Drug Channels News Roundup, January 2018: PBM Exclusions, Hospital Finances, 340B Updates, and Amazon

Here at our worldwide headquarters in Philadelphia, Eagles super bowl fever has landed. Before trying to climb a Crisco-covered light pole, please enjoy this month’s playbook of articles, intercepted for you from the Drug Channels gridiron.

• An insightful analysis of the formulary exclusions at CVS Health and Express Scripts

• A surprising look at hospital systems’ finances

• A must-read overview of the 340B program

Plus: some good news for Amazon CEO Jeff Bezos! (No, it's  not about today's breaking news.)

P.S. Join the more than 5,000 people who run after me at @DrugChannels on Twitter. Every day, I tackle links to neat stuff for you.

Expanded Access Programs 2018

Expanded Access Programs 2018
March 28-29, 2017 | Washington, DC

CBI’s Expanded Access Programs 2018 focuses on the design, development and practical implementation of early access programs. The summit convenes top industry stakeholders and regulators to examine current approaches in providing investigational, pre-launch or end-of-lifecycle drugs to patients for treatment purposes. A multi-stakeholder faculty will address key issues affecting EAPs and review the potential impact of the evolving legislative landscape.

Visit www.cbinet.com/EAP for more information. Drug Channels subscribers will save $400 off of the standard registration rate when they use discount code CGR664.*

Key Topics to Be Addressed:

• Share best practices and review comparable processes and regulations between U.S. and global expanded access programs
• Streamline policies and procedures to enable the successful launch and sustainability of global EAPs
• Review industry trends in the collection of real-world data in expanded access programs
• Navigate pricing, payment and reimbursement policy for expanded access programs
• Discuss strategies to integrate EAPs into your drug development process at the busiest point of the drug development life cycle
• Understand the clinician’s perspective on single-patient access and group EAPs — Consider barriers to access

This multi-stakeholder event is focused on U.S. and global models 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

Visit www.cbinet.com/EAP for more information. Drug Channels subscribers will save $400 off of the standard registration rate when they use discount code CGR664.*

REGISTER TODAY!

*Applies to standard 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.

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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.

The Role of Specialty Pharmacy in Population Health and Value-Based Care

Today’s guest post comes from Russel Allinson, Chief Executive Officer at Therigy.

Russel describes the current shift from volume-based to value-based contracting for enhanced population health and patient care. He explains Geisinger’s innovative and successful Medication Therapy Disease Management Program.

Russel highlights how TherigySTM enables the transition from volume-based to value-based contracting. The system’s new features help specialty pharmacies better manage care delivery, tracking, and reporting to stakeholders, while maintaining focus on the bottom line.

Read on for Russ’s insights.

New Part D Data: CVS Wins Big in 2018's Preferred Pharmacy Networks

Just-released data from the Centers for Medicare & Medicaid Services (CMS) confirms that preferred cost sharing networks will continue to dominate Medicare Part D. Our exclusive analysis finds that for 2018, 99.9% of seniors are enrolled in Prescription Drug Plans (PDPs) with preferred pharmacy networks.

Below, we use the new enrollment data to analyze the major pharmacy chains’ position within the 22 major Part D plans that have preferred networks. As you will see, CVS looks poised in 2018 to recapture major market share from Walgreens and Walmart. Poor ol’ Rite Aid will once again lag far behind.

As long as pharmacies accept lower reimbursements in exchange for increasing or maintaining store traffic, preferred networks will continue to dominate the marketplace. For 2018, CVS will gain significant prescription market share—but at the cost of lower prescription profit margins. Unlike poker, the Part D preferred network winners play the lowest card.

PAP 2018 – CBI’s 19th Annual Patient Assistance & Access Programs

PAP 2018 – CBI’s 19th Annual Patient Assistance & Access Programs
March 6-7, 2018 | Baltimore, MD
www.cbinet.com/pap

Copay programs and premium support are increasingly under a scrutinizing microscope at a time when underinsurance continues to plague many patients.

Leaders from the patient assistance and product access field - manufacturers, copay foundations, non-profits, free clinics, advocacy organizations, hospitals and more – convene in Baltimore on March 6-7 to address the legal environment, industry best practices and policy watch-outs related to prescription access and financial assistance. You can read all about it here.

