Drug Channels News Roundup, October 2020: Accumulator Nonsense, GoodRx Fees, 340B Dollars, and Our Simulated World

Halloween is truly scary this year. Since we can’t trick-or-treat, spend some time with our spooky roundup of Drug Channels news stories:

• Creepy! UnitedHealthcare expects physicians to enforce its copay accumulator policy

• Vampiric! How GoodRx sucks money from the channel

• Shocking! 340B haunts even more of the industry than you envisaged

Plus, a scary reason to be cheerful: Chances are 50/50 that we are living in a simulation!

P.S. Stretch out your arm and join the zombie horde who shamble after me at @DrugChannels on Twitter. My recent tweets have highlighted: UnitedHealth’s DivvyDose acquisition, independent analyses of Rutledge vs. PCMA, importation problems in Wyoming and Florida, Medicaid enrollment, fake news from NASHP, and unexpected public policy cameos by Drug Channels. (You can also join my followers on LinkedIn.)

Battle of the Giants: CVS, Kroger, Walgreens, and Walmart Expand in 2021 Part D Preferred Networks

In Preferred Pharmacy Networks Dominate in 2021 Medicare Part D Plans, I highlighted how those networks will again rule next year’s Part D prescription drug plans (PDP).

Today, I examine the largest retail chains’ participation in the 27 major 2021 Part D preferred networks that the nine largest plan sponsors will offer. 

As you will see, most major chains increased their position as a preferred pharmacy in many 2021 networks. Only Rite Aid lost position. As usual, we provide you with a handy table for scoring each chain’s participation and all changes from 2020 to 2021.

The chains’ expanded participation may turn out to be a trick, not a treat. COVID-19 has not fundamentally altered the negative industry trends haunting retail pharmacies. Narrow networks force pharmacies to trade volume for profits. Expect another scary drop in the number of U.S. pharmacies. 

As the African proverb says: "When elephants fight, it is the grass that suffers."

GTN 2020 – Informa Connect - CBI’s Gross-to-Net Summit

GTN 2020 – Informa Connect - CBI’s Gross-to-Net Summit
November 16-18, 2020 | Virtual Event
www.informaconnect.com/gtn

Join the life sciences community next month at Informa Connect - CBI’s GTN Summit, now in the 10th year. The event is being held virtually November 16-18, 2020 and is designed to position your organization for success in the end-to-end management of GTN. Benefit from live expert panels, presentations and summits, live polling and Q&A, and a library of on-demand content for you to watch as your schedule allows. All presentations will be available for viewing for 30 days after the event concludes!

Visit www.informaconnect.com/gtn for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code GNB425 and register prior to October 30th.*

You can download the complete agenda here.

You’ll hear perspectives from companies such as ADC Therapeutics, Alkermes, Amgen, Apellis Pharmaceuticals, Bristol-Myers Squibb, Cipla Therapeutics, Deloitte & Touche LLP, Eisai US, Eli Lilly & Co, IntegriChain, Intra-Cellular Therapies, MyoKardia, Paratek Pharmaceuticals and Teva Pharmaceuticals. Our speakers are all ready to share their insights into strategic forecasting, accounting estimates, analytics and finance reporting strategies, specifically for life science companies.

Hot topics on the agenda include GTN Process and Governance, Managed Care and Payer Contracting, Market Changes and GTN Implications, Digital Finance and Robotics within GTN, Advanced Data and Analytics for Pricing and Payer Contracts, GTN Automation for Improved Forecasting, GTN Assumptions for New Product Launches, Medicare Part D and Coverage Gap, 340B and GP Programs, Managed Care and Specialty Product Rebates, Commercial and Government Chargebacks, Product Returns, Copay/Coupon Programs, and so much more!

Download the agenda to plan your sessions and wrap up your week armed with critical updates and valuable takeaways.

Visit www.informaconnect.com/gtn for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code GNB425 and register prior to October 30th.*

Informa Connect-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.

New Payer Policies Introduce Copay Accumulators to Medical Benefit Products: Implications for Manufacturer Programs

Today’s guest post comes from Jason Zemcik, Senior Director, Product Management and Rick Fry, Senior Vice President, Commercial Solutions, at TrialCard.

Jason and Rick discuss the use of copay accumulators for drugs covered under a patient’s medical benefit. 

To better understand how these policies may impact your brand, join TrialCard’s Jason Zemcik on Thursday, November 5th at 1 p.m. ET for a free live webinar Implications of Copay Accumulators on Medical Benefit-Covered Products. You can also email TrialCard at sales@trialcard.com.

Read on for Jason's and Rick’s insights.

A Primer on 340B Contract Pharmacies and Medicaid Duplicate Discounts (video)

Below is a brief video primer on a hot Drug Channels topic. I review:

• The growth of the 340B Drug Pricing Program

• The role and expansion of 340B contract pharmacies

• How 340B intersects with the Medicaid drug rebate program

• Challenges with duplicate discounts

This 10 minute video provides a quick and efficient primer on the key issues. Grab some popcorn and enjoy!

Preferred Pharmacy Networks Dominate in 2021 Medicare Part D Plans: The Scoop on Cigna, CVS Health, Humana, WellCare, and More

Last week, open enrollment began for the 2021 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 2021, 98% of Medicare Part D regional prescription drug plans (PDP) will have a preferred network. By the beard of Zeus!

Below, I provide historical data on preferred networks’ growth and then discuss the top nine companies offering the 2021 plans. None of these major plan sponsors will offer a national plan with an open network for 2021.

