTN) while also making medications more affordable for patients.
During my recent Drug Channels Outlook 2025 video webinar, I tackled a wide range of crucial topics—including the controversial 340B Drug Pricing Program. As I explain in this video excerpt, we may finally see reform of this rapidly expanding program.
What’s more, implementing the Inflation Reduction Act will disrupt the current operations of the 340B program—and could shift program oversight from Health Resources and Services Administration to the Centers for Medicare & Medicaid Services.
The inaugural Drug Channels Leadership Forum (DCLF) is coming soon! This exclusive event will be held from March 17 to 19, 2025, at the Turnberry Resort and Spa in Miami.
Our first event will provide attendees with an opportunity to explore the most pressing strategic issues and crucial uncertainties that will impact all participants across U.S. drug channels.
Speakers and panelists include top industry executives and subject matter experts from throughout the drug channel. Registered attendees include senior executives from pharmaceutical manufacturers, pharmacy benefit managers, health systems, physician practices, pharmacies, wholesalers, and more.
View the full Drug Channels Leadership Forum agenda. It’s filled with senior industry executives who will participate in fireside chats with me as well as topical panel discussions moderated by a diverse set of subject matter experts.
Click here to request an invitation to attend. DCI will carefully review all submissions to include participants from a broad range of organizations. We are extending invitations on a rolling basis. Once you receive your invitation, you will have 15 business days to accept and complete the registration by paying the registration fee.
Please note that the DCLF is strictly limiting the number of attendees from technology companies, business services, financial firms, and other industry vendors. Vendors are only able to participate as part of a sponsorship. Click here to learn more about available sponsorship opportunities. There will be no exhibit hall and no media.
Everyone here at Drug Channels Institute (DCI) is excited to bring this novel event to the drug channels community. Visit the event website for more information on the registration process and our policies.
Below, I have reproduced our original press release. I hope you can join us!
It's time for Drug Channels’ annual examination of U.S. brand-name drug pricing.
For 2024, average brand-name drugs’ list prices grew by only 2.3%. What’s more, after adjusting for overall inflation, brand-name drug net prices dropped for an unprecedented seventh consecutive year. Details and additional commentary below.
As I predicted two years ago, the combined impact of changes to Medicaid rebates, the Inflation Reduction Act (IRA), and novel formulary access strategies have led multiple manufacturers to pop the gross-to-net bubble for high-list/high-rebate products. Consider the 18 products with list-price cuts shown below. Other drugmakers have reduced the rate of price increases, thereby inflating the bubble more slowly.
Employers, health plans, and pharmacy benefit managers (PBMs) determine the extent to which patients with insurance share in this ongoing deflation. But signs of change to the conventional approaches are undeniable.
New channel models—including smaller PBMs, cost-plus pharmacies, patient-paid discount card prescriptions, and manufacturers’ direct-to-patient businesses—are creating novel paths for drugs that can be sold without gross-to-net bubble distortions.
The bubble won’t vanish overnight. But for the first time in years, I can foresee a time when SpongeBob SquarePants will move on from Drug Channels.
Once again, I thank you, dear readers, for welcoming Drug Channels into your inboxes, browsers, and apps. I’m proud of the diverse and thoughtful audience who follows and comments on our unique content. The DCI community now includes more than 100,000 subscribers and followers from all parts of the industry. To stay in touch, you can sign up for an email subscription or follow me on LinkedIn.
We’ve enjoyed bringing you our perspectives and curated links in 2024. We hope that you had fun engaging with us and the DCI community.
Wishing you and your family health and happiness,
Adam and the DCI team
In this issue:
Unexplainable pharmacy reimbursements in Medicare Part D
Surprise! There are more (not fewer) independent pharmacies
Plan risks from shady alternative funding programs
A brief but enlightening history of pharmacy from 1385 to today
Jim Gaffigan jokes about GLP-1s
Plus, a fun photo of two cool (but familiar) dudes.
The econowonks at the Centers for Medicare & Medicaid Services (CMS) recently released the latest projections for U.S. spending on healthcare. (See links below.) These data provide the latest official look at how the Inflation Reduction Act (IRA) will affect U.S. healthcare spending.
As you will see below, CMS projects that outpatient prescription drugs dispensed by retail and mail pharmacies will remain a small share of total U.S. healthcare spending. The Inflation Reduction Act’s changes to the Medicare Part D program, along with coming demographic shifts, will have a significant impact on future spending by government programs and consumers.