PAP 2018 features four strategy streams, seven learning labs, more than twenty sessions and fifty plus speakers. Here is a snapshot of what some of the sessions will focus on:

• Legal and policy dynamics influencing access and affordability
• Advancements in patient support technology
• Patient experience, access and adherence optimization
• PBM restrictions on manufacturer-sponsored copay assistance programs

Visit www.cbinet.com/pap for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code TGU584 and register prior to February 2nd.*

CBI will see you there!

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rate or non-profit 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.

Employers Are Getting More Rebates Than Ever—But Sharing Little With Their Employees

Yesterday, I examined new data showing that employers are receiving an increasing share of the rebate money collected by pharmacy benefit managers. See Employers Are Extracting More of Their Rebate Dollars from PBMs.

The data, from a Pharmacy Benefit Management Institute (PBMI) survey, also documented a troubling reality. Employers acknowledged that they are hoarding rebates rather than sharing the savings with the employees whose prescriptions generated the rebate funds. It’s the first time that I’ve seen such an admission from plan sponsors.

Consider the data below as confirmation of the warped incentives caused by the gross-to-net bubble—the growing spread between a manufacturer’s list price for a drug and the net price. Consider the diabetes example below. Fixing this situation will be more challenging than walking to Mordor. Point-of-sale (POS) rebates may be a good place to start, but employers seem unwilling to part with their precious.

Employers Are Extracting More of Their Rebate Dollars from PBMs

The debate about drug prices and the drug channel system will continue in 2018. Let’s shed some light on one murky, little-understood corner of this world: how employer-sponsored health plans access the billions of dollars in manufacturer rebates that are negotiated by their pharmacy benefit managers (PBMs).

We turn to data from the Pharmacy Benefit Management Institute’s (PBMI) excellent 2017 Trends in Drug Benefit Design. (Free download with registration.) As far as I know, it’s the only public data source for understanding PBM-client rebate practices.

According to PBMI’s survey data, larger and smaller employers increasingly receive 100% of manufacturer rebates for traditional drugs. Many have also negotiated guaranteed rebates that shift risk to PBMs. Other employers get a share of the rebates or a flat guaranteed amount.

Below, I delve into the data and offer my observations. Tomorrow, I’ll examine what employers are doing with these rebate dollars. Spoiler alert: It’s usually not good for patients.

The Life Sciences Patient Congress

The Life Sciences Patient Congress
March 19-21, 2018 | Philadelphia, PA
www.worldcongress.com/events/patientcongress

The Patient Congress features 4 co-located Summits aiming to convene a forum to aid pharma with breaking down internal silos to incorporate the patient voice across the entire product lifecycle in order to drive collaborative, innovative solutions from essential stakeholder partnerships, and enhance health outcomes.

Join together with 250+ industry leaders from life science, pharmacy, health plans, provider organizations, patient leaders, and policy makers to share innovative ideas and strategies, drive innovation, and create a community of stakeholders to provide value-based care to patients.

Register today!

(Use discount code DC200 and save $200.)

Tracks include:

• 6th Annual Patient Adherence & Engagement Summit
• 6th Annual Patient Advocacy Summit
• Patient Journey Mapping for Speed to Therapy Summit
• Patient-Centered Clinical Trials Summit

How will you benefit?

• 4 co-located events for the price of 1, allowing each attendee to create their own personalized conference experience that caters to their individual needs and allows enhanced networking
• An exemplary speaking faculty including 80+ speakers from FDA, Pfizer, AstraZeneca, Novartis, Sanofi, Genetech, Merck, Astellas, BMS, GSK, and more!
• Be a part of the first ever Patient Choice Awards, an awards ceremony recognizing Pharma and Patient collaborations: The only awards gala led by a judging panel of Patient Leaders
• Real-time insight from patients with a Patient Reaction Panel to provide the patient perspective throughout the conference
• Break down internal silos, network, and form alliances with game changers and thought leaders across all stakeholder groups within the healthcare ecosystem at the only event looking at how to incorporate the patient voice throughout the entire product lifecycle, from the research and development phase all the way through commercialization and post-commercialization.

Register today!

(Use discount code DC200 and save $200.)

Visit www.worldcongress.com/events/patientcongress for more information.

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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.

2026 Pharmacist Job Outlook Looks Good, Especially for Hospital Pharmacists

Hey there, pharmacists! Ready for some good news?