In upcoming articles, I’ll examine how chain and independent pharmacies will participate in these plans and what that means for pharmacy profits. As always, Drug Channels brings you the news—so you don't have to get it yourself.

16th Annual Life Sciences Trade and Channel Strategies

16th Annual Life Sciences Trade and Channel Strategies
December 1-3, 2020 | Virtual Event
www.informaconnect.com/trade-channel

Get ready to hit the ground running in 2021 by closing out the year at Trade and Channel 2020! The life science industry's foremost thought-leaders will come together virtually on December 1-3 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. You’ll benefit from 3 days of live content, as well as a robust library of on-demand content – with all live and on-demand sessions available for viewing for 30 days after the event concludes.

Visit www.informaconnect.com/trade-channel for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code GJE973 and register prior to October 30th.*

You can download the complete agenda here.

Gain Critical Insight from Industry Trailblazers During a Time of Transformative Change – Speakers will include:

• Bill Roth, Founding Partner, Blue Fin Group
• Rob Osborne, Vice President Pharma Trade Relations, Express Scripts, Accredo, CuraScript SD
• Ray Tancredi, RPh, MBA, CSP, Divisional Vice President, Specialty Pharmacy Development &
• Brand Rx/Vaccine Purchasing, Walgreens
• Eric D. Hargan, Deputy Secretary, Department of Health and Human Services (HHS)
• Natalie Bedford, Executive Director, National Channel Account Team, AstraZeneca
• Timothy Paine, Vice President, Pharma Strategy & Relations, Fairview Pharmacy Services
• Dave MacLeod, Head of Patient Services and Specialty Pharmacy Operations, Amylyx Pharmaceuticals
• Brent Warner, Vice President, Gene Therapy, Novartis Pharmaceuticals
• And more!

Live Keynotes Delivering Timely Updates and Insights on High-Impact Topics, Including:

• Critical Update – Market Dynamics Drastically Impacting the Channel
• Navigate the Evolving State of Regulatory Reform Driving Innovation and Access
• Emerging and Future Trends in Channel Strategy, Distribution and 3PL
• Pharmacy Spotlight – Innovative Models Redesigning Care in 2020 and Beyond

Insightful Strategy Sessions:

• Discuss Reimbursement Models for Cell and Gene Therapies
• Orphan and Rare – How Does Your First 5 Years of Channel Strategy Change for this Product Type?
• Channel Strategy for First Medical Product – A Look at Channel Considerations for Pharmacy vs. Medical

Plus – Tailored Track Options Based on Company Size:

• Emerging/Small Companies – Infrastructure Set-Up, License Procurement and 3PL Contracting
• Mid-Large Companies – How Do I Think About My Portfolio Differently Based on Product Type?

Download the agenda to plan your sessions and wrap up your week armed with critical updates and valuable takeaways.

Visit www.informaconnect.com/trade-channel for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code GJE973 and register prior to October 30th.*

Informa Connect - 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 or 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.

Utilizing Gini Coefficient To Anticipate Price Movement, Drug Shortages And Pricing Elasticity

Today’s guest post is sponsored by Elsevier and presented by Elsevier’s solution partner Todd Grover, Co-Founder of Glass Box Analytics.

Todd discusses how the Predictive Acquisition Cost (PAC) is utilizing the concept of a Gini coefficient to anticipate price movement, predict drug shortages, and pricing elasticity.

To learn more, read the brief: Predictive Acquisition Cost – a better standard.

Prime Therapeutics Deepens Its Reliance on Express Scripts: Our Four Takeaways From Their New Pharmacy Relationship

Last week, news broke that Prime Therapeutics is expanding its relationship with Cigna’s Express Scripts to include mail and specialty pharmacy dispensing. So far, there's been very little written about this transaction.

Below, I share my thoughts on the following topics arising from the deal:

• The mail and specialty pharmacy market

• The future of AllianceRx Walgreens Prime

• The emerging Express Scripts industry platform

• A reminder about why the Federal Trade Commission won’t challenge the relationship

Prime is becoming increasingly dependent on outsourcing to Cigna’s Express Scripts business. This new pharmacy contract furthers the industry’s move toward vertical consolidation and the disappearance of the independent PBM industry. 

Once again, channel intermediaries continue to gain power and extract profits. More to come.

NEW: The 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

I am pleased to announce our new 2020–21 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)

• New Drug Channels Institute Study Examines Impact of COVID-19 on U.S. Drug Distribution Industry (press release)

We’re offering special discounted pricing if you order before October 23, 2020!

The 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors—our 11th edition—remains the most comprehensive resource for analyzing the pharmaceutical distribution industry’s economics, market structure, growth rates, forces of change, and interactions with the U.S. healthcare system.

This 2020-21 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. Three new sections address COVID-19 and its impact on wholesalers, including the potential financial effects on wholesalers of widespread distribution of one or more COVID-19 vaccines.

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.

WHAT’S GOING ON

Twice a year, I spend my evenings and weekends writing two comprehensive, fact-based, and nonpartisan reports on drug channel economics. In some small way, I try to make the world a better and smarter place.

Licenses for our DCI reports are regularly purchased by nearly every company involved in the drug channel: pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospitals, buyers, benefit managers, managed care executives, policy analysts, investors, consultants, and more. So, you can find out what your customers, partners, and competitors are reading.

The 2020–21 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors is the only resource of its kind available anywhere. It offers 136 proprietary charts, exhibits, and data tables.

FOUR FUN FACTS

• The 9 chapters are self-contained and do not