Which PBM Best Managed Drug Trend in 2014: CVS Health, Catamaran, or Express Scripts?

Three of the biggest pharmacy benefit managers (PBMs)—Catamaran, CVS Health, and Express Scripts—have now released their 2014 drug trend reports. (Links below.) That means it’s time for my annual review of what the reports say about drug spending—and which questions remain unanswered.

Drug trend measures the change in a plan sponsor’s total prescription drug expenditures—excluding rebates and (sometimes) administrative fees.

Express Scripts and CVS Health reported comparable drug trend figures, while Catamaran’s were much lower. Oddly, Prime Therapeutics issued a spending report that omitted drug trend figures. When it publishes a more complete analysis, I’ll publish an update.

As I noted last year, the top-line figures don’t tell the full story, due to differences in methodology and data presentation differences. When you read a PBM’s drug trend report, don’t forget Mark Twain’s observation: Confidence is the feeling you have before you fully understand the situation.

Expanded Access Programs

Expanded Access Programs
July 22-23, 2015 | Bethesda, MD
www.cbinet.com/expandedaccess

New draft legislation and widespread advocacy efforts aim to improve patients’ access to experimental unapproved medicines. CBI’s Expanded Access Programs is the industry’s leading event dedicated to the nuances and complexities of designing and implementing early access programs.

Expanded Access Programs focuses on U.S and global considerations for a variety of access management programs, including, but not limited to: Expanded Access Programs, Early Access Programs, Compassionate Use Programs, Named Patient Programs and Managed Access Programs.

The FDA and a broad array of key stakeholders are coming together for an in-depth and meaningful discussion on Expanded Access Programs where the implications, prevailing policies and current industry approaches are discussed in detail. Don’t miss the opportunity to join your peers and share best practices around providing investigational, pre-launch or end-of-lifecycle drugs to patients for treatment purposes.

FDA Address:

Richard Klein, Patient Liaison Program Director, Office of Health and Constituent Affairs, FDA

Trailblazing Industry Thought Leaders and Pioneeering Patient Advocacy Perspectives Include:

Abigail Alliance, Alcon, Ax-S Pharma, ALS Emergency Treatment Fund, Biotechnology Industry Organization, Bristol-Myers Squibb, CurePSP, Eli Lilly and Company, Janssen R&D, Max Cure Foundation, Inc., Millennium, The Takeda Oncology Company, former NORD, Novartis Oncology, Pfizer Inc,, Sage Therapeutics, The Leukemia & Lymphoma Society, and more!

Advanced Discussions on Key Issues and the Path Forward for Early Access and Compassionate Use:

• Deep-dive into the Andrea Sloan CURE Act and “Right to Try” Laws
• Assess the new FDA guidance and early access form
• Explore new models for simplified and accelerated access to investigational medicine
• Enhance global protocol development and analyze country-specific regulations
• Benefit from physician collaboration models for advancing access to lifesaving therapies
• Navigate the pricing, payment and reimbursement policy for EAPs
• Discuss strategies for ethical, compliant and successful managed access programs
• Implement innovative outreach and educational efforts to align stakeholders
• Leverage social media for advocacy, access and awareness
• Optimize strategies for forecasting and establishing supply

REGISTER TODAY! 

Visit www.cbinet.com/expandedaccess for more information. Drug Channels subscribers will save $400 off the standard registration rate when they use discount code HKM882*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates. 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.

A Few Thoughts on the CVS Health-Omnicare Deal

Well, the Bloomberg story from yesterday’s news roundup turned out to be true: CVS Health is acquiring Omnicare. Read the press release.

This a great deal for CVS Health, which extends its leadership in specialty dispensing, expands into long-term care and assisted living, and enlarges its generic and brand buying power. The transaction is a bit pricey, but strategically sound and a good use of capital.

The Wall Street Journal and The New York Times had good coverage of the story. Both included a few comments from yours truly and cited data from our 2014-15 Economic Report on Retail, Mail, and Specialty Pharmacies. Cool!

Links and highlights below.

News Roundup, May 2015: Walgreens, Catamaran, OptumRx, CVS Health, Omnicare, and More

Time to get your barbecue ready for Memorial Day! Before you fire up the grill, dig into this month’s menu of noteworthy news patties, seasoned perfectly for your reading pleasure.

