Drug Channels News Roundup, March 2019: The Insulin Gross-to-Net Bubble, HHS Blasts Rebates, a New 340B Report, and Theranos

Spring has finally reached our worldwide headquarters here in lovely downtown Philadelphia. (See photo at right.) Before your allergies kick in, please inhale this month’s selection of noteworthy news stories:

• Eli Lilly discloses the bonkers gross-to-net economics for Humalog insulin

• John O’Brien of HHS blasts the current drug pricing system

• The Community Access National Network’s 340B Commission releases an excellent new report—and you can read my testimony, too!

Plus, a compelling new HBO documentary delves further into the sordid tale of Elizabeth Holmes and Theranos.

P.S. Join the more than 7,200 people who follow my comments and links at @DrugChannels on Twitter.

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SAVE THE DATE: Drug Channels Institute will hold a special live, interactive webinar titled Preparing for a World Without Rebates on April 12, 2019, at 12 PM ET. Details and registration information will be announced on Monday.

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Latest CMS Forecast: Hospitals and Physicians Will Grab Most of the $1.3 Trillion Increase in U.S. Healthcare Spending

The econowonks at the Centers for Medicare & Medicaid Services (CMS) have recently published new projections for U.S. National Health Expenditures (NHE). You’ll find links and my data analysis below.

As you will see, total U.S. spending on healthcare is projected to grow, from $3.5 trillion in 2017 to $4.8 trillion in 2023. Spending on hospitals and professional services is expected to grow by a combined $750 billion—about 59% of CMS’s projected $1.3 trillion increase in U.S. healthcare spending.

CMS also projects that spending on outpatient prescription drugs will account for only 9% of the total increase in U.S. healthcare spending. What’s more, total growth in spending on healthcare administration by the government and insurance companies is roughly equivalent to the growth in total spending on outpatient prescription drugs. Guess which of these categories will contribute more to patients’ well-being!

These sobering figures put the debate about drug spending in context. To say that slashing drug spending would solve the healthcare spending problem is like saying you can afford a New York City penthouse by making fewer trips to Starbucks.

CBI’s 21st Annual Medicaid and Government Pricing Congress

CBI’s 21st Annual Medicaid and Government Pricing Congress
May 20-22, 2019 | Orlando, FL
www.cbinet.com/medicaid

Exclusive Offer – Register by April 5th
and save $500* with promo code MDCDC5.

As our healthcare system proves to be more turbulent than ever, with a slew of regulatory and political announcements, hearings, the never-ending drug pricing debate, and most recently, FDA Commissioner Scott Gottlieb announcing his resignation and talks of doing away with rebates and/or PBMs, the time has never been more opportune to convene with industry colleagues at the 21st Annual Medicaid and GP Congress this Spring in Orlando.

The 2019 agenda boasts 55+ speakers, 30+ customizable sessions and 7 hours of dedicated networking time. Bio/pharma, regulatory and government experts representing Johnson & Johnson, OIG, Sunovion, Pfizer, Ingenus, Chiesi, AstraZeneca, Amneal, Hikma, CMS, Bristol-Myers Squibb, Apotex, Fresenius Medical Care, UCB, Alvogen, PhRMA, Jazz Pharmaceuticals, Insmed, Arbor Pharmaceuticals, Eisai, Goldwater Institute, Amicus Therapeutics and many others are set to drive the dialogue.

Stay on the pulse with timely, up-to-the-minute insights on the political and regulatory landscape, industry hot topics and best practices:

• Political and Legislative Trends
• 340B Guidance
• State and Federal Transparency Regulations
• Civil Monetary Penalties
• Value-Based Frameworks
• State Invoicing and Disputes
• Contracting with PBMs
• Changes to Medicare
• Bona Fide Service Fees
• GTN and Accruals
• And many other critical topics. Download the complete agenda.

Drug Channels Readers – Register today with promo code MDCDC5 and save $500.*

*Discount offer valid through 4/5/2019; applies to standard rates only and may not be combined with other offers, categories, promotions or applied to an existing registration. Offer not valid on workshop-only or 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.

A World Without Rebates: Predictions for How the Channel Will Evolve and Why Drug Prices Will Go Down

Two years ago on Drug Channels, I wrote about a shift from rebates to discounts as a black swan event—a massively important yet unexpected break from current practice.

Given recent developments, I believe that we are moving ever closer to a world without rebates. Yet there are many unanswered questions were such a radical shift to occur.

