Drug Channels News Roundup, October 2019: Express Scripts + 340B, Government Negotiation, Compounding Pharmacies, and Red Meat (with Onion)

Eeek! Time for my Halloween roundup of Drug Channels news stories.

In this issue:

• Creepy! Express Scripts invests in 340B

• Shocking! What Americans really think about government drug price negotiations

• Scary! A terrifying tale of compounding pharmacies and the Cats movie

Plus, the best take on nutrition research I have ever read.

P.S. Join the more than 8,300 people who follow @DrugChannels on Twitter. My recent tweets have highlighted biosimilars, Part D in 2020, generic drug approvals, H.R.3 and its effects, 340B hypocrisy, ICER, Jamaican monetary policy, billionaires, and more.

Even More Independents Avoid 2020 Part D Preferred Pharmacy Networks

Last week, I highlighted the largest pharmacy chains that will participate in next year’s Medicare Part D prescription drug plans (PDP).

Today, I examine how independent pharmacies will participate as preferred cost sharing pharmacies via the pharmacy services administrative organizations (PSAOs) that that represent these pharmacies in negotiations with plans.

For most independent pharmacies and their PSAOs, the profit sacrifices of Medicare Part D preferred networks are apparently no longer worth the incremental volume. As I predicted last year, they are starting to reject preferred networks:

• McKesson’s Health Mart Atlas will be the only PSAO whose members’ level of participation in preferred Part D networks will be comparable to that of the big chains.

• Pharmacy members of AmerisourceBergen’s Elevate network will again skip preferred status in the major Part D networks.

• Members of Cardinal Health’s PSAOs and the independent Arete Pharmacy Network will be preferred in many fewer 2020 networks compared with 2019.

You’ll find details and a handy scorecard below.

With independents fleeing preferred networks, will the Centers for Medicare & Medicaid Services (CMS) take a closer look at the market? And are independents really ready to say that they are never ever, ever, ever getting back together with preferred networks?

CBI’s Specialty Therapies and Biosimilars Congress

CBI’s Specialty Therapies and Biosimilars Congress
January 22-24, 2020 | Miami, FL
www.cbinet.com/specialtytherapies

Kick off 2020 in Miami at the Specialty Therapies and Biosimilars Congress! Come together with colleagues from across the industry to tackle the challenges involved in managing the cost and quality of innovative therapies that are controlling or conquering diseases that were once considered untreatable.

Visit www.cbinet.com/specialtytherapies for further details and to register. Drug Channels readers will save $400 off the standard rate when they use promo code SPT400 and register prior to November 22nd.*

The quest to drive better outcomes, ensure access and manage costs is more vital than ever. Don’t miss the chance to be part of the conversation. Sign up to see the agenda here.

Experts from Blue Cross Blue Shield of Michigan, MedImpact Healthcare System, Fairview Specialty Pharmacy, Ochsner Health System, Boehringer Ingelheim, AHIP, Hemophilia Alliance, BBCIC, Mayo Clinic, Sunovion Pharmaceuticals and more will lead robust discussions on topics such as:

• Biosimilar Litigation and Patent Law
• Cell and Gene Therapy Reimbursement and Funding Strategy
• Medicare Report 2020
• Barriers to Entry – Challenges and Solutions for Entering the Marketplace
• Collaboration in a Complicated Landscape – The Role of Specialty Pharmacies in Controlling Cost
• Managing the Patient’s Journey – Payer Contracts, Points of Care and Formulary
• Real World Data and Demonstrated Value – The Care for Biosimilars and Expensive Therapies
• The Evolving Role of the Specialty Pharmacy in Oncology Management

Visit www.cbinet.com/specialtytherapies for further details and to register. Drug Channels readers will save $400 off the standard rate when they use promo code SPT400 and register prior to November 22nd.*

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.

---

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

Winning? CVS, Kroger, and Walmart Expand in 2020 Part D Preferred Pharmacy Networks

In Preferred Pharmacy Networks Rebound in 2020 Medicare Part D Plans, I highlighted how those networks will again dominate next year’s Medicare Part D prescription drug plans (PDP).

