Drug Channels News Roundup, September 2020: FQHCs and 340B, Drug Prices, CVS Health’s Zinc, Telehealth, All-Time Greatest Songs, and 10K on Twitter

Autumn is here! We’ve been squirrelling away these acorns from the mighty Drug Channels oaks:

• I agree. FQHCs are not the problem in 340B.

• Brand-name drug prices keep on dropping

• It’s official: CVS Health’s Zinc GPO actually exists!

• Telehealth takes a dive

Plus, vote for your 10 favorite songs of all time!

P.S. This month, @DrugChannels exceeded 10,000 followers on Twitter. Thank you to everyone who follows my curated links to neat stuff! Click here to join the crowd.

You can also join my 12.3K followers on LinkedIn.

Informa Connect-CBI’s 8th Annual Coupon and Copay Forum

Informa Connect-CBI’s 8th Annual Coupon and Copay Forum 

October 13-16, 2020 | Virtual Event

www.informaconnect.com/coupon-copay/

Exclusive Offer for Drug Channels Readers – View the complete agenda and register today – Be sure to use your exclusive promo code USAVE3 to save $300*

It’s time to talk. As managing copay programs continues to be significantly more complex, it is imperative to stay on top of current trends, emerging regulations and future legislation. Hundreds of leaders in patient access and affordability have benefited from Informa Connect- CBI’s Coupon and Copay Forum conference series. Join key stakeholders at this timely meeting and examine the design of coupon and copay programs aimed at driving the most effective and efficient patient access and affordability.

Unlike a webinar or zoom training, Coupon and Copay serves as a full virtual 4-day conference experience. As always, the caliber of content and peer-to-peer engagement is second to none. Experts from Diverse Biotech, Mallinckrodt Pharmaceuticals, ConnectiveRX, Orange Grove Bio, National Hemophilia Foundation, Akebia Therapeutics, Vanderbilt University Medical Center, HHS, AbbVie, PhRMA, The AIDs Institute, National Alliance of Healthcare Purchaser Coalitions, Sol-Gel Technologies, The GW School of Medicine, Apellis Pharmaceuticals, Innocoll Pharmaceuticals, Tris Pharma, kaléo and more will lead robust discussions on compelling topics, including:

• Innovative copay program design and operations
• Impact of COVID-19 on affordability
• Formulary barriers, increasing patient awareness and driving adherence
• Performance metrics to justify the cost of copay programs
• Pharmacy surveillance of specialty brand copay programs
• Breaking down current barriers to prescription drug access and assistance
• PAP compliance trends and implications of copay programs
• Copay accumulator and maximizer programs
• Employer shifts in benefit plan design to address the growing costs of advanced therapeutics

Unparalleled Virtual Capabilities:

• Interactive presentations and panels
• Live Q&A and polling
• Live and on-demand sessions, all available 30-days post-event to review at your leisure
• 1-1 meeting opportunities and peer-to-peer engagement
• Sophisticated and seamless scheduling tools

Exclusive Offer for Drug Channels Readers – View the complete agenda and register today – Be sure to use your exclusive promo code USAVE3 to save $300*

Informa Connect-CBI will see you there!

*Discount offer valid through 10/9/2020; 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.

Mapping the Specialty Medication Journey—Digital Patient Engagement Made Easy

Today’s guest post comes from Julia Laurin, Chief Product Officer at ConnectiveRx.

Julia discusses the medication access and adherence challenges specialty patients face. She introduces us to mobileCare Manager™ a mobile platform built specifically for the specialty patient experience.

To learn more about ConnectiveRx’s mobile engagement platform, download their one-pager or visit their website to connect with one of their experts.

Read on for Julia’s insights.

Specialty Pharmacy Keeps Disrupting Buy-and-Bill—and COVID-19 Will Accelerate It

Will COVID-19 trigger long-term share gains for specialty pharmacies as suppliers to hospitals and physician offices?

Before the pandemic, specialty pharmacies—via white, brown, and clear bagging—had already displaced buy-and-bill distribution channels for a substantial chunk of provider-administered specialty drugs. See below for detailed data on oncology and non-oncology products.