In this issue:

• Get up and close and personal with Alex Gourlay and learn more about his strategy for Walgreens

• Peek behind the scenes of the OptumRx-Catamaran deal

• Guess whether CVS Health will buy Omnicare

PLUS: Pharm.D. programs will soon require that students become proficient in pharmacy rewards programs as ExtraCare, Balance Rewards, and wellness+. It’s about time!

P.S. Follow @Drug Channels on Twitter for daily updates on news and ideas. My kids won't be impressed until I have more Twitter followers than Taylor Swift. (Only 58 million to go.)

Surprise! Government Data Again Show Rising Drugstore Profits

The U.S. Census Bureau recently released its latest Annual Retail Trade Report. These government-collected data provide the most complete industry picture of retail drugstore profits.

As you can see in the chart below, drugstores’ gross margins reached 24.6%—their highest levels in eight years. Meanwhile, the industry’s gross profit dollars grew to a record $58.2 billion.

These impartial data show that the drugstore industry continues to do well, despite its many competitive challenges. The data also contrast with the perspective of the industry’s doom-and-gloomsters. YMMV.

GPO and Institutional Sales Strategy Summit

GPO and Institutional Sales Strategy Summit
July 21-22, 2015 | Philadelphia, PA
www.cbinet.com/GPO2015

CBI is back with the only event tailored specifically for Institutional Sales Representatives in the biotech, pharmaceutical and medical device industries!

The 3rd Annual Summit drills down into case studies and includes updated content on navigating new terrain and calibrating your IDN and GPO strategy for national product success.

Top Reasons to Attend:

• Develop a successful GPO roadmap that goes beyond the scope of purchasing contracts
• Hear ACO, GPO and IDN perspectives on how to build an effective engagement strategy
• Explore how hospitals are adapting to changes in the Affordable Care Act and best practices for working with hospital networks

Industry Insights From:

• Astrazeneca
• Premier Healthcare Alliance
• Pfizer
• UCB Inc.
• And more...

REGISTER TODAY!

Visit www.cbinet.com/GPO2015 for more information. Drug Channels subscribers will save $400 off the standard registration rate when they use discount code HQB234.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates. 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.

Inflated Generics Still No Match for Brand and Specialty Costs

Today’s guest post comes from Todd Grover, Co-Founder, Glass Box Analytics. Todd discusses generic, brand, and specialty drug pricing. He also discusses some of the findings from Elsevier’s recent Generic Price Volatility Survey. These survey results are published in The Impact of Rising Generic Drug Prices on the U.S. Supply Chain. (Free download)

Todd believes that all drug claims should be handled by drug price specialists. Medical claim specialists should have drug price training and access to comprehensive, current, and reliable drug pricing information. Also, providers should check and make sure that they are not over-paying their suppliers.

Read on and see if you agree.

Employers See Differences Between Specialty and Retail Pharmacy...For Now

The Pharmacy Benefit Management Institute (PBMI) recently released its 2015 PBMI Specialty Drug Report. (Free download with registration.) The report provides insights about how employers view specialty drugs covered under medical and pharmacy benefits.

The results illustrate why payers limit and manage the pharmacies eligible to dispense specialty medications. Most employers believe that specialty pharmacies have better clinical services than retail pharmacies. Some employers, however, consider retail pharmacies’ capabilities to be comparable to those of specialty pharmacies. See my summary chart below.

The PBMI survey questions imply that there is a clear distinction between dispensing formats. I expect, however, that retail/specialty comparisons will become trickier and more nuanced. Channel strategy will be all about these blurred lines.

Specialty Pharmacy’s Bright but Complex Future: Seven Reflections on #Armada15

Last week, Paula and I had the pleasure of attending the 2015 Armada Specialty Pharmacy Summit, in wonderful Las Vegas.

Armada has cemented its position as the must-attend event for anyone participating in the specialty channel. Kudos to Larry Irene and Robert Irene. They’ve had the vision and wisdom to invest in making the meeting bigger and better every year. The social media buzz also was impressive. Check out the many, many #Armada15 tweets.

Continuing my annual violation of Vegas code, I'll tell you what happened there—what I heard and learned about specialty pharmacy’s future. If you were there, please add your own comments and observations.

