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 nearly 100,000 subscribers and followers. Learn more...
Today’s guest post comes from Timothy Nielsen, Vice President of Customer Success at AssistRx.
Timothy discusses the affordability and patient journey challenges of specialty-lite products for patients, manufacturers, and health care providers. He explains how AssistRx's Advanced Access Anywhere (AAA) solution streamlines processes for specialty-lite products and facilitates enrollment via a digital hub.
Contrary to what you may have heard, the Inflation Reduction Act’s (IRA) inflation rebates for Medicare Part B drugs do not always save money for seniors.
As we document below, a growing share of Part B drugs have inflation-adjusted coinsurance rates that have been increasing, not declining. In many cases, the coinsurance rate declines only briefly before rebounding back to the standard 20% rate. What’s more, these fluctuations have triggered huge jumps in patients’ out-of-pocket obligations for some drugs—even when a drug’s costs were falling.
Chalk off these coinsurance surprises to yet another unintended consequence of the IRA. Seniors who are expecting to see costs drop may find they are instead being taken for a rollercoaster ride.
The 340B contract pharmacy market shows little sign of slowing down. Drug Channels Institute’s exclusive analysis of the 2024 market reveals that:
About 33,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—act as contract pharmacies for the hospitals and federal grantees that participate in the 340B program.
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.
Federal grantees are aligned primarily with the vertically intergated organizations' retail pharmacies, while hospitals rely on mail and specialty pharmacies.
Over the past four years, manufacturers’ restrictions on 340B contract pharmacies have led hospitals to deepen their relationships with the largest PBMs—even as those PBMs have simultaneously limited hospitals’ direct participation in specialty pharmacy networks.
Last week, the Federal Trade Commission (FTC) released the redacted version of administrative complaint against the three largest pharmacy benefit managers (PBMs). The FTC rightly calls out how the gross-to-net bubble can raise patients’ out-of-pocket costs, while also acknowledging how rebates can reduce a plan's (but not the patient’s) costs. Apparently, the FTC believes that PBMs’ customers are pretty dumb, because PBMs are able to prevent plans from “appreciating” such healthcare financing dynamics.
Section V.E. of the complaint (starting on page 23) focuses on the PBMs’ alleged unlawful conduct related to preferring high-list/high-rebate insulin products over versions with lower list prices. I thought it would therefore be fun to take the Wayback Machine to November 2021, when I wrote about this specific topic.
Below, you can review my commentary about the warped incentives behind Viatris’ dual-pricing strategy for its interchangeable biosimilar of Lantus. Much of the FTC’s description of the drug channel aligns with my commentary. But before you fist pump too hard for Ms. Khan’s FTC, you should pause to reflect on the agency’s legal theories in light of plans’ revealed preferences.
The Food & Drug Administration (FDA) recently approved the first interchangeable biosimilar insulin product: the insulin glargine-yfgn injection from Viatris. Read the FDA’s press release.
Alas, I’m sad to report that the warped incentives baked into the U.S. drug channel will limit the impact of this impressive breakthrough.
Viatris is being forced to launch both a high-priced and a low-priced version of the biosimilar. However, only the high-list/high-rebate, branded version will be available on Express Scripts’ largest commercial formulary. Express Scripts will block both the branded reference product and the lower-priced, unbranded—but also interchangeable—version. Meanwhile, Prime Therapeutics will place both versions on its formularies, leaving the choice up to its plan sponsor clients.
Consequently, many commercial payers will adopt the more expensive product instead of the identical—but cheaper—version. As usual, patients will be the ultimate victims of our current drug pricing system.
Below, I explain the weird economics behind this decision, highlight the negative impact on patients, and speculate on what this all could mean for biosimilars’ future. Until plan sponsors break their addiction to rebates, today’s U.S. drug channel problems will remain.
The access and affordability landscape is undergoing a seismic shift. Evolving legislation, disruptive market forces and the ever-growing complexities of cost sharing programs threaten patient adherence and commercialization strategies. Are you ready?