Nonetheless, taxpayers—primarily via Medicare and Medicaid—will continue to dominate the employer-sponsored insurance market. Like it or not, vertically integrated insurers, PBMs, specialty pharmacies, and providers will continue to prosper.
This week, I’m rerunning some popular posts while I prepare for tomorrow’s Drug Channels Outlook 2025 live video webinar. During the webinar, I'll share some thoughts on how vertical integration will affect the buy-and-bill channel.
Time for DCI’s annual update on the channels for provider-administered drugs. Below, I review the latest data on 2024 trends and compare them to the pre-pandemic figures.
For 2024, payers report that specialty pharmacies—via white and clear bagging—have displaced buy-and-bill for a meaningful share of commercial covered lives utilizing provider-administered oncology drugs. However, provider pushback has limited specialty pharmacies' share gains, so that buy-and-bill remains the most common channel for these products.
Payers’ adoption of white bagging—and provider’s push back—reflect the ongoing battle for oncology margin in U.S. drug channels. Let’s hope that patients don’t get caught in the crossfire.
This week, I’m rerunning some popular posts while I prepare for Friday’s Drug Channels Outlook 2025 live video webinar. During the webinar, I'll provide an update the 340B program, which continues to defy gravity. Click here to see the original post.
In my recent The 340B Drug Pricing Program: Trends, Controversies, and Outlook video webinar, I provided an update on the economics of the 340B program, reviewed the multiple controversies surrounding the program’s operations, discussed state and federal legislation, and analyzed how the Inflation Reduction Act of 2022 (IRA) will alter the 340B market.
In the video excerpt below, I walk through a brief history of 340B contract pharmacies. I then document how five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via OptumRx), and Walgreens, Walmart—continue to dominate the 340B contract pharmacy market. I conclude with a “follow the dollar” example of 340B prescription economics with contract pharmacies.
PBMs’ negotiating leverage against pharmaceutical manufacturers has been a key factor inflating the gross-to-net bubble—the ever-growing dollar gap between sales at brand-name drugs’ list prices and their sales at net prices after rebates, discounts, and other reductions.
For 2023, DCI estimates that the total value of manufacturers’ gross-to-net reductions for all brand-name drugs was $334 billion. (As we describe below, our latest estimates make a crucial change in the presentation of these figures compared with previous editions.)
Multiple forces are poised to pop the gross-to-net bubble for high-list/high-rebate products. This will force PBMs to further evolve their business models, while challenging plan sponsors and the FTC to follow the dollars.
Alas, patients remain caught in the drug channel's murky waters. I still can’t predict when SpongeBob SquarePants departs from Drug Channels—although I wish him a happy 25th birthday!
This week, I’m rerunning some popular posts while I prepare for Friday’s Drug Channels Outlook 2025 live video webinar. Click here to see the original post. During Friday's webinar, I’ll share some updated thoughts on biosimilars and PBM’s private label products.
The Humira biosimilar market just took another step forward—but remains far from its ideal state.
Below, we review the 20 products competing with Humira—including four private-label products marketed by in-house subsidiaries owned by CVS Health and Cigna.
As you will see below, CVS Health’s formulary actions led to rapid uptake of a low-list-price biosimilar. Express Scripts’ 2025 strategy will also drive biosimilar adoption, although its pricing strategy is more problematic.
But what’s really going to bake your noodle later: Would the largest PBMs have popped the gross-to-net bubble for Humira if they hadn’t been able to profit from the switch?
It’s time to pay attention to the money behind the 340B curtain.
Minnesota just released the industry‘s first ever mandated financial report on the 340B Drug Pricing Program. Below, I do a wicked deep dive into the data and highlight crucial implications about spending, profits, pharmacies, plans, patients, program integrity, and more.
There are important limitations to these data. But Minnesota’s report marks a valuable first step on the yellow brick road to the wonderful world of transparency. I suspect similar reports are gonna be popular.
And don't forget to put on your ruby slippers and hear from Doctor of Thinkology Adam J. Fein. During next week’s Drug Channels Outlook 2025 live video webinar, he'll tell you what's ahead for the program that continues to defy gravity.
Coming soon: Drug Channels Outlook 2025, our biggest live video webinar of the year. Join Adam J. Fein, Ph.D., on December 13, 2024, from 12:00 p.m. to 1:30 p.m. ET., as he helps you and your team get ready for 2025 by outlining key issues and uncertainties that will surely affect your planning. Click here to learn more and sign up.