Today, I examine chain pharmacies’ participation in the major 2020 Part D preferred networks that the nine largest plan sponsors offers. Some highlights:

• CVS will retain its position as a preferred pharmacy in many 2020 networks, while Walgreens will pull back on its preferred pharmacy participation. 

• For the first time in years, Rite Aid will expand its participation in plans that are independent of its EnvisionRx subsidiary.

• Walmart will regain its position as the chain most committed to preferred networks. Kroger and Albertsons will maintain the strong positions that they have established over the past few years.

Below, we provide you with a handy table for scoring each chain’s participation and all changes from 2019 to 2020.

The winners will gain and/or retain Part D prescription volume, but profits will suffer due to direct and indirect remuneration (DIR) price concessions, a.k.a., DIR fees. The retail chains have never clearly disclosed how they tradeoff prescription volume for profits. Remember: you can’t spell “pyrrhic victory” without victory.

Preferred Pharmacy Networks Rebound in 2020 Medicare Part D Plans: Details on WellCare, CVS Health, Humana, Cigna, and More

The Centers for Medicare & Medicaid Services (CMS) has released its data on the 2020 Medicare Part D plans.

Our exclusive analysis of these data reveals that preferred cost sharing pharmacy networks will maintain their dominance as an established component of Part D benefit design. For 2020, 95% of Medicare Part D regional prescription drug plans (PDP) will have a preferred network. In 2019, 92% of plans had such a network.

Below, I provide historical data on preferred networks’ growth and then discuss the top nine companies offering the 2020 plans. Humana is the only major plan sponsor to offer a national plan with an open network for 2020.

The prominence of preferred networks will again pressure pharmacy profits. That’s because pharmacies must pay direct and indirect remuneration (DIR) price concessions, a.k.a., DIR fees. In my next post, I’ll examine chain pharmacies’ participation in these plans and what it means for pharmacy profits.

P.S. Today’s post is brought to you by the letter D.

CBI’s FDA/CMS Summit 2019

FDA/CMS Summit
December 3-4, 2019 | The Westin Arlington Gateways | Arlington, VA www.cbinet.com/FDACMS

Exclusive Offer for Drug Channels Readers:

Register Now to SAVE $400* using code DNU682

The 27th Annual FDA/CMS Summit, taking place December 3-4 in Arlington, VA, offers an outstanding opportunity to garner the latest regulatory updates and strategic priorities directly from regulatory leaders representing the FDA, HHS and CMS.

This year’s robust agenda features an excellent speaking faculty participating in keynotes, interactive Q&A sessions and panels addressing policy changes, federal review processes and technology advances in healthcare and technology, including:

• Opening Keynote Address from Norman Sharpless, Acting Commissioner—FDA
• CDER Keynote Address: 2019 and the Year Ahead—Strategic Plans and Priorities, Janet Woodcock, Director, Center for Drug Evaluation & Research (CDER)—FDA
• Three Interactive Q&A Sessions
  
  • Advanced Therapeutics and Cell and Gene Therapies, Celia M. Witten, M.D., Ph.D., Deputy Director, Center for Biologics Evaluation and Research (CBER)—FDA
  • Updates on the Innovation and Investment Summit—Eric D. Hargan, Deputy Secretary, U.S. Department of Health and Human Services
  • Rare Diseases—Common Issues in Drug Development Guidance for Industry, Peter Stein, M.D., Director, Office of New Drugs, Center for Drug Evaluation and Research (CDER)—FDA
• Jeet Guram, MD, Senior Advisor, Office of the Administrator, Centers for Medicare and Medicaid Services (CMS) and Anand Shah, MD, Senior Medical Advisor for Innovation, Office of the Administrator, Centers for Medicare and Medicaid Services (CMS) share insights on panel discussions addressing: Value-Based Payment Models and the Shifting Regulatory Policy Landscape for Cell and Gene Therapies

Download the conference agenda for the complete speaker and session lineup, then register using discount code DNU682 to receive $400 off* the standard rate!

 *Discount expires 12/2/19; applicable for bio/pharma manufacturers only; cannot be combined or applied to existing registration. Other restrictions may apply.