We estimate that in the first half of 2020, the coronavirus pandemic accelerated this shift. Some of the changes will likely be transitory, as patients return to their healthcare providers. But payers will try to retain some of these gains—especially if they also own a specialty pharmacy.

Read on and see if you agree.

Preorder now: The 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

On October 13, 2020, Drug Channels Institute will release The 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. This report—our eleventh edition—remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry. Notable new material in the 2020-21 edition includes three sections that address COVID-19 and its impact on wholesalers.

We are providing you with the opportunity to preorder this thoroughly updated and revised 2020-21 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 October 13.

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

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.

Preorder and launch pricing discounts will be valid through October 23, 2020.

15th Hub, SPP and eServices Summit

15th Hub, SPP and eServices Summit

September 29-October 2, 2020 | Virtual Event

www.informaconnect.com/hub-spp-eservices/ 

 This important event convenes key stakeholders including manufacturers, specialty pharmacies, hubs, payers, PBMs, physicians and more to explore strategies for developing and integrating hub programs and other patient-centric services to ensure product access and optimal reimbursement. 

Drug Channels readers will save $300 off the standard registration rate when they use code MDU494.* 

  In-Depth Discussions and Actionable Takeaways on Critical Topics: Hub Excellence

• Innovative Affordability Strategies and Hub Models for Specialty Products
• Examine Support Service Model Design and Strategies for Implementation
• Training and Staff Advancement for Hub Excellence through Resource Management
• Strategic Integration of Patient Support, Distribution, Field and Commercial Strategies for Innovative Therapies

SPP Partnering

• Ask the Experts—Elevate Stakeholder Collaboration to Optimize Patient Access
• Uncover Innovative Strategies to Optimize SP Networks
• Striking the Right Balance—A Look at the Level of Integration Between Hub and Pharmacy
• Pharmacy Perspective—Assess the Impact of Real-Time Benefit Verification on Patient Access

eRx, ePrior Auth and eServices

• ONC Keynote Address—Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs
• Manufacturer Insights—Assess Opportunities to Prevent Un-Due Delay of Patient Care
• Standards Update—Navigate NCPDP Initiatives, Guidance and Future Proposals for Innovation
• Navigate ePrior Authorization and Real-Time Benefit Verification Complexities within Medicare

Featured Speakers:

• Alicia Dixon, MHA, Director, Patient Access and Reimbursement, Tricidia, Inc.
• John Wiedemann, Director of Patient Support Service, Retrophin
• Jackie Barnard, Associate Director, Field Reimbursement, Paratek Pharmaceuticals
• Bill Goodson, Director, Patient Access and Reimbursement Services, Eisai US
• Keith White, Vice President and Head, Global Market Access, Corbus Pharmaceuticals
• Stephen Samuel, Chief Executive Officer, Premier Specialty Pharmacy Services
• John Klimek, R.Ph., Senior Vice President, Standards & IT, NCPDP
• Sarah Krug, Executive Director, Cancer 101
• Sheila M. Arquette, R.Ph., Executive Director, National Association of Specialty Pharmacy (NASP)
• David Kowalsky, Director, Market Access and Patient Services, EyePoint Pharmaceuticals
• Andrew Gettinger, Chief Clinical Officer, ONC at US Department of Health & Human Services
• And more!

REGISTER TODAY

Drug Channels readers will save $300 off the standard registration rate when they use code MDU494.*

*Offer 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.

Three Ways to Boost Patient Access to Orphan Drugs—With an Independent Specialty Pharmacy

Today’s guest post comes from Ela Lourido, Vice President of Business Development at Biologics by Mckesson.

Ela discusses the important role independent specialty pharmacies play in educating payers, supporting patients, and ultimately getting potentially life-saving therapies into the hands of patients.

Click here to learn more about Biologics by McKesson's patient access services for biopharmaceutical manufacturing companies.

Read on for Ela’s insights.

My Wall Street Journal Op-Ed about the 340B Program

Last Friday, The Wall Street Journal published my opinion piece: The Federal Program That Keeps Insulin Prices High. The article text is pasted below for those who don't subscribe.