As I see it, a world without rebates would force manufacturers to use net price as a competitive weapon. If PBMs and payers behave logically, then drug prices would drop as manufacturers are forced to compete more aggressively for prescriptions.

These conclusions are based on the predictions about market changes that I describe below. Other key implications include:

• Winner-take-all auctions and narrow formularies for categories with therapeutically comparable products

• Broader formularies to encourage indication-based price competition for other therapeutic categories

• Faster patient access to new drugs with superior efficacy for certain subgroups of patients

• Fewer pharmacy benefit tiers and a greater ability for physicians and patients to make cost/value tradeoffs

• The popping of the gross-to-net bubble and declines in brand-name list prices

• Slower growth in drug prices

This is a longer-than-average post, but I still only scratch the surface in speculating how our world could change. If the black swan continues to spread its wings, I’ll expand in future posts on implications for drug makers, pharmacy benefit managers (PBMs), wholesalers, pharmacies, health plans, and patients. As always, I encourage you to leave your comments and ideas below.

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SAVE THE DATE: Drug Channels Institute will hold a special live, interactive webinar titled Preparing for a World Without Rebates on April 12, 2019, at 12 PM ET. Details and registration information will be announced in the first week of April.

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CBI’s Real-Time Benefit Check & ePrior Authorization Summit

CBI’s Real-Time Benefit Check & ePrior Authorization Summit
May 14-15, 2019 | Philadelphia, PA
www.cbinet.com/eprior

CBI’s Real-Time Benefit Check & ePrior Authorization Summit is your chance to stay on the pulse of groundbreaking advancements and innovations in real-time benefit verification and prior authorizations in this evolving and complex healthcare environment. Convene with industry stakeholders from bio/pharma, PBMs, payers, health systems, prescribers and system solution providers to discuss the latest in standards, adoption and best practices to enable streamlined healthcare team workflow and quicker access to therapy to improve patient outcomes.

Visit www.cbinet.com/eprior for further details and to register. Drug Channels readers will save $300 off the standard rate when they use promo code ANS268 and register prior to April 5th. *

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

• Real-Time Prescription Benefit and ePrior Authorization
• New Regulations from CMS on Medicare Part D and RTBT
• Implementing Medical Specialty Drug ePA
• eBV and ePA Frameworks for the Future of the Medical Benefit
• Reducing Friction in the Prescribing Process
• Fixing ePrior from a Prescriber Perspective
• Collaborating to Improve Patient Outcomes
• Low Utilization of RTBC and ePA Among Stakeholders
• Turnaround Time for Accelerated Patient Access to Therapy
• Real-Time Benefit Data at the Point of Prescription
• HL7 Da Vinci Project for Value-Based Care Interactions between Payers and Providers

Featured Sessions:

• Trailblazer Talk- Hear Updates on Industry Scorecard
• Melissa Paige, Oncology/Infusion Patient Access Principal Coordinator, University of Virginia
• Eric Weidmann, M.D., Chief Medical Officer, eMDs
• Evan Grossman, Vice President, Integration Services, athenahealth
• Working Group for Specialty Pharmacy Advancements and Standard Updates in Real-Time Prescription Benefit and ePrior Authorization
• John Klimek, R.Ph., Senior Vice President, Standards and Industry Information Technology, NCPDP

Visit www.cbinet.com/eprior for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code ANS268 and register prior to April 5th. *

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.

Employers Are Absorbing Even More Manufacturer Rebates from Their PBMs

The likelihood of a radical restructuring of the U.S. drug channel has never been greater. A serious effort exists to remove or decrease the role of rebates.

Today, we shed light on one crucial aspect of the current rebate system: how employer-sponsored health plans access the billions of dollars in manufacturer rebates that are negotiated by their pharmacy benefit managers (PBMs). For this analysis, we rely on the Pharmacy Benefit Management Institute’s (PBMI) excellent new reports.

As you will see, employers are receiving an increasing share of the rebate money collected by pharmacy benefit managers. However, employers’ rebate agreements with PBMs vary widely. Important differences also exist in rebate arrangements for traditional vs. specialty drugs.

Despite these data, we still don’t know how much of these rebates offset out-of-pocket costs for the patients whose prescriptions generated the rebate funds. As I warned last August: The focus of rebate reform will turn from PBMs to the plan sponsors that are absorbing rebate dollars.

