Drug Channels News Roundup, February 2019: Diplomat’s Troubles, Sanofi’s Gross-to-Net Bubble, and the Legality of Accumulators

Winter—or at least February—is almost over! Celebrate the imminent return of spring with our selection of noteworthy news from around the drug channel. In this issue:

• My $0.02 on Diplomat’s failures and the new realities of specialty pharmacy

• Sanofi’s 2018 gross-to-net bubble

• Legal issues for copay accumulators

Plus, The Onion reports a health insurance miracle!

P.S. My @DrugChannels Twitter account now has more than 7,000 followers. Join the fun for my daily commentary on the industry’s news.

The Top 15 U.S. Pharmacies of 2018: M&A Reshapes the Market

Next week, Drug Channels Institute will release our 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the tenth edition of our popular and comprehensive examination of the entire drug pricing, reimbursement, and dispensing system.

The exhibit below—one of 180 in our new report—provides a first look at the 15 largest pharmacies, ranked by total U.S. prescription dispensing revenues for calendar year 2018.

As you will see, vertical and horizontal mergers and acquisitions are reshaping the pharmacy and PBM industries—and enabling the big to get even bigger. I highlight some of the major transactions that affected our ranking.

For a sneak peek at the complete report, click here to download a free pre-publication draft overview (including the table of contents and a list of exhibits).

CBI’s 5th Annual Formulary, Copay and Access Summit

CBI’s 5th Annual Formulary, Copay and Access Summit
April 9-11, 2019 | San Francisco, CA
www.cbinet.com/formulary

Accumulator programs, state-level copay legislation, formulary exclusions, high-deductible plans, changes in benefit design, NDC blocks, step therapy programs - the challenges continue to arise. This April, the industry comes together to tackle these topics and more at the Formulary, Copay and Access Summit in San Francisco.

Visit www.cbinet.com/formulary for further details and to register. Drug Channels readers will save $300 off the standard rate when they use promo code KRA435 and register prior to March 22nd.*

Download the agenda here and see in-depth coverage on critical issues, such as:

• Explore perspectives on accumulator adjustment programs and identify trends for the future
• Demystify proposed legislations and policies for lower drug prices
• Overcome challenges of high-deductible plans, copay caps and the evolving healthcare landscape
• Gain insight on strategies for fast tracking prior authorization and copay assistance for specialty prescriptions
• Gain insight on key stakeholder challenges to discover new methods for manufacturers to collaborate with payers, pharmacists and physicians to improve patient outcomes
• Develop best practices to communicate with field reps when there are issues with co-pay cards
• Break down rebates and reimbursements and the impact on pricing strategies

Visit www.cbinet.com/formulary for further details and to register. Drug Channels readers will save $300 off the standard rate when they use promo code KRA435 and register prior to March 22nd.*

Wait a minute – we almost forgot the most exciting part! On April 9th, benefit from a pre-conference workshop on Copay Accumulator Programs, where experts in the field will discuss navigating the complexities and impact of the emerging cost-shifting benefit design. You can tack this workshop on to your Formulary Summit registration, or just attend the workshop itself. Learn more here.

CBI will see you there!

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates, clinic/hospital rates, non-profit rates other offers. 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.

How Health Plans Profit—and Patients Lose—From Highly Rebated Brand-Name Drugs

My Wall Street Journal op-ed (Don’t Blame Drug Prices on ‘Big Pharma’) has received a lot of attention.

Especially notable was a letter to the editor from American Health Insurance Plans (AHIP). It claims that “the savings that insurance providers negotiate are returned directly to consumers through lower premiums and out-of-pocket costs."

Don’t believe this misleading half-truth. It distorts the primary argument of my WSJ op-ed: Patients often pay full price for drugs that are sold to insurers at deep discounts.

Below, to show you why, I follow the dollar for an expensive, highly rebated brand-name drug used by a consumer with a high-deductible health plan. As you will see, the consumer pays more than twice the true discounted price of the drug. Meanwhile, the health plan pockets a large rebate.

That's the uncomfortable reality of the gross-to-net bubble that AHIP wants to hide. Insurers may not use rebates to lower the out-of-pocket costs for the patient whose prescription generated the rebate. And at the same time, AHIP indignantly blames "the prices drugmakers set." We all deserve better.

CBI’s 4th Edition Drug Pricing Transparency Congress

CBI’s 4th Edition Drug Pricing Transparency Congress
March 25-26, 2019 | Philadelphia, PA
www.cbinet.com/drugpricing

From implementation and changes made across the country in states like Oregon, California and Nevada to the release of the long-awaited HHS proposed rebate rule, complexities continue to arise for industry. According to HHS Secretary Alex Azar, this proposal “has the potential to be the most significant change in how Americans’ drugs are priced at the pharmacy counter, ever.”

With all that is going on with drug pricing within state and federal laws, uncertainty arises for stakeholders with responsibilities in commercialization, reimbursement, pricing and compliance practices. Is your organization prepared to act? And fast?

Join CBI’s 4th Edition Drug Pricing Transparency Congress to strategize and gain best practices regarding drug pricing transparency to overcome challenges and remain compliant.

