Drug Channels News Roundup, July 2018: Amazon’s med-surg business, Naughty 340B hospitals, GoodRx pricing data, and CVS’s musical controversy

The lazy days of summer are here. Take some time off from the gross-to-net bubble and enjoy my curated collection of timely articles. This month:

• A must-read Q&A on Amazon’s healthcare products distribution business

• A new GAO study discovers that more than one in five 340B hospitals provides minimal charity and uncompensated care

• Fresh data from GoodRx about the crazy variability in pharmacies’ prescription prices

Plus, The Wall Street Journal publishes some hard-hitting journalism about the controversial hold music played at CVS pharmacies.

P.S. Join the more than 6,000 people who follow my daily musings and neat links at @DrugChannels on Twitter. Recent tweets have tackled biosimilars, specialty pharmacy, copay accumulators, drug pricing, health policy news, and much more.

CBI’s PAP Legal Update Forum

CBI’s PAP Legal Update Forum
September 25-26, 2018 | Arlington, VA
www.cbinet.com/papupdate

Join CBI this fall at the PAP Legal Update Forum to delve into the nuances of compliance for patient assistance programs, address new copay card legislation, analyze critical areas of risk within the Anti-Kickback Statute, and explore strategies for effective risk management and compliance monitoring to optimize and ensure patient access.

You can read all about it here.

Participate in compelling discussions led by expert speakers:

• Examine the Impact of Legal Actions and Developments Related to Patient Assistance Programs
• Analyze PAP Critical Risk Areas within the Anti-Kickback Statute (AKS), False Claims Act (FCA) and Other Key Laws
• Redefine Relationships between Manufacturers and 501(c)3 Foundations
• Dissect Evolving State Copay Card Legislation in California, Massachusetts and Rhode Island
• Tackle Critical Challenges in Providing Assistance for Rare Disease and Specialty Therapeutics Patients
• Build Effective Strategies to Balance Patient Centricity and Compliance in Patient Access
• Implement Robust Compliance Monitoring Programs for PAPs

Visit www.cbinet.com/papupdate for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code YHX639 and register prior to August 24th.*

CBI looks forward to seeing 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.

Building a New Drug Wholesaler Compensation Model: What Happens as Brand Inflation Slows?

Today, drug wholesalers make money from distribution in a straightforward manner: Buy low, sell high, collect early, and pay late. They also profit as brand-name list prices increase. Like other drug channel intermediaries, wholesalers have warped incentives to prefer ever-higher list prices.

But what happens to their business model if list prices don’t rise—or even if they decrease?

This question is no longer theoretical. Many drug makers—Pfizer, Roche, Novartis, Novo Nordisk, Sanofi, and others—have announced an intention not to raise list prices for 2018 or have rescinded planned increases. Merck has gone further and become the first major manufacturer to reduce the list price of a brand-name, patent protected product, albeit for a product with minimal sales. And for the first time, there is a serious attempt to pop the gross-to-net bubble and build a system without rebates.

Below, I analyze what this could mean for the Big Three drug wholesalers—AmerisourceBergen, Cardinal Health, and McKesson. I explain some of the problems that arise when wholesalers are compensated based on a brand-name drug’s list price. I then suggest an alternative approach that would reshape wholesalers’ economics. It appears that even the wholesalers’ trade association supports some sort of new model.

Given what’s happening, it’s clearly time for some ch-ch-ch-ch-changes.

CBI’s 11th Hub and SPP Model Optimization

CBI’s 11th Hub and SPP Model Optimization
September 12-13, 2018 | San Diego, CA
www.cbinet.com/hubswest

In order to keep up with the escalating challenges associated with rebooting or maintaining your hub model, your organization requires novel and innovative strategies for customizing your products and services. CBI has once again gathered the pioneers in the industry to share practical strategies for advancing patient services, enhancing program effectiveness and driving speed to therapy.

Join CBI in San Diego, CA for the 11th installment of the Hub and SPP Model Optimization Summit on September 12-13. You can read all about it here.