---

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

How Technology Will Drive the Future of Patient Access Services

Today’s guest post comes from Erica Conroy, Vice President of Specialty at CoverMyMeds, and Heather Morel, Senior Vice President and General Manager, Access and Adherence at RxCrossroads by McKesson.

Erica and Heather describe how access, affordability, and adherence challenge specialty patients. They outline the shortcomings of traditional hub service programs and introduce AMP: Access for More Patients™, a new solution from CoverMyMeds and RxCrossroads by McKesson.

To learn more, visit go.covermymeds.com/amp and download their case study: End-To-End Electronic Support Improves Patient Access for Specialty Medications.

Read on for Erica’s and Heather’s insights.

Grim Job Outlook for Retail Pharmacists Gets Even Grimmer

In Pharmacist Job Market: Salaries Keep Growing While Retail Employment Drops, I profile pharmacist employment and salaries in 2018.

According to our exclusive analysis of the U.S. Bureau of Labor Statistics’ (BLS) new Occupational Outlook Handbook, the total pharmacist employment figure is projected to remain unchanged over the next 10 years.

However, the pharmacist outlook varies by industry. Pharmacist jobs at hospitals, physician offices, and other non-retail settings will outpace growth at retail outpatient settings. Chain and independent drugstores are projected to employ 11,000 fewer pharmacists in 2028 than they do today.

Read on for an industry-by-industry look at the outlook. And if you are a retail pharmacist: Plan accordingly! I briefly highlight some implications for pharmacists, pharmacy students, and schools of pharmacy. The future is predictable, but hardly anybody bothers to predict it.

Pharmacist Job Market: Salaries Keep Growing While Retail Employment Drops

October is American Pharmacists Month, so it’s a good time to update our exclusive annual analysis of pharmacist salaries.

For 2018, U.S. government data show that the average gross base salary for a pharmacist at a retail, mail, long-term care, and specialty pharmacy exceeded $123,000—up slightly from the 2017 figure. Pharmacists who work in hospitals had greater salary increases than did pharmacists in outpatient dispensing formats. However, pharmacists at physician offices saw their salaries decline for the third straight year. Below you will find complete details, organized by practice setting.

One surprise: Total pharmacist employment did not grow in 2018, and the number of pharmacists working in retail settings decreased. This pushed the share of pharmacists who work at hospitals to a new high. Are we seeing the early warning signs of employment losses due to retail pharmacy challenges?

Join me at CBI’s 15th Annual Life Sciences Trade and Channel Strategies

Are you ready for some channel strategy? Then join me at CBI’s 15th Annual Life Sciences Trade and Channel Strategies conference, being held this December in Philadelphia. CBI’s annual event is one of our industry’s key events for bio/pharma trade management.

I’ll kick things off with an interactive keynote address titled Drug Channels Update–Things to Watch in 2020. I'll highlight the key trends for the year ahead. This is the only CBI event where I give a presentation.

I'll also be moderating a panel with Wall Street experts. We'll delve further into industry trends and such other hot topics as stock market valuations, M&A, drug pricing, Amazon, and more.

Drug Channels readers will save $300 off the standard rate when they use discount code XTY397 and register prior to November 8th.*

I hope you’ll join me in Philadelphia this December.

Regards,
Adam

A MESSAGE FROM CBI

CBI’s 15th Annual Life Sciences Trade and Channel Strategies
December 3-5, 2019 | Philadelphia, PA
www.cbinet.com/trade

Get ready to hit the ground running in 2020 by closing out the year at CBI’s Trade and Channel 2019! The life science industry's foremost thought-leaders will come together on December 3-5 to navigate the complex distribution and contracting landscape, and will take a deep dive into ways to optimize channel strategies to reach patients in need and provide the necessary services based on product type, site of care and reimbursement.

Visit www.cbinet.com/trade for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code XTY397 and register prior to November 8th.*

You can download the complete agenda here.