I summarize issues with the role of contract pharmacies in the 340B Drug Pricing Program. My arguments will be familiar to regular readers of Drug Channels. I wrote this piece for a general business audience, so it's highly readable and omits industry insider terminology. To help you get the most from the article, I have included additional links to source materials in the text.

Note that my commentary focuses primarily on hospitals, which account for the vast majority of 340B program sales. Federal grantees are more likely to pass discounted 340B prices to needy patients. However, grantees should consider my warning from 2014: The good apples—the 340B entities that require additional financial support to support needy patients—should be worried that the bad ones could rot away the program for everyone.

Please share your comments below and I'll respond where appropriate.

New for 2021: The Drug Channels Quarterly Video Webinar Series

We are proud to bring you something new for 2021!

Join Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI), for five live video webinars—one every calendar quarter, starting in the fourth quarter of 2020. These live, interactive events will be broadcast via Zoom from the Drug Channels Video studio in beautiful downtown Philadelphia.

During these quarterly updates, Dr. Fein will address the latest issues confronting the U.S. drug channel. Topics will be determined based on what’s happening—trends, policy changes, executive orders, company announcements, and more. He’ll also share DCI’s latest market data to help you stay on top of new developments. You will be able to use these events as both a capstone of your quarterly learning and a touchpoint for the future.

The 75-minute events are scheduled for 12:00 p.m. to 1:15 p.m. ET on:

• December 18, 2020 (Drug Channels Outlook: What You Need to Watch in 2021)

• March 26, 2021 (Drug Channels Update: 2021Q1)

• June 25, 2021 (Drug Channels Update: 2021Q2)

• September 24, 2021 (Drug Channels Update: 2021Q3)

• December 17, 2021 (Drug Channels Outlook: What You Need to Watch in 2022)

PLUS: Dr. Fein will take your questions during each event. We will also offer an opportunity to submit questions in advance of each event.

Read on for full details on pricing, including substantial discounts for multiple sites.

Why Generic Medicines Are Especially Good for the U.S. Right Now

Today’s guest post comes from George Keefe, Senior Vice President of External Affairs and Public Policy at Teva Pharmaceuticals.

George examines the economic impact of generic pharmaceuticals on the U.S. economy. He argues that the generics industry provides safe, effective, and affordable medicines for many Americans.

To learn more, download the Teva United States Economic Impact Report.

Read on for George’s insights.

The State of Specialty Pharmacy 2020: Market Data and Trends (video)

In May, I recorded a brief video webinar for an on-demand business education session at Asembia's 2020 Specialty Pharmacy Summit Virtual Experience.

You can watch the full video below. I review:

• The role of specialty drugs in the pharmacy industry

• Our latest data on specialty pharmacy accreditation

• Commentary on PBM’s role in the specialty industry

The data are drawn from our 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Why Do CVS And Express Scripts Rely on Secretive Private Companies to Run Their Copay Maximizer Programs? (rerun)

This week, I’m rerunning some popular posts while I work on the forthcoming 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from June 2020. It was one of my most popular articles in 2020.

One minor update: PrudentRx finally has a website! It's still uninformative and misleading, but I suspect that my original article shamed them into putting up a better placeholder.

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In Copay Maximizers Are Displacing Accumulators—But CMS Ignores How Payers Leverage Patient Support, I explained a new Centers for Medicare and Medicaid Services (CMS) final rule regarding health plans’ use of copay accumulator adjustment. I also highlighted why plans have responded to the negative patient impact from accumulators with copay maximizer programs.

However, maximizers are being implemented very differently from accumulators.

The two largest PBMs—CVS Health’s Caremark and Cigna’s Express Scripts—have each partnered with secretive and independent private companies to operate specialty drug maximizer programs for their plan sponsor clients. What’s more, at least one of these private companies earns fees equal to 25% of the manufacturer’s copay support program.

These arrangements are very odd. Why do multi-billion-dollar public companies rely on these private companies to administer their maximizer programs? Why do these small companies deserve such outrageous fees? Why are beneficiaries required to affirmatively sign up with the companies—or face ludicrous costs that far exceed their plan’s out-of-pocket maximums? Does any oversight exist for these arrangements?

Here’s what I managed to uncover about these businesses. See what you think.