Visit www.cbinet.com/hubswest for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code TJC549 and register prior to August 17th.*

Conference Highlights Include:

• Discover how to best streamline the information generated by the hub back to the manufacturer
• Review the overall end-to-end experience from the physician and patient perspective in e-prescribing, prior authorization and dispensing workflows
• Discuss the impact of DIR Fees on practice-based pharmacies
• Examine best practices on the development and administration of a third-party monitoring and oversight program
• Understand the consequences of narrow channel medication distribution on patient adherence in post-acute care
• Gain an understanding for how to consolidate specialty distribution data
• Use EHR technologies to determine formulary, launch electronic prior authorizations and streamline fills at retail pharmacies and through mail-away hubs

PLUS! Don't miss the heart-wrenching Keynote Address from former NFL great Rolf Benirschke, current CEO of Legacy Health Strategies.

Visit www.cbinet.com/hubswest for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code TJC549 and register prior to August 17th.*

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.

Specialty Pharmacies and PBMs Penetrate the 340B Program—And How Manufacturers Should Respond

In two recent Drug Channels articles, I have documented the phenomenal growth in pharmacies participating in the 340B Drug Pricing Program and the superior profits that pharmacies earn from the program.

Today, I turn to the less well-known role of specialty pharmacies and pharmacy benefit managers, which are now significant participants as 340B contract pharmacies. Below, we present our first exclusive analysis of how independent and PBM-owned specialty pharmacies have deepened their relationships with hospitals and other 340B covered entities.

We estimate that nearly 10% of all specialty prescriptions are dispensed by 340B contract pharmacies, which makes this channel one of the fastest-growing components within the 340B program. Despite this growth, pharmaceutical manufacturers have limited transparency into the behavior of these 340B contract pharmacies. Drug makers therefore pay 340B discounts on prescriptions for which they also pay commercial, Medicare Part D, and managed Medicaid rebates.

Below, we explain why manufacturers should have access to the prescription-level data that would permit the identification of 340B claims. Playing Where’s Waldo? for 340B claims is no way for this multi-billion dollar program to operate.

CBI’s 6th Annual Coupon and Copay Summit

CBI’s 6th Annual Coupon and Copay Summit
October 2-3, 2018 | Philadelphia, PA
www.cbinet.com/coupon

CBI’s Coupon and Copay Summit begins with their Chairman, Chris Dowd, Executive Vice President, Market and Product Development of ConnectiveRx addressing the state of the marketplace – accumulator programs, drug rebates, rising out-of-pocket costs and the drug pricing debate.

This two-day summit is filled with key issues:

• Assessing the Impact of Industry Consolidations and Cost Shifts
• Understanding Key Trends Affecting Market Access, Patient Affordability and the Future of the Drug Pricing Ecosystem
• Identifying Challenges in Copay Access and Reimbursement from Patient Advocacy, Pharmacy and Manufacturer Perspectives

Click here for the full agenda.
Register by August 10th 2018 and receive $500 off the standard rate with the discount code DCC500.

As the healthcare marketplace continues to evolve, CBI’s Coupon and Copay Summit convenes an exceptional group of industry experts to discuss key market factors affecting the future of copay assistance and copay program design.

Here’s a snapshot of the experts you’ll meet and with whom you’ll benchmark best practices:

• Chris Boneham, Executive Director, Managed Markets, Aralez Pharmaceuticals
• Fred Brownfield, Former Director, Pharma Innovative Contracting, Humana
• David Eskew, Deputy Chief, Criminal Division, United States Attorney’s Office, District of New Jersey
• Dina Inverso, Strategy Leader, Patient Engagement and Reimbursement, CSL Behring
• Joseph Mack, Senior Compliance Counsel, U.S. Office of Compliance, Bayer U.S.
• Philip W. McCreary, Pharm.D., MBA, Medication Access Program Director, Vanderbilt University Medical Center
• Dennis Murphy, Pharm.D., Manager, Commercial Strategy, Radius Health
• Peter J. Pitts, Former Associate Commissioner, FDA; President, Center for Medicine in the Public Interest

And much more …

Please visit CBI’s site for more information. Register by August 10th 2018 and receive $500 off the standard rate with the discount code DCC500 (an additional $100 off the Advantage Pricing!).