In-Depth Summits, Interactive Workshops and Tailored Tracks focusing on:

• New Product Launch Planning
• Mitigate Compliance Risk in Manufacturer and Specialty Pharmacy Contracts
• Digital and Blockchain Technology Adoption and Implementation
• Retail and POS Contracting
• Forward-Thinking Strategies for Specialty Generics and Biosimilars
• 340B - Best Practices to Improve Compliance and Manage Drug Diversion
• Specialty Channel Network Design and Contracting
• Market Access, Patient Support and Hub Services Optimization
• Next-Gen Specialty Product Data Strategies

Can't Miss Keynotes include:

• Drug Channels Update - Things to Watch in 2020
  Adam J. Fein, Ph.D., CEO, Drug Channels Institute
• Fireside Chat - Candid Conversation with an Industry Pioneer
  Bill Roth, Founding Partner, Blue Fin Group
• Healthcare Policy Address - Current State of Regulatory Reform Driving Innovation and Access
  Eric D. Hargan, Deputy Secretary, Department of Health and Human Services (HHS)
• How the New Wave of Algorithmic Care Will Disrupt Your Business
  Zen Chu, Investor, PillPack; Senior Lecturer in Healthcare Innovation, MIT Sloan School of Management and Harvard-MIT Health Sciences & Technology

Plus - New Features for 2019:

• Women's Leadership Forum
• Exclusive Benchmarking Report - Industry Intelligence on the State of the Bio/Pharma Trade and Channel Landscape
• Industry-Only Trade Director's Executive Exchange

Download the agenda to plan your sessions and prepare to return to the office armed with critical updates and valuable takeaways.

Visit www.cbinet.com/trade for further details and to register. Drug Channels readers will save $300 off the standard rate when they use discount code XTY397 and register prior to November 8th.*

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.

---

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

Patients Are the Key to Understanding Adherence

Today’s guest post come from Heather Morel, Senior Vice President and General Manager of Access and Adherence at RxCrossroads by McKesson.

Heather discusses how to overcome barriers to patient adherence. To learn more about RxCrossroads by McKesson’s patient support programs, download their free white paper: The Impact of Behavioral Coaching on Adherence.

Read on for Heather’s insights.

How Express Scripts Plans to Disrupt the Emerging Cell and Gene Therapy Channel

Cell and gene therapies are poised to transform the treatment of many serious and previously untreatable conditions.

As this new market develops, payers and PBMs are laying the groundwork for disruptive channel models. Below, I examine how Cigna’s Express Scripts business has begun to shape this channel’s development. Its new models show the promise of private market innovation for the financing and commercialization of novel therapies.

These approaches will also shake up existing channels. If payers rub this magic lamp, these innovative channel models would: 1) enhance the role of the vertically-integrated insurer/PBM/pharmacy companies, 2) reduce or eliminate buy-and-bill by providers, and 3) minimize the role of the largest wholesalers. Consider the examples below to be early warnings of change.

FYI: Today’s post is an excerpt from Chapter 6 of our new 2019–20 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

NEW: The 2019–20 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

I am pleased to announce our new 2019–20 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, available for purchase and immediate download.

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

• Click here to read the press release

We’re offering special discounted pricing if you order before October 18, 2019!

The 2019–20 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors—our 10th edition—is the most comprehensive, fact-based tool for understanding and analyzing the U.S. pharmaceutical distribution industry.

This 2019-20 edition contains the most current financial and industry data along with detailed information about the strategies and market positions of the largest companies: AmerisourceBergen, Cardinal Health, and McKesson. It updates our annual analysis of each wholesaler’s business segments and underlying business profitability, based upon our proprietary economic models. An intriguing new section reviews the financial factors that determine executive compensation at each of the public companies. See page vi of the free report overview for a summary of key changes and updates in this 2019-20 edition.

See below for more info and some behind-the-scenes tidbits. 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.

CBI’s 3rd Nurse Educator Programs

CBI’s 3rd Nurse Educator Programs
November 20-21, 2019 | Philadelphia, PA
www.cbinet.com/nurseeducator

Exclusive Offer for Drug Channels Readers – Register by 11/1/2019 and save $400* (mention promo code “400NEP”)

During a time with advanced therapy regimens and complex reimbursement models, Nurse Educators are pivotal to address the knowledge gap and simplify the path forward for patients, from clinical interactions to commercialization. CBI’s Nurse Educator Programs tackles emerging challenges and provides the tools and strategies to optimize patient adherence and uncover best practices for improving the overall patient experience.

