The Explosion in Accredited Specialty Pharmacies

How many specialty pharmacies are there?

Surprisingly, even we can’t definitively answer this question. Any pharmacy can designate itself a “specialty pharmacy” if its business focus is self-administered specialty pharmaceuticals covered under a patient’s pharmacy insurance benefit.

Manufacturers and third-party payers therefore limit specialty pharmacy networks. That’s why accreditation is now a key tool for pharmacies that want to dispense specialty medications.

To measure specialty pharmacy growth, we crunched data from URAC, a leading independent accreditation company. As the chart below shows, the number of accredited specialty pharmacies is doubling every year. As of December 2013, there were 59 URAC-accredited companies operating 114 specialty pharmacy locations. We project that next year, those numbers will grow to 110 companies.

More specialty pharmacies and more competition mean channel strategy will be even more important than the Prime Directive. Fascinating.

NEW: 2013-14 Economic Report on Retail, Mail, and Specialty Pharmacies

I am pleased to announce the availability of our new report: the 2013-14 Economic Report on Retail, Mail, and Specialty Pharmacies. We’re offering special discounts if you order before February 14, 2014.

This completely updated, revised, and expanded 2013–14 edition provides an up-to-date, fact-based analysis of the latest industry developments. If you like Drug Channels, then you'll love this report.

I worked hard to make the report into an essential tool for pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, benefit managers, managed care executives, healthcare policy analysts, consultants, and investors. Whether you're a newbie or a grizzled veteran, the 2013-14 Economic Report on Retail, Mail, and Specialty Pharmacies will help you and your team build deep business acumen about U.S. dispensing channels.

Read on for more details, or download the report today. Enjoy!

Strategic Reimbursement and Contracting

Strategic Reimbursement and Contracting–A Master Class for navigating the latest updates on reform, market access, the exchange marketplace, 340B and much more–is being held at the Wyndham Philadelphia Historic District Hotel, February 24-25 in Philadelphia and is a terrific opportunity to unite with industry colleagues amidst the post-ACA environment.

The agenda features an Exchange Strategy Summit, case studies and expert panels led by a diverse group of industry experts representing Acorda Therapeutics, Astellas, AstraZeneca, Apexus, Auxilium, BIO, Durata Therapeutics, Grifols, Lilly, Orexo and West-Ward, all set to deliver solutions to the most significant challenges affecting industry today:

• Reimbursement trends and the impact on market access
• Contracting and compliance challenges with the implementation of the ACA
• The underlying terrain of the exchange marketplace, open enrollment and implications for pharma
• Insight into various gold, silver and bronze metal plans
• Strategies to engage with ACOs and ensure product access
• 340B intricacies and programs updates
• The impact of Medicaid expansion on pricing, contracting and reimbursement, patient assistance programs and co-pay offset strategies
• And much, much more!

Plus, as a valued reader of Drug Channels, CBI is offering $300 off when you register by Friday, February 7. Mention promo code CONTDC.

* Offer valid through February 7, 2014, applies to standard rates only and may not be combined with other offers, category rates, promotions or applied to a current registration.

2013’s Top Pharmacies by Rx Revenues: The Big Get Bigger

Next week, Drug Channels Institute will release our updated and expanded 2013-14 Economic Report on Retail, Mail, and Specialty Pharmacies. Here's a sneak peek at 2013's top pharmacies.

The exhibit below, one of 98 in our new report, shows each company's market share of total U.S. prescription revenues for calendar year 2013. Highlights:

• The top five dispensing pharmacies—CVS Caremark, Walgreens, Express Scripts, Rite Aid, and Walmart—accounted for about 65% of U.S. prescription dispensing revenues in 2013.

• Market share concentration in 2013 was slightly greater than that of 2012.

• We project total 2013 retail, mail, and specialty pharmacy revenues of $287.0 billion, up 1.6% from 2012.

Read on for the 2013 details. For a sneak peek at the new 2013-14 report, check out the free Overview.

eyeforpharma Philadelphia 2014 Summit

Today's pharma environment is being transformed by new players, new media and new technologies as well as new regulatory, access and communication demands. eyeforpharma Philadelphia 2014,  focuses on improving health outcomes and features a plenary keynote session and 3 focused tracks including:

• Value Beyond the Pill
• Multichannel Engagement
• Sales Excellence. 

With 420+ pharma senior executives and healthcare stakeholders expected, the program is set to provide the roadmap to customer-centric commercial models empowering healthcare professionals, facilitating better outcomes for patients and ultimately maximizing business results.

A glimpse at some of the speakers and what they’ll be sharing:

• James Immormino, VP Commercial Innovation, Novartis, will share his insights on KAM

• Mike Moran, VP Field Force Effectiveness, GSK, will pinpoint the do’s and don’ts for sales training programs

• Brad Perkins, EVP Strategy & Innovation, Vanguard Health System, will share insight on how to partner with stakeholders to improve health outcomes

• David Stern, SVP, Head of Global Business Franchise, , will present a case study on optimizing mobile strategy

Click here to download the brochure and see the full agenda, speaker lineup and exclusive networking opportunities.

If you have any questions or feedback about the Philadelphia 2014 event, please contact Evena Liao, conference director, at evena@eyeforpharma.com or 201-204-1914.