According to our exclusive analysis of the U.S. Bureau of Labor Statistics’ (BLS) new Occupational Outlook Handbook, the total pharmacist employment figure is projected to grow by almost 18,000 jobs by 2026.

The pharmacist outlook, however, varies by industry. Pharmacist jobs at hospitals, physician offices, and other non-retail settings will outpace growth at conventional retail and mail outpatient pharmacies.

Read on for an industry-by-industry look at the outlook. And if you are a retail or mail pharmacist: Plan accordingly! Drug Channels humbly suggests some alternative career ideas below.

New Data: Pharmacy Owners' Profits Fall As Industry Competition Rises

Time for my annual look at independent pharmacy owners’ business economics, drawn from the recently released 2017 National Community Pharmacists Association (NCPA) Digest, Sponsored by Cardinal Health. Here's the press release: NCPA Releases 2017 Digest.

Below, I review our latest estimates on pharmacy economics and margins. Our analysis reveals that independent pharmacy owners are now performing poorly. In 2016, we estimate that the average pharmacy owner saw their salary decline by more than 20%, to about $156,000. The number of independent pharmacies and gross margins also are trending downwards.

It’s the third consecutive year in which owner’s compensation declined. Read on for my look at pharmacy profits, comments on the industry’s competitive dynamics, and advice to pharmacy owners.

When times were good, pharmacy owners and their lobbyists complained bitterly about low pharmacy profits. Now that the endgame is truly beginning and reality matches the rhetoric, don’t be surprised that policymakers and others are skeptical.

sPCMA Business Forum 2018

sPCMA Business Forum 2018
March 5 & 6, 2018
Hilton Bonnet Creek | Orlando, FL

The sPCMA Business Forum covers critical industry issues and offers invaluable networking and education for individuals and companies involved in specialty drug benefit management, including PBMs and specialty pharmacies, pharma/biotech manufacturers, industry consultants, and others.

Conference sessions will cover critical issues, such as the value and net price of prescription drugs, how payers use drug pipeline data to make decisions, the value and use of digital therapeutics in patient care, the latest implications of the 21st Century Cures Act and FDAMA 114, considerations for rare and ultra-rare product development and commercialization, and much more.

Confirmed speakers include:

• Amy Bricker, President, Supply Chain, Express Scripts
• Laurent Carter, Vice President, Strategic Payer Marketing, U.S. Value, Access, and Payment, Bristol-Myers Squibb
• Scott Honken, Senior Vice President, Payer Sales and Strategy, Voluntis
• Steve Johnson, Assistant Vice President, Health Outcomes, Prime Therapeutics
• Doug Long, Vice President, Industry Relations, IQVIA
• Alan Lotvin, Executive Vice President, Specialty Pharmacy, CVS Health
• Rae McMahan, Vice President & General Manager, Specialty Pharmacy, Prime Therapeutics
• Mark Merritt, President & Chief Executive Officer, PCMA
• Jon Roberts, Executive Vice President & Chief Operating Officer, CVS Health
• Will Shrank, Chief Medical Officer, UPMC
• Brian Solow, Chief Medical Officer, Optum Life Sciences
• Caroline York, Senior Vice President, Operations, WellDoc
• Additional speakers from Express Scripts, Magellan Rx Management, OptumRx, and others TBA

Register today!

sPCMA Business Forum

March 5 & 6, 2018

Hilton Bonnet Creek | Orlando, FL

Contact PCMA
Please contact Jenny Bradham (jbradham@pcmanet.org) with questions or to request information about the Affiliate Program or conference sponsorships.

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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.

Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit

Let’s kick off 2018 with a Last Jedi-themed look at copay accumulator programs—a benefit design option that I expect to become highly controversial this year.

Accumulator programs target specialty drugs for which a manufacturer provides copayment assistance. Unlike conventional benefit designs, the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum.

As you will see below, plan sponsors—employers and health plans—will save big money because accumulators shift a majority of drug costs to patients and manufacturers. Accumulator programs will further lower a plan’s drug spending by discouraging the appropriate utilization of specialty therapies and reducing adherence. What’s worse, many patients won’t understand their new “benefit.”

Given the direct human healthcare impact of copay accumulator programs, I don’t see how they can be considered value-based designs. Is it any wonder that people think their employers and insurance companies are from the dark side?