Download the complete agenda here.

Join your compliance, medical affairs and access peers November 20-21 in Philadelphia, PA, and hear expert perspectives from U.S Attorneys, Johnson & Johnson, Lexicon Pharmaceuticals, Alnylam, Janssen, Otsuka and many more.

Cutting Edge Topics on the Agenda Include:

• Compliant Patient Interactions Workshop:
• Patient Assistance and Copay Programs
• Foundation Support
• Hub Services
• Risks Associated with Field Reimbursement Teams
• Patient Spotlight — Elevate Meaningful Patient Engagement Programs to Advance Education and Outcomes
• Enforcement Oversight — Gain Insight into Federal Enforcement of Patient Assistance and Nurse Educator Programs
• Ready for Launch? Critical Considerations, Objectives and Decision-Making when Developing and Implementing Nurse Educator Programs
• Explore Innovative Partnership Opportunities between Industry and Patient Advocates
• Risk Avoidance in the Patient Journey — Make Privacy a Priority

Register today and save $400 — Be sure to mention promo code “400NEP”.

*Offer valid through 11/1/2019; applies to standard rates only and may not be combined with other offers, promotions or applied to an existing registration. Offer not valid on academic or workshop only registrations. Other restrictions may apply.

---

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

The Big Three Wholesalers: Revenues and Channel Share Up, Profits Down

Next week, Drug Channels Institute will release our 2019–20 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. It’s the 10th edition of our comprehensive and highly-regarded examination of U.S. prescription drug distribution channels. It will be released on October 8, but is available now for preorder at discounted pricing.

The exhibits below—2 of the 136 in our new report—provide a look at the revenues and market share of the Big Three wholesalers: AmerisourceBergen Corporation, Cardinal Health, Inc., and McKesson Corporation.

As you will see below, the Big Three wholesalers’ revenues continue to grow faster than those of the overall pharmaceutical industry. This growth has increased the wholesale share of the U.S. drug distribution channel and enabled the big to get even bigger. In the report, we document that gross profits have not kept pace with revenues.

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 Contracts & Chargebacks Critical Update Summit

CBI’s Contracts & Chargebacks Critical Update Summit
November 14-15, 2019 | Philadelphia, PA
www.cbinet.com/chargebacksupdate

CBI’s Contracts & Chargebacks Critical Update Summit offers an important opportunity to connect with key stakeholders on timely updates in this evolving contracting landscape.

Benefit from tremendous networking opportunities and forward-thinking content addressing strategies for process implementation and collaboration excellence among key stakeholders. Experience an interactive dialogue, best practices and innovative models in a rapidly changing market to maximize stakeholder relationships, improve chargeback processes, navigate class of trade complexities and streamline membership management.

Visit www.cbinet.com/chargebacksupdate for further details and to register. 

Drug Channels readers will save $300 off the standard rate when they 

use code ZAB852 and register prior to October 25, 2019.

This event will kick off on Thursday, November 14 at 3pm with two inclusive summits for operational excellence and re-convene the next day for a full day of benchmarking, learning and networking on the topics that matter most to your organization.

Inclusive, Interactive Workshops on November 14th:

1. Implement and Operationalize Complex Contracts
2. Manage Membership and Chargeback Administration

Main agenda topics include:

• Mitigate Challenges Through Stakeholder Collaboration and Operational Excellence
• Wholesaler Playbook for Process Optimization in a Shifting Market
• Navigate Class of Trade Assignments–Maximizing GPO Alignment for Streamlined Workflow
• Valuable Strategies for Payer Cost Control Approaches
• Technology Innovation – Advance Data Exchange Through EDI and Blockchain
• Keep a Pulse on Regulations for Contract Compliance— Chargeback adjudication for 340B Pricing

Request the agenda here and prepare to return to the office armed with critical updates and valuable takeaways.

Visit www.cbinet.com/chargebacksupdate for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code ZAB852 and register prior to October 25, 2019.

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.

---

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.