*Discount expires 08/10/2018 and may not be combined with other offers, category rates, promotions, or applied towards an existing registration. Offer not valid on workshop only or academic/nonprofit registrations. 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.

The Trump Administration’s Blueprint: A Preview of the 23rd Annual MDRP Summit

Today’s guest post comes from Jean-Francois Denault, CEO and Owner of Impacts.CA. He discusses the Trump Administration’s Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. He outlines potential changes and their impact on pharmaceutical manufacturers.

Knect365’s 23rd Annual Summit on the Medicaid Drug Rebate Program (MDRP) in Chicago will provide an opportunity to learn more about the administration’s drug pricing plans and such other topics as government pricing, rebates, and regulation. This event is notable for including many government officials along with over 500 industry participants.

Register by July 27 to save up to $400 off the regular registration fee. Visit medicaiddrugrebates.com for more information.

Read on for Jean-Francois’s insights.

Our Exclusive Analysis: Nearly One in Three U.S. Pharmacies Is a 340B Contract Pharmacy; Five Chains Dominate

Pharmacies continue to profit from the 340B Drug Pricing Program’s explosive growth.

Our latest exclusive analysis finds that about 21,600 pharmacy locations now act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. The total number of locations has grown by 9% over the past 12 months. The five largest retail pharmacy chains—Walgreens, CVS, Walmart, Albertsons/Rite Aid, and Kroger—account for two-thirds of 340B contract pharmacy locations.

This growth is unsurprising. The U.S. Government Accountability Office (GAO) has now documented the tremendous profits available to 340B contract pharmacies. See GAO Confirms It: 340B Hospitals and Contract Pharmacies Profit from Low-Income, Uninsured Patients.

Does Congress really want the 340B program to provide outsize financial benefits to a handful of large, multi-billion-dollar, for-profit pharmacy chains? Should investors be concerned about how much pharmacies are earning from this embattled program?

GAO Confirms It: 340B Hospitals and Contract Pharmacies Profit from Low-Income, Uninsured Patients

The United States Government Accountability Office (GAO) has just issued a must-read report on the 340B Drug Pricing Program: Federal Oversight of Compliance at 340B Contract Pharmacies Needs Improvement.

Some of the report’s most startling revelations confirm our worst fears about how hospitals and pharmacies are abusing the 340B program.

Here are two especially dispiriting findings from the GAO’s analysis:

• 16 out of 28 hospitals (57%!) did not provide discounted drug prices to low-income, uninsured patients who filled prescriptions at the hospital’s 340B contract pharmacy. Seriously?!?

• Many 340B contract pharmacies can earn excessive profit margins of 15% to 20% from brand-name 340B prescriptions. As I have long suspected, large, publicly-traded pharmacies are sharing in the 340B discounts generated for covered entities.

Bottom line: Hospitals and pharmacies are making money from poor people. Are you kidding me?!? For shame!

The 340B program’s apologists will have a hard time rebutting the uncomfortable facts from this GAO report. Calling something a “drug discount program” apparently doesn’t mean that the neediest patients get access to those discounts. Read on, and prepare to be outraged.

P.S. In two upcoming articles about 340B, I’ll review the pharmacies participating in the program and then examine the role of specialty pharmacies and pharmacy benefit managers.

2nd Annual Pharma Digital Marketing & Multichannel Integration Summit

2nd Annual Pharma Digital Marketing & Multichannel Integration Summit
September 13-14, 2018 | Boston, MA
www.worldcongress.com/digitalmarketing

Join industry innovators at the 2nd Annual Pharma Digital Marketing & Multichannel Integration Summit, September 13-14, in Boston, MA as they share how to deliver information to customers in a way that is tailored to them, through their preferred channels. The agenda is structured to provide solutions to common problems felt by today’s pharma marketers and empower attendees to return to the office with innovative strategies and tangible takeaways to enhance the customer experience and drive business results.

Key Topics in 2018 include:

• Applying innovative technologies such as virtual reality (VR) and augmented reality (AR) to your marketing campaign
• What the pharma industry can learn from Amazon’s marketing tactics
• Building a data-driven marketing strategy
• Utilizing digital health to transform patient care
• Evolving your organization’s culture to transform the customer experience.