A program driven by marketplace insights and led by industry trailblazers, Copay, Reimbursement and Access Congress is back November 18-20 and will deliver up-to-date insights necessary to enhance patient affordability, ensure program sustainability and navigate the regulatory landscape. In a time where remaining compliant has never been more complex and program innovation has never been more important, be sure to join your industry counterparts to drive adherence, access and commercialization forward.
Why attend the Copay, Reimbursement and Access Congress?
Keeping up with shifting market dynamics in the midst of maximizing access, while also meeting business objectives is a challenging task and brings about many questions for access professionals.
Is your program sustainable and innovative to better support patients?
Accumulators, maximizers, AFPs – What are your next steps to ensure effective reimbursement strategies?
In an election year, what is the future of health policy?
Experts will tackle these questions and more as the industry comes together to benchmark best practices to accelerate access and commercialization. Do not miss your chance to join seasoned leaders, your peers and leading solution providers as they navigate marketplace trends and dive into the impact coupons, benefit design, accumulators, maximizers, alternative funding programs and drug pricing legislation have on patient affordability and out-of-pocket costs. This is your chance to gain critical insights on industry standards, forward-thinking strategies to optimize your copay and cost sharing programs and so much more.
Content highlights:
Over 20 hours of content, including 7+ dedicated sessions to help decipher copay legislation
Crucial perspectives from Pfizer, Sanofi, Janssen, Teva, Ascendis Pharma, Melinta Therapeutics, GSK, HIV + Hepatitis Policy Institute and more
Insights direct from enforcement agents on the top trends and actions within the copay and patient services space
Illuminating case study, Navigating the Patient Journey in a Shifting Copay Landscape from Spark Therapeutics
465 minutes of valuable in-person networking with colleagues and counterparts to expand your network and establish powerful partnerships
Additional content access through Streamly, a platform that gives you 12-month access to all of the available conference content** to review at your leisure
And more!
Download the agenda and register today—Be sure to use your exclusive promo USAVE24 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.
**Pending speaker permissions
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 George Moore, Chief Information Technology Officer at CareMetx.
As George explains using novel survey data, manufacturers view new technologies as crucial for patient services. He then explains how digital technology, artificial intelligence (AI), and machine learning (ML) can be used to improve patient adherence and increase hub efficiencies.
During these events, Dr. Fein will address the latest issues confronting the U.S. drug channel. Topics will be determined based on what’s happening—trends, policy changes, company announcements, and more. He’ll share DCI’s latest market data to help you stay on top of new developments. You will be able to use these events as both a capstone of your current learning and a touchpoint for the future.
The three events are scheduled for 12:00 p.m. to 1:30 p.m. ET on the following dates:
April 4, 2025
June 20, 2025
December 12, 2025 (Drug Channels Outlook 2026)
For 2025, we are offering a Corporate Pricing option that will allow larger organizations to register hundreds of colleagues for one fixed price. Please contact Paula Fein (paula@drugchannels.net) for details.
Read on for full details on pricing, including substantial discounts for multiple sites.
The complex components of gross-to-net management requires cross-functional collaboration in order to effectively develop sound accrual estimates, proper forecasting, optimized pricing and contracting models and accurate financial reporting, all with minimal disruption to market access strategies.
The CPE-accredited Pharma/Biotech GTN Summit is the ideal opportunity to engage in comprehensive sessions for end-to-end GTN excellence, connect with peers to exchange experiences and solutions to common challenges, and participate in interactive discussions that address real-world scenarios to enhance GTN accuracy and efficiency.
