Drug Channels News Roundup, September 2018: Gilead’s Price Cuts, Out-of-Pocket Costs, Hospital-Physician Vertical Integration, and WXPN + Me

Autumn is here, and we’ve squirrelled away some great acorns that have fallen from the mighty Drug Channels oak trees:

• Gilead’s new pricing starts to pop the gross-to-net bubble

• New fact-based insights on patient out-of-pocket costs and prescription abandonment

• Cool new stats on hospital-physician vertical integration by specialty

• The U.S. healthcare crisis will probably never end (Sorry.)

Plus, your friendly neighborhood blogger joins the board of 88.5 WXPN, the country’s leading non-commercial Triple A (adult, album, alternative) radio station.

P.S. Follow my daily stream of links to neat stuff at @DrugChannels on Twitter.Recent tweets have highlighted rebates, step therapy, PSAOs, white bagging, PBM network spreads, lab-based microbreweries, and more.

The Cigna-Express Scripts Deal's Intriguing Connections With—And Implications For—AmerisourceBergen and Walgreens

Almost there! Last week, the U.S. Department of Justice (DOJ) Antitrust Division closed its investigation of Cigna’s proposed acquisition of Express Scripts. Click here to read the DOJ’s closing statement.

As with everything in the U.S. drug channel, there’s more to this transaction than meets the eye.

Below, I explain how the transaction will benefit AmerisourceBergen (ABC), which supplies the mail and specialty pharmacies of Express Scripts. But as you’ll see, Express Scripts has been relying less on ABC as a source of supply for its mail and specialty pharmacies.

Meanwhile, the new organization transaction will have few degrees of separation from Walgreens Boots Alliance (WBA). To add to the intrigue: WBA is both ABC’s largest customer and its largest shareholder. Below, I map how Cigna, Express Scripts, AmerisourceBergen, and Walgreens Boots Alliance connect with one another.

Drug channels are organizing and aligning themselves into multifaceted entities that cross traditional functional boundaries. Are you ready to compete, collaborate, and coexist with a complex arrangement that crosses many traditional boundaries?

CBI’s 10th Federal Pricing and Reporting – VA, DoD, PHS

CBI’s 10th Federal Pricing and Reporting – VA, DoD, PHS
November 7-8, 2018 | Baltimore, MD
www.cbinet.com/fedpricing

At CBI’s 10th Federal Pricing and Reporting Summit, elevate the conversation and take a deep dive into the complexity of contracting with the “Big 4” federal programs. In an era of political transformation and industry uncertainty, this highly acclaimed meeting is a must-attend, offering bio/pharma manufacturers best practices and timely updates from government officials and industry counterparts on pricing models and processes for complying with complicated rules and regulations.

With perspectives from Marci Anderson of the VA, Vincent Valinotti of the DoD, Captain Robert W. Hayes of PHS, and Captain Mike Crockett of the BoP, along with a Spotlight Session from J'Aime Conrod and Eric Escobar of UCB, this is a meeting you can't afford to miss!

Visit www.cbinet.com/fedpricing for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code ATT954 and register prior to October 12th.*

You can read all about the Summit here.

Featured Sessions Include:

• Uncover leading strategies and best practices for coordination with the DoD
• Receive answers to critical questions related to TAA Non-Compliant Covered Drugs Policy and its specific role in the Acetris Health LLC v. United States court cases
• Navigate the recent and impending changes to 340B legislation and guidance and their impact on federal contracting and reporting
• Discuss the financial implications of government contracting strategies in the context of GTN
• Analyze and build your understanding of non-FAMP and Federal Ceiling Price with regard to the calculations and data from which they are derived
• Gain insight on key challenges surrounding the Federal Supply Schedule (FSS)
• Hear directly from the VA OIG regarding FSS contract compliance and audit expectations

Visit www.cbinet.com/fedpricing for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code ATT954 and register prior to October 12th.*

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.

It’s Time to Rethink Channel Strategy for Oral Oncolytics

Today’s guest post comes from Akin Odutola, Senior Vice President, Specialty and Branded Product Access, Strategic Global Sourcing, at AmerisourceBergen.

Akin discusses the challenges facing patients treated with oral oncology drugs in community practices and health systems. He then describes AmerisourceBergen’s solution for coordinating patient care and providing aggregated specialty pharmacy data from healthcare providers.

To learn more, download Rethink: Channel Strategy for Oral Oncolytics.

Read on for Akin’s insights.