3rd Annual Manufacturers’ 340B Summit

3rd Annual Manufacturers’ 340B Summit
May 16-17, 2019 | Philadelphia, PA
www.worldcongress.com/manufacturers340B

Join pharmaceutical manufacturers, legal experts, thought leaders, and leading regulatory strategists at World Congress’ 3rd Annual Manufacturers’ 340B Summit, May 16-17, in Philadelphia. This event is your first opportunity of 2019 to ensure you have the internal strategies in place to effectively execute 340B processes.

Register with promo code DC200 and save an additional $200 on current early bird rates.

How will you benefit from attending?

• Review the scope of the 340B Program and possible changes to the program
• Utilize data to identify duplicate discounts and other inconsistencies
• Explore challenges of contract pharmacies and solutions that work for all stakeholders
• Evaluate the implications of penny pricing, limited, distribution networks, ceiling price calculation, and civil monetary penalties
• Survey best practices for working with the states and covered entities

Shouldn’t you be there?

Register with promo code DC200 and save an additional $200 on current early bird rates.
Can’t leave the office? Live stream this event from the convenience of your office.

This event, co-located with the 4th Annual Covered Entities’ 340B Summit, provides comprehensive coverage of the 340B program.

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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.

Delivering an Enhanced Patient and Prescriber Experience for Personalized Therapies

Today’s guest post comes from Rob Brown, VP/GM of Pharmacy Solutions at McKesson Life Sciences.

Rob provides insights on designing patient-centric channel strategies. He also reviews the role of centralized hub services with an integrated specialty pharmacy.

Click here to download McKesson’s case study. It describes how an emerging biotech company streamlined access for patients with an acute complex condition.

Read on for Rob’s insights.

NEW: The 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

I am pleased to announce our new 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, available for purchase and immediate download.

• Click here to download a free report overview (including the Table of Contents and a List of Exhibits)

• New Drug Channels Institute Study Analyzes U.S. Drug Pricing and Rebates, Predicts Further Shakeout and Consolidation (press release)

We’re offering special discounted pricing if you order before March 22, 2019!

The 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers is the only resource of its kind available anywhere. With 180 proprietary charts, exhibits, and data tables, the report provides the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system.

The 2019 edition has been significantly restructured since last year’s edition. Many sections and chapters have been expanded or reorganized to better cover the latest industry developments. Throughout the report, we have added new industry data sources, deepened our coverage of many topics, added more trending information.

Below, you can read more info and some behind-the-scenes tidbits. See page viii of the free report overview for a summary of the many significant changes and updates in this 2019 edition. Happy reading!

P.S. If you would like to pay by corporate purchase order or check, please email Tamra Feldman. If you preordered the report, you should have already received an email with download instructions. Please contact us if you did not receive the email.

Join Me for Asembia’s Specialty Pharmacy Summit 2019

Asembia’s Specialty Pharmacy Summit 2019
April 29 to May 2, 2019 | Las Vegas
www.asembiasummit.com

Please join me at Asembia's Specialty Pharmacy Summit 2019 which will take place from April 29 to May 2, 2019 in Las Vegas.

This is a must-attend event for anyone connected to specialty pharmacy. You'll meet an impressive diversity of people from pharmacies, manufacturers, health plans, wholesalers, hospital systems, pharmacy benefit managers, patient advocacy groups, and more. Click here to view the agenda.

This year, I will again lead the Featured Session, titled Specialty Pharmacy Industry Outlook: What's Next? I'll be joined by Doug Long from IQVIA and Lisa Gill from J.P. Morgan Securities. And of course, I'm looking forward to another epic selfie!

Here's my review of last year's Summit: Reflections from #Asembia18: The State of Specialty Pharmacy 2018.

Read on for more details about this great specialty pharmacy event and register now. See you in Vegas!

A MESSAGE FROM ASEMBIA

As the nation’s largest annual healthcare conference for specialty pharmacy, Asembia’s 2019 Specialty Pharmacy Summit will welcome 6,500+ attendees from over 1,200 pharmacy providers, health systems, pharma/biotech manufacturers, payers, drug wholesalers and many other specialty pharmacy stakeholders.

Don’t miss this unique opportunity to gain in-depth understanding of specialty pharmacy from industry experts who share current information and insightful commentary on the many facets of the $150+ billion specialty pharmacy channel.

The value-packed 2019 agenda includes interactive business seminars, continuing education sessions, business workshops, extraordinary networking events and engaging exhibits.

Register and learn more at www.asembiasummit.com.

Watch the 2018 Video Highlights.

Asembia's 2018 Specialty Pharmacy Summit - Event Highlights from Asembia on Vimeo.

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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.