For 2014, 3 out of 4 Seniors Choose a Narrow Network Medicare Drug Plan—and Humana, UnitedHealthcare Win Big

The Centers for Medicare & Medicaid Services (CMS) just released the first batch of 2014 enrollment data for Medicare Part D Prescription Drug Plans (PDPs). These close-to-final numbers provide an initial look at the winners and losers.

Highlights of our exclusive Drug Channels analysis:

• 60 of 2014's 106 PDPs have a preferred pharmacy network design.

• Three out of four (75%) seniors enrolled in one of these 60 plans.

• The six Humana and UnitedHealthcare plans, which all had preferred networks, account for 45% of total Part D enrollment.

• Cigna and Aetna did better with preferred network plans than open network plans.

• Rite Aid again failed to launch a co-branded plan.

Alas, preferred networks have flown too close to the sun. CMS is targeting preferred networks for tighter regulation and expanded oversight, per CMS Wants It That Way: Big Medicare Part D Pharmacy Changes. 2014 will likely turn out to be the peak year for preferred pharmacy networks in Medicare Part D.

Drug Channels News Roundup: January 2014

The weather may be chilly, but our monthly news update will keep you purring. Here are four questions to ponder as you digest this month’s noteworthy news highlights:

• What’s McKesson’s next move, post-Celesio bid failure?

• What does Cardinal Health’s CEO think about Obamacare’s effects?

• Is Walgreen’s CEO overpaid?

• How much did Walgreens pay for Kerr Drug?

Plus, the Onion reports on an exciting new antidepressant from Eli Lilly. Is it an antidote to Facebook?

P.S. If you can’t wait for our monthly news updates, then follow @Drug Channels!

Hub Models and Program Design

Anyone involved in specialty drug commercialization should plan to attend CBI’s Hub Models and Program Design conference.

For specialty drugs, hubs are crucial service providers that biopharmaceutical manufacturers hire and fund. They coordinate and standardize patient reimbursement and care, regardless of a patient’s specialty pharmacy.

On the agenda are speakers from Aetna, CareMetx, inVentiv Health, Novo Nordisk, Occam Health, Omnicare, ProMetrics, Protean LLC, Raptor Pharmaceuticals, SonexusHealth, ThromboGenics, UBC/Express Scripts, and more. The conference will be held at the Wyndham Historical District Hotel, in Philadelphia, PA on February 27 and 28, 2014.

Drug Channels readers should register with promo code GKS292 to receive $200 off your registration fee. Thanks, CBI!

For additional details, read the official description below or visit the event website.

CMS Wants It That Way: Big Medicare Part D Pharmacy Changes

This week, the Centers for Medicare & Medicaid Services (CMS) followed through on its 2014 Call Letter threats with 157 pages (!) of proposed Medicare rules: Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs.

CMS is proposing major changes to Part D’s pharmacy regulations. Most notably, CMS wants to shake up the current model for preferred pharmacy networks, which would be required to explicitly save money for both the government and the Part D beneficiaries. CMS also wants to open up these networks to any pharmacy willing to cut prices.

Under the proposed rules, plan sponsors and pharmacy benefit managers (PBMs) would face intense scrutiny over cost savings, pharmacy network design, and generic prescription reimbursement using Maximum Allowable Cost (MAC). CMS also wants to remove certain cost sharing advantages for mail pharmacies, which would be another big negative for PBMs.

Below, I summarize the key issues. Comments are due by March 7, 2014, so you better start reading!

Medicare Up, Everyone Else Down: The Latest U.S. Drug Spending Data

Let’s start the new year by looking at the new 2012 National Health Expenditure data, released yesterday by the Centers for Medicare and Medicaid Services (CMS). Full wonkitude in this Health Affairs article: National Health Spending In 2012: Rate Of Health Spending Growth Remained Low For The Fourth Consecutive Year.

Here’s what I found by crunching the latest prescription spending numbers:

• Total U.S. expenditures on outpatient prescription drugs were $263.3 billion, a mild 0.4% annual increase vs. 2011.

• For the second year, prescription drug expenditures were the slowest growing part of the U.S. health care system, which grew by 3.7%.

• Medicare was the only payer with higher spending. All other payers, including private health insurance, spent less.

• Consumers’ out-of-pocket expenditures remained at historically low levels.

Credit the generic wave and benefit design for low drug spending growth. Sorry, Obamacare fans. You can’t attribute the slowdown in overall national health care spending to the Affordable Care Act. (See the CMS comments below.)

Read on for our detailed review and analysis.

2014 sPCMA Business Forum

Happy New Year! Don’t forget to put the sPCMA Business Forum on your 2014 calendar. This important PBM and specialty pharmacy industry event is taking place March 12 and 13 in Orlando, FL.

Conference features include remarks by Former Secretary of State Hillary Rodham Clinton, 30+ educational sessions with 20+ hours of CPE, time and facilities for private meetings, pre-conference networking via the LinkedIn Group PCMA-Connect and several networking receptions.

Conference topics will be timely and thought-provoking, covering everything from “Paying for Specialty Pharmaceuticals,” and “Government and Regulatory Battles over Specialty,” to diagnostics, biosimilars, 340B, and channel insights. A more comprehensive agenda will be posted to the event webpage soon, be sure to check back.

Register Now!