Preorder Now: Our 2018–19 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

On October 9, 2018, Drug Channels Institute will release The 2018–19 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

It’s the ninth edition of our annual evaluation of the economic and business realities driving U.S. drug distribution. This definitive, nonpartisan resource remains the most comprehensive tool for analyzing the industry. The 2018-19 edition has been thoroughly updated and revised with the latest information.

This year, we are providing you with the opportunity to preorder the 2018-19 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 on or before October 9.

You can pay online with all major credit cards or via PayPal. Email admin@drugchannels.net if you would like to pay by corporate purchase order or check. Preorder and launch pricing discounts will be valid through October 26, 2018.

I’ll share more details when we release the full report in a few weeks. In the meantime, click here to download a free pre-publication draft overview.

If you have any questions before purchasing a license to the report, please email me.

All the best,
Adam

Copay Accumulator Update: Widespread Adoption As Manufacturers and Maximizers Limit Patient Impact

In January, I alerted you to an important new benefit design trend in Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit. It is by far the most widely read article ever published on Drug Channels.

New data from Zitter Health insights (ZHI) suggest that these programs are widely used. Nearly one-third of commercially-insured lives are enrolled in plans that have implemented copay accumulator adjustment or closely-related copay maximizers. (We explain the benefit design math behind maximizers below.)

ZHI also found that a surprising number of plans are already set up to use these programs, but have not done so yet. And many more are planning implementation for 2019 and beyond. Check out the full data below.

Manufacturers have stepped up with more financial support to shield patients from the worst aspects of these benefit designs. This support further inflates the gross-to-net bubble. Plan sponsors’ use of maximizers instead of accumulators has also blunted the impact on patients.

Accumulators, maximizers, and large copay support programs are inefficient solutions to flaws in the U.S. drug channel system. Alas, it looks like they are all now a common—but possibly not even fully utilized—feature of the benefit design landscape.

GTN 2018 - CBI’s Gross-to-Net Summit

GTN 2018 - CBI’s Gross-to-Net Summit
November 15-16, 2018 | Philadelphia, PA
www.cbinet.com/gtn

With the total value of off-invoice discounts and rebates increasing over the last few years, it is pivotal that pharmaceutical and biotech manufacturers stay on the forefront of gross-to-net management. CBI’s GTN Summit, now in the 8th year, is the first step toward positioning your organization for success in the years ahead. You can download the complete agenda here.

The meeting is coming up on November 15-16 at the Hilton Philadelphia at Penn’s Landing and features expert perspectives from companies such as Adamas, Amgen, Amneal/Impax, Astellas, BMS, Chiesi, Daiichi Sankyo, GSK, EMD Serono, Insmed, Medac Pharma, Merck, Sandoz, Spark Therapeutics, Sunovion, Takeda and more, all ready to share their insights into strategic forecasting, accounting estimates, analytics and finance reporting strategies, specifically for life science companies.

Hot Topics on the Agenda Include:

• Benchmarking and survey data illustrating company best practices for GTN management
• Advanced analytics, new technology and accurate data sets for efficiency and reduced revenue leakage
• Real-time analysis of the President’s ‘Patients First’ plan and the state of play for coupons, co-pay programs, accumulators and rebates
• Industry insights on Coverage Gap changes, drug pricing and transparency laws
• Current and future trends in revenue management and value-based contracting
• Strategies for new product launch forecasting and financial planning and financial
• GTN models for product returns and pipeline accruals
• Profitability strategies when negotiating contracts with payers
• Emerging issues with government programs and Medicaid calculations

Visit www.cbinet.com/gtn for further details and to register. Drug Channels readers will save $400 off of the standard rate when they use discount code QZD886 and register prior to September 28th.*

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.

Artificial Intelligence (AI): How Specialty Pharmacies Are Making Medication Package Management More Predictable, Scalable, and Efficient

Today’s guest post comes from Scott Knight, Founder and President at ParcelShield.

Scott explains how artificial intelligence is being used to improve medication package management in specialty pharmacy. It’s an intriguing look at the application of next-generation technologies that can benefit patients.

To learn more about AI in specialty pharmacy, download ParcelShield’s free white paper Man Vs. Machine: How Artificial Intelligence (AI) Makes Specialty Parcel Management More Predictable, Scalable, and Efficient.

Read on for Scott’s insights.

