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.

Diplomat Delays Release of 2018 Financial Results and Filing of 10-K, PR Newswire

Last week, Diplomat Pharmacy issued a disturbing press release. The company postponed its fourth quarter earnings report, withdrew its 2019 guidance, highlighted multiple problems in its core specialty pharmacy business, and disclosed massive customer losses from its PBM.

Diplomat is learning that it’s hard to be a small fish in a big pond. Its PBM strategy has failed. Its specialty pharmacy is losing share to the top 4 PBM-owned and insurer-owned specialty pharmacies, which constituted 70% of specialty revenues in 2018.

We’ll have more details about the evolving specialty pharmacy market in our forthcoming 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

In the meantime, I wonder how much longer Diplomat can remain an independent company.

Prescription Medicine Pricing: Our Principles and Perspectives, Sanofi

The gross-to-net bubble is alive and well. For 2018, Sanofi reported that its average list prices ROSE +4.6%, but its average net prices FELL -8.0%. Total rebates were 55% of list prices.

Here’s the key chart from the Sanofi report:

[Click to Enlarge]

As I demonstrate in How Health Plans Profit—and Patients Lose—From Highly-Rebated Brand-Name Drugs: Patients often pay full price for drugs that are sold to insurers at deep discounts.

Assessing the Legal and Practical Implications of Copay Accumulator and Maximizer Programs, Managed Care

This interesting perspective argues that “copay accumulator and maximizer programs remain in a legal gray area.” Payers and their PBMs should be paying attention to these issues.

Man Wakes From Coma With Ability To Understand Health Insurance Policy, The Onion

The Onion reports on a modern medical miracle. Amazing!