Copay Maximizers Are Displacing Accumulators—But CMS Ignores How Payers Leverage Patient Support (rerun)

This week, I’m rerunning some popular posts while I work on the forthcoming 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from June 2020.

I'll have an update on accumulators in September.

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COVID-19 has not stopped the wheels of policy bureaucracy from grinding. Last week, the Centers for Medicare and Medicaid Services (CMS) released its final Notice of Benefit and Payment Parameters for the 2021 benefit year. You’ll find the document links below.

This final rule permits insurers to exclude the value of a pharmaceutical manufacturer’s copay support program from a patient’s annual deductible and out-of-pocket maximum obligations.

Translation: CMS has confirmed that insurers have the option to use copay accumulator adjustment for their pharmacy benefit programs.

Patients on specialty drugs lose big from accumulators, while plans profit from the lower spending that results. Consequently, copay maximizers have emerged as a more patient-friendly alternative to accumulators. Below, I remind you of the math behind these alternatives.

Plan sponsors are publicly denouncing copay support programs—while they’re privately embracing them. CMS’s final rule ignores the troubling reality behind maximizers and accumulators: They encourage plans to use pharmacy benefit deductibles as a scheme that allows payers—not patients—to reap the greatest benefits from a manufacturer’s patient support program.

Walgreens and CVS Top the 28,000 Pharmacies Profiting from the 340B Program. Will the Unregulated Party End? (rerun)

This week, I’m rerunning some popular posts while I work on the forthcoming 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from July 2020.

I'm rerunning this post to provide context for manufacturers' recent actions regarding 340B contract pharmacies. The "SUBREGULATORY MISCHIEF" section below explains crucial background.

Yesterday, Eli Lilly announced that its products can be dispensed only at covered entities and their child sites, but not via external pharmacies. However, Lilly will permit its insulin to be dispensed from 340B contract pharmacies—as long as patients receive the discounted 340B prices of $0.03 per 3 mL pen or $0.10 per 10 mL vial. Amazing.

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It’s time for our annual look at the 340B Drug Pricing Program’s booming pharmacy component.

Our exclusive analysis of government data finds that 28,000 pharmacy locations—almost half of the U.S. industry—now act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. Over the past 12 months, the number of pharmacies in the program has grown by more than 3,300 locations.

As you will see below, multi-billion-dollar, for-profit, publicly traded pharmacy chains—Walgreens, CVS, Walmart, Rite Aid, Kroger, and Albertsons—continue their unchecked 340B expansion.

Despite this astonishing growth, the contract pharmacy component does not have—and has never had—a regulatory infrastructure. That’s because the subregulatory notice that created contract pharmacies wasn’t subject to any rulemaking procedures. Eli Lilly recently challenged this notice, which forced the government to concede that its own pharmacy guidance is “not legally enforceable.”

As you review our analysis, ponder why manufacturers still comply with HRSA’s non-binding guidance—and why investors remain unconcerned with the risks of public companies’ participation in the out-of-control 340B program.

PBMs and Drug Spending in 2019: CVS Health and Express Scripts Outperform Prime Therapeutics (rerun)

This week, I’m rerunning some popular posts while I work on the forthcoming 2020-21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Click here to see the original post and comments from June 2020.

Since my original article below, MedImpact has released its annual drug trend report. Like Prime, MedImpact also underperformed the larger PBMs. Click here to view the updated chart that I posted on @DrugChannels.

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It’s time for our annual Drug Channels examination of PBM drug spending reports. For 2019, we again aim our magnifying glass at the annual trend reports from the largest pharmacy benefit managers (PBMs): CVS Health, Express Scripts, and Prime Therapeutics. (See their report links below.)

Once again, we find that commercial drug spending did not race higher—contrary to what you keep hearing from journalists and politicians. Spending rose by less than 3% in 2019, continuing a multiyear trend of slow growth. At some plan sponsors, total drug spending even declined. For specialty drugs, higher utilization—not drug costs—was again the biggest factor driving specialty spending growth.

Notably, clients of Prime Therapeutics fared worse than those of Express Scripts and CVS Caremark. Below, I explain three factors behind Prime’s underperformance. Its third place finish highlights why the PBM industry continues to consolidate.