Updated Part B Data: Hospitals Are Displacing Physician Offices Even Faster Than We Thought

The Medicare Payment Advisory Commission (MedPAC), the independent agency that advises Congress on the Medicare program, recently released its latest annual report: June 2018 Data Book: Health Care Spending and the Medicare Program. It’s a charming, 216-page data romp through all aspects of Medicare. Chapter 10 focuses on prescription drugs.

This year’s report provides new and revised details about the locations where Part B buy-and-bill spending occurs. As you will see below, physician offices account for a smaller share of spending than what we previously reported. Hospital outpatient departments account for a higher share. What’s more, the new MedPAC data show that the shift to hospitals is happening even faster for oncology products.

For years, I have been buzzing about the growing role of hospital outpatient departments in the buy-and-bill market. I’m afraid that these data will sting those hoping for a physician office rebound.

The Medical Affairs Launch Strategy Summit

The Medical Affairs Launch Strategy Summit
October 22-23, 2018 | Alexandria, VA

The World Congress' Medical Affairs Launch Strategy Track is designed to bring multiple stakeholders together including medical affairs executives, payers, IDNs and advocacy to examine stakeholder engagement opportunities and overcome patient access challenges.

As the role of medical affairs becomes increasingly important in ensuring product launch success, it is imperative pharma and biotech executives examine pre-launch strategies, develop effective scientific, medical and commercial communications and build stakeholder partnerships.

Key Topics in 2018 include:

• Define the role of “value” and determine an effective pre-launch strategy to ensure patient access
• Navigate pre-launch channels and develop a unified and scientific message
• Engage with key stakeholders including physicians, patients, and payers
• Network with senior medical affairs leadership to collaborate on common challenges and establish best practices
• Attend an expert-led, intensive workshop on the Development of a Product Launch Strategy
• Hear how medical affairs can partner with RWE and HEOR teams for commercialization projects

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.

How 2017’s Fastest-Growing, Private Specialty Pharmacies Highlight an Industry Slowdown

Time for our annual review of the Inc. 5000 list, the magazine’s annual ranking of the fastest-growing private companies in the United States. The list offers a valuable snapshot of the dynamic specialty pharmacy industry. This marks our sixth annual review of the list.

We have identified nine specialty pharmacies on the 2018 list, which is based upon revenue growth from 2014 to 2017. Annual revenues range from $61.3 million to $1.4 billion. The companies on the list are larger but growing more slowly than those in our previous analyses.

The pharmacies and key stats are listed below. For the eight companies returning from last year’s list, median revenues in 2017 grew by 14%. This marks the second year of slower growth.

This year’s list showcases the maturation of the specialty pharmacy industry. The go-go growth years are fading. It’s becoming harder to enter the industry and more challenging to scale a business. OptumRx is rumored to be acquiring Avella Specialty Pharmacy, the largest company on the list. Everyone has to grow up someday.

3rd Annual Life Sciences Value-Based Contracting

3rd Annual Life Sciences Value-Based Contracting
October 22-23, 2018 | Alexandria, VA

Join cross-industry stakeholders at the 3rd Annual Life Sciences Value-Based Contracting Track, part of the Value-Based Health Care Congress, and learn how to design successful value-based agreements between manufacturers and payers.

How will you benefit?

• Explore key strategies and opportunities in value-based contracting with payers
• Examine value-based contracting terms, conditions, and metrics necessary to implement a successful value-based strategy
• Hear a case example of how Spark Therapeutics created an innovative contracting model and outcomes-based agreement for the first FDA-approved gene therapy
• Gain a high-level overview from CMS of the future of pharmaceutical regulations
• Uncover a shared vision amongst pharma, plans, PBMs, and providers for reducing and sharing risk
• Understand how to partner with ACOs and IDNs to ensure the optimal use of treatment to support the performance of the drug and drive the best outcomes
• Leverage technology and experience to implement successful and scalable innovative contracts
• Discuss the implications of the AMP rule and Best Price concerns
• Mitigate the risk of fraud, abuse, privacy, and anti-trust allegations

Key speakers include executives from:

Pfizer | Novartis | Aetna | Express Scripts | CMS | J&J | Horizon Blue Cross Blue Shield of New Jersey | Spark Therapeutics | GSK | and many more!

Download the brochure for the full agenda and speaker line-up.

ACT NOW! Register with discount code DC200 and save $200 off current rates.

This event is part of the Value-Based Health Care Congress, a 4-track event bringing together stakeholders from all walks of health care to break down silos, coordinate efforts, and bend the cost curve. Benefit from shared Keynotes and networking breaks with the entire Congress delegation.

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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.