In recognition of this year’s Summit, Drug Channels Institute is offering special savings on our 2014–15 Economic Report on Retail, Mail, and Specialty Pharmacies. Use discount code ARMADA15. The discount expires on June 1, 2015.

Reimbursement and Access 2015

Reimbursement and Access 2015
August 12-13, 2015 | Philadelphia, PA
www.cbinet.com/reimbursement

Now in its 3rd year, CBI’s Reimbursement and Access provides valuable learning and benchmarking, covering the most important pricing and reimbursement trends and access strategies. In this constantly-evolving healthcare system, attendees benefit from in-depth sessions covering pressing issues, including new payment models, Exchange plan formularies and participation, pharmacy benefit design, ICD-10, global market access, specialty drug pricing, hub models and much more!

Compelling Sessions, Expert Panels and Interactive Discussions Covering:

• The transition from fee-for-service to models of value-based reimbursement
• Strategies to best prepare for ICD-10 program implementation
• In-depth analysis of plan participation, benefit design and formulary coverage in Exchange plans
• The evolution of pharmacy benefit design and utilization management
• Hub design and channel strategies that streamline patient access
• Best practices to overcome patient cost-share and OOP cost challenges
• Complexities in specialty drug dispensing and patient management requirements
• Coupon and co-pay offset initiatives and cost-share structures
• Advancements in technology to streamline patient access

PLUS! Choose Between Three Education Streams on August 12th:

A: Value-Based Contracting and Risk-Share Agreements
B: Managing 340B Program Complexity – Manufacturer’s Perspective
C: Global Market Access Requirements & Strategies

REGISTER TODAY

Visit www.cbinet.com/reimbursement for more information. Drug Channels subscribers will save $400 off the standard registration rate when they use code XED653.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates. 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.

2014’s Top Retail Pharmacy Chains, According to Drug Store News

Drug Store News (DSN) has just released its latest rundown of the top pharmacy retailers in the powerfully-titled PoweRx Top Pharmacy Retailers. (Links below.)

As always, I highly recommend the PoweRx list to anyone who competes with, sells to, or otherwise interacts with retail pharmacies. This useful resource provides brief profiles of most organizations.

This year, Walgreens tops the DSN list, with $49 billion in prescription sales. Colorado-based chain Pharmaca Integrative Pharmacy is no. 60, with $61 million in prescription sales—0.1% of Walgreens’ revenues.

Below, I show DSN's top 15 chains and highlight how the list differs from our broader but shorter list of 2014’s top retail, mail, and specialty pharmacies.

Summit on Managed Care Market Strategies

8th Summit on Managed Care Market Strategies
June 22-23, 2015 | Philadelphia, PA
www.cbinet.com/managedcare

As one of the longest running annual conferences dedicated to managed markets professionals, Managed Care Market Strategies offers a unique opportunity to identify and review proven solutions to demonstrate the value of your product and maximize its positioning in an evolving managed market. Conference highlights include:

• Value based contracting, pricing, and reimbursement
• Update on the impact of Medicaid expansion, growth of ACOs, and health insurance exchanges on pharma
• Key considerations for specialty product reimbursement and access
• Leverage HEOR and CER data for targeted value propositions and to achieve market access

Visit www.cbinet.com/managedcare for more information. Drug Channels subscribers will save $400 off of the standard registration rate when they use code THZ868.*

Register today!

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates. 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.

Taking Specialty Prior Authorization From 5 Days to 5 Minutes

Today’s guest post comes from Scott Pribyl, CEO of SamplifyRx. Scott discusses RapidPA Score™—an intriguing scoring system for specialty drug prior authorizations. He also reviews the benefits of a cloud-based tool that allows for near real-time prior authorization (NRTPA) approvals. Interesting concept. Check it out.

Scott will be at the 2015 Armada Specialty Pharmacy Summit in Las Vegas next week. Email him at scott@samplifyrx.com to learn more about SamplifyRx’s new, cloud-based PA solution or to set up a meeting.

BTW, Lew Morris, former Chief Counsel to the Inspector General, analyzed how the SamplifyRx solution improves a manufacturer's compliance with OIG guidance for copayment coupons. Click here to download Lew's analysis.