The expert speaker faculty includes representatives from:
Amazon Web Services, AZ, GSK, Merck, Novartis, WEGO Health, eHealth Initiative, BMS, Lilly, and many more!

Register with discount code DC200 and save $200 on rates.

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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.

Democrats and Republicans Agree: Drug Channels Is Awesome!

I can’t recall any period in my life when our country has been so divided and polarized.

So just in time for our nation’s birthday, I’m happy to report some good news. When it comes to healthcare analysis, both Republicans and Democrats can agree on one thing: Drug Channels is the go-to source!

Each political party’s major drug pricing policy document draws prominently from our research and writing. See below for the patriotic details of this historic bipartisan validation.

Through the Drug Channels Institute, I strive to provide you with fact-based and balanced coverage. I’m proud that your friendly neighborhood blogger can be a unifying force for our troubled nation.

CBI’s 4th Annual Compliance Congress for Specialty Products

CBI’s 4th Annual Compliance Congress for Specialty Products
September 13-14, 2018 | Boston, MA
www.cbinet.com/specialtycompliance

CBI’s 4th Annual Compliance Congress for Specialty Products explores the unique compliance challenges for specialty bio/pharmaceutical companies, pre- and post-commercialization.

While specialty products are immensely valuable to patients, they also bring unprecedented risks for manufacturers. A comprehensive compliance program is essential to correctly assessing risks, including patient assistance programs, non-commercial activities, third-party relationships and pharmacy contracting.

At this meeting, take the opportunity to identify and address the top risk areas for specialty product manufacturers and compare strategies for promoting a compliant culture within your organization.

Register by 7/27/2018 and receive $400* off the standard rate with discount code SPC400.

Valuable Insights from 35+ Thought Leaders, Including:

• Gregg Shapiro, Assistant U.S Attorney, Chief of Affirmative Civil Enforcement Unit, U.S Department of Justice (Boston)
• Charles Graybow, Assistant U.S. Attorney, U.S. Attorney's Office, District of New Jersey
• Bill Hrubes, Vice President, Chief Compliance Officer, ACell, Inc.
• Shoshanna Clark, Head of Operations, NA Ethics & Business Integrity, Sanofi
• Alessandra Ravetti, Executive Director and Assistant General Counsel, Regeneron Pharmaceuticals, Inc.
• Trish Shorey, Privacy Officer, Global Compliance and Risk Management, Shire
• Heidy Abreu, Vice President, Legal and Corporate Secretary, Axcella Health, Inc.
• Kelly Pitt, Director, Legal & Compliance, Sobi, Inc.
• Amy Wilson, MBA, MSJ, Director, Enterprise Compliance, Alexion Pharmaceuticals
• Alessandro Martuscelli, Chief Global Therapeutics Counsel, Bioverativ
• Chad Morin, Senior Director, Healthcare Compliance, bluebird bio
• Brian Conner, Vice President, Head of Corporate Compliance, Strongbridge Biopharma plc
• Sarah Whipple, Senior Corporate and Compliance Counsel, Akebia Therapeutics, Inc.
• David Ryan, Vice President, Associate General Counsel, Chief Compliance Officer, Haemonetics Corporation

Key Reasons to Attend:

• Create a balance between effective patient assistance programs and maintaining compliant practices
• Address the legal issues related to “proactive” versus “reactive” presentations around disease state
• Gain insight into operational safeguards around copay assistance and charitable donations
• Determine if a nurse educator program is necessary and where it should sit within the organization
• Review current and pending state transparency and disclosure legislation
• Assess the controls that compliance or legal need to put in place to ensure that value-based agreements comply with the Anti-Kickback Statute
• Examine the changes in E.U. privacy laws and discuss why it matters to U.S. companies

Register by 7/27/2018 and receive $400* off the standard rate with discount code SPC400.

*Offer expires July 27, 2018; applies to standard rates only and may not be combined with other offers, category rates, and promotions or applied to an existing registration.

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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.