Register by Friday, March 15 and save $300* off the standard rate with promo code DCB300.

Key Topics Addressed:

• Pre-Conference Workshop (March 25): Medicare Drug Pricing and Reimbursement – Deep Dive into the Emerging International Pricing Model
• Review drug pricing transparency legislation and litigation — Including a deep-dive, state-by-state analysis of laws in Oregon, California and Nevada
• Explore how the future of drug pricing transparency regulation and the proposal to exclude rebates will impact commercialization, reimbursement and drug pricing models
• Deliver comprehensive legal interpretations of drug pricing transparency and reporting laws currently on the books and the policy outlook for 2019
• Benchmark overall state compliance practices related to drug pricing reporting
• Discuss organizational shifts within legal and compliance departments to handle drug pricing obligations and reporting

Hear from Industry Experts, Including:

• Debbie A. Walters-Francique, Vice President, Assistant General Counsel, Pfizer Inc.
• John A. Murphy III, Deputy General Counsel, BIO
• Amie Phillips Pablo, Associate Director, Compliance Government Reporting, Novo Nordisk
• Brian A. Bohnenkamp, Partner, FDA & Life Sciences Practice, King & Spalding LLP
• William Harris, Assistant General Counsel, US Market Access, Sanofi
• Susan Hibbard, Senior Manager, Transparency and Disclosure, Ethics and Compliance, Boehringer Ingelheim
• David Gibbons, Associate, Hyman, Phelps & McNamara, P.C.
• Joanne Chan, Assistant General Counsel, PhRMA
• Kendra Martello, Senior Director, Public Policy, Government Affairs and Public Policy, Mallinckrodt Pharmaceuticals
• James Kim, Attorney, McDermott Will & Emery LLP
• Sarah diFrancesca, Partner, Cooley LLP
• Trevor L. Wear, Partner, Sidley Austin LLP

Don't miss this critical dialogue. Register by Friday, March 15 and save $300* off the standard rate with promo code DCB300.

*Offer expires 3/15/19; 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.

Pharmacy Fraud Within Pharmaceutical Co-Pay Programs: What You Need To Know

Today’s guest post comes from Tim Ogren, Senior Vice President, Products at TrialCard.

Tim discusses the rise in pharmacies making fraudulent claims and the costs of these claims. Learn more in Trialcard’s white paper: Detecting Pharmacy Fraud: Is Your Brand’s Co-Pay Program Protected?

TrialCard developed Spotlight®, a pharmacy fraud detection product for manufacturers. To learn more, contact Tim Ogren, TrialCard’s Senior Vice President of Products, at tim.ogren@trialcard.com.

Read on for Tim’s insights.

Preorder Now: Our 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

On March 5, 2019, Drug Channels Institute will release The 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

This new tenth edition is the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing and distribution system.

The 2019 edition has been significantly expanded and restructured since last year’s edition. We have added new industry data sources, deepened our coverage of many topics, and added more trending information. There are also 2 new chapters and many new exhibits.

CLICK HERE to download a free pre-publication draft overview
(including the Table of Contents and a List of Exhibits).

This year, we are providing you with the opportunity to preorder this thoroughly updated and revised 2019 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 before March 5.

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to email us if you would like to pay by corporate purchase order or check.

Special pricing discounts will be valid through March 22, 2019.

As always, thank you for your interest in our work. If you have any questions before purchasing a license to the report, please email me. Enjoy!

Express Scripts Confirms It (Again): Minimal Growth in Drug Spending and Prescription Costs

Last week, Express Scripts released its 2018 Drug Trend Report. (Free download.)

As you will see below, drug spending is not “skyrocketing” or “soaring.” All payer types experienced extremely low growth in pharmacy benefit spending. Average net (post-rebate) drug costs declined.

These data also shed light on specialty drug spending. Greater use of specialty medications—not cost increases—was the most significant driver of spending.

The latest Express Scripts data confirm the cost and spending slowdown that I have highlighted in previous Drug Channels articles. I’ll ask again: Can someone please alert the media and our elected officials?

Meanwhile, the report dodges crucial questions about the effect on patients. Overall drug spending is growing very slowly—but the sickest Americans are stuck paying ever-higher out-of-pocket costs for drugs with net prices that are flat or declining. That's worse than getting an empty box of chocolates for Valentine's Day.

Expanded Access Programs 2019

Expanded Access Programs 2019
March 27-28, 2019 | The Inn at Penn | Philadelphia, PA
www.cbinet.com/EAP

CBI’s Expanded Access Programs 2019 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.

Drug Channels readers will save $300 off of the standard registration rate
when they use code AGK946.* REGISTER TODAY!