Featured Thought-Leaders Leading the Dialogue Include:
Nancy Bell, Vice President, Head of US Patient Value & Access, Takeda Oncology
Chris Boneham, Vice President, Market Access US, Y-mAbs Therapeutics
Prakash Chainani, Vice President – Finance, HR & IT, Lifestar Pharma LLC (a Mankind Group Company)
George Kappus, Associate Director, M&S Controlling (GtN, Boehringer Ingelheim
Learn more and see why the GTN Summit remains a great choice for education and benchmarking on strategic forecasting, estimates, analytics and reporting through best practices for gross-to-net management.
Drug Channels subscribers — Save 15% when you reserve your place using the VIP code 24DGC15.
*Offer applies to the current rate and maybe not be applied to existing registrations; additional terms may apply, see website for full details.
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 Josh Marsh, Vice President and General Manager, Sonexus™ Access and Patient Support at Cardinal Health
Josh discusses challenges manufacturers may face when outsourcing patient support programs. He outlines a process that smoothly transitions hubs and minimizes disruptions for patients and healthcare providers.
On October 8, 2024, Drug Channels Institute will release our 2024-25 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. This report—our fifteenth edition—remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry.
9 chapters, 350+ pages, 178 exhibits, 750+ endnotes: There is nothing else available that comes close to this valuable resource.
We are providing you with the opportunity to preorder this thoroughly updated, revised, and expanded 2024-25 edition at special discounted prices. This means that you can be among the first to access our new report. Those who preorder will receive a download link before October 8.
The Patient Support Services Congress is designed to help educate and share innovative program design, latest customer strategies and practical solutions to overcome complex access barriers, enhance program performance and deliver best-in-class patient programs amidst evolving regulations. Benefit from key stakeholder interaction, dedicated breakouts, and detailed case studies on control enhancement and operational excellence to further strengthen your programming.
Prepare for Robust Discussions On:
Enforcement Update – Explore Rising Oversight and High Priority Risk Areas for Patient Services Compliance
Navigating Today’s Patient Support Program Operating Models – Trends, Insights and Strategic Best Practices
The Journey of the Inflation Reduction Act
Optimizing Patient Support in this New Era – Accumulators, Maximizers and Alternative Funding Programs
Unleashing the Power of AI for Patient Support
PLUS! Tailored Tracked Content for a Customizable Experience
Compliance and Legal
Innovation and Operations
And more!
Featured Faculty Driving the Conversation:
Suzanne Marinakos, Director, Patient Services Operations, Novo Nordisk
Jonathan Amar, Assistant General Counsel, Sanofi
Maria Pandolfo, Vice President, Patient Services, Catalyst Pharma
Richard Liner, Senior Assistant General Counsel, Bayer
Tara Kennedy, Global Director, Ethics & Compliance, Apellis Pharmaceuticals
Emily Gibb, Vice President, Head of Novartis Patient Support Cardiovascular, Renal, and Metabolic, Novartis
Lee Cortes, Executive Assistant United States Attorney, United States Attorney’s Office, District of New Jersey
Erica Devine, Director, Patient Experience and Support Nephrology/Rare, Otsuka
Patrick Gomez Menzies, Director, Market Access, Chiesi USA, Inc.
Meghan Jones, Associate Director, Patient Support Services, Rare Blood Disorders, U.S. Sanofi Genzyme
Lakia Lewis-Latin, Director, Program Management Strategy, Abbvie
Kristin Manzolillo, Senior Director and Team Lead, US Oncology Patient Solutions Strategy, Pfizer
And so many more!
View the complete agenda today and join one of the prominent conferences showcasing insightful discussions on access strategy, patient interactions, case management, compliance frameworks and more to help professionals strengthen and innovative their patient-oriented programs.
Drug Channels subscribers — Save 10% off the current registration rate with promo code 24DC10*. Register today.
*Offer applies to current rates only and may not be combined with other offers, category rates, promotions or applied to an existing registration. Offer not valid on workshop only or academic/non-profit registrations.
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).
This week, I’m rerunning some popular posts while we put the finishing touches on DCI’s new 
This week, I’m rerunning some popular posts while we put the finishing touches on DCI’s new 