Join Expert Thought Leaders Including:

• Marcel van Kuijck, Vice President UltraPrograms, Global Medical Affairs, Ultragenyx Pharmaceutical Inc.
• Tom Watson, Executive Vice President, Early Access Programs, Bionical
• Naomi Lopez Bauman, Director of Healthcare Policy, Goldwater Institute
• Sharon Ellison, DUHS IRB Chair; pharmacist, Duke University Hospital
• Gretchen M. Randlett, Consultant – Clinical Trial Commercial Product Strategy and Process, Eli Lilly and Company
• Alison Bateman-House, Ph.D., MPH, MA, Assistant Professor, Division of Medical Ethics, NYU Langone Health; Co-Director, NYU School of Medicine Working Group on Compassionate Use and Preapproval Access (CUPA)
• Dawn Sullivan, Department Manager, Global Medical Affairs & UltraPrograms, EAPs/ISTs, Ultragenyx Pharmaceutical Inc.
• Erika Segear, Ph.D., RAC, Associate Director of Regulatory Affairs, Duke University

Key Topics to Be Addressed:

• Implement practical guidelines for responding to inquiries around Right to Try
• Assess whether there is an opportunity to seek reimbursement through traditional payer channels
• Navigate the development process of sibling Early Access Programs
• Bring the patient voice into the development of Early Access Programs
• Learn how global organizations are handling new legislation on patient privacy
• Explore how crowd funding bridges Right to Try, stem cell and new frontiers
• Discuss post-clinical trial access when a program does not meet endpoints

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 readers will save $300 off of the standard registration rate
when they use code AGK946.* 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.

My Wall Street Journal Op-Ed: Don’t Blame Drug Prices on ‘Big Pharma’

Yesterday, The Wall Street Journal published my op-ed: Don’t Blame Drug Prices on ‘Big Pharma’. The article text is pasted below for those who don't subscribe.

I wrote this piece for a general business audience, though my arguments about rebates and patient out-of-pocket costs will be familiar to regular readers of Drug Channels. Alas, I had to omit such insider terms as gross-to-net bubble, direct and indirect remuneration, and SpongeBob SquarePants.

A personal note: I have been reading the WSJ daily since I was 18 years old. It’s a genuine thrill to see my byline on an op-ed in this newspaper. Another item off my bucket list!

Partnering with IDNs BioPharma Strategy Summit West

Partnering with IDNs BioPharma Strategy Summit West
March 20-21, 2019 | Scottsdale, AZ
www.cbinet.com/IDN

As part of an evolving healthcare environment, the life science industry is continually challenged to be effective in how it engages health system partners. It is critical that discussions evolve to meet the needs of today and also where healthcare is headed tomorrow.

To address the challenges and opportunities ahead, join a distinguished group of industry pioneers at CBI’s Partnering with IDNs BioPharma Strategy Summit West – an important event for learning how to best meet the needs of these evolving networks for better patient outcomes.

REGISTER TODAY!

Drug Channels subscribers will save $400 off the standard registration rate
when they use promo code RMD779* by March 1, 2019.

Diverse Perspectives from Industry Pioneers:

• Matthew Portch, Vice President, Managed Markets, Sunovion
• Marla Weigert, Vice President, System Pharmacy Services, President, Dignity Specialty Pharmacy
• JD Fischer, Sr. Health Policy Analyst, Policy Division, Washington State Healthcare Authority
• John Robicsek, Assistant Vice President, Strategy, Business and Program Development, Pharmacy Administration, Atrium Health
• Jacob Jolly, Program Director, Specialty Pharmacy, Vanderbilt University Medical Center
• Melissa Leedock, Director Pharmacy Formulary and Commercial Operations, Pharmacy Services, Capital Blue Cross
• Jay Weaver, PharmD, MPH, Divisional Vice President, Enterprise Pharmacy, Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas
• John Musil, Founder and Chairman, Avella Specialty Pharmacy
• Dawn Bina, Account Manager, BioPharm, Novo Nordisk Inc.
• Lauren Vela, Senior Director, Member Value, Pacific Business Group on Health

Discuss Innovative Partnership Models, Compare Population Health Management Strategies and:

• Explore employer trends in cost sharing, utilization management, pharmacy network strategy and more
• Assess the best approach for working with providers on data collection and integrity
• Discuss how to take pilot key learnings and craft a meaningful IDN value story
• Consider engagement strategies for risk-based contracting with evolving IDNs
• Examine the different approaches to IDN-SP integration and how manufacturers can utilize this information for strategic planning
• Describe the benefits of collaboration across the industry to optimize and standardize outcomes reporting
• Plus! Benefit from 12+ hours of networking with manufacturers, health systems, payers, specialty pharmacies
• And More!

REGISTER TODAY!

Visit www.cbinet.com/IDN for more information. Drug Channels subscribers will save $400 off the standard registration rate when they use promo code RMD779* by March 1, 2019.

*Offer expires 3/1/19, 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.

Shaping an Effective Data and Analytics Strategy for Your Oncology Therapy in 2019

Today’s guest post comes from Derek Rago, VP/GM of Data, Evidence & Insights at McKesson Life Sciences.

Derek discusses how biopharma companies can use real-world evidence to gain efficiencies and build effective strategies. He also outlines the key elements of an effective data and analytics strategy.

To learn more about McKesson’s data, evidence and insights solutions, visit McKesson.com/DataInsights.

Read on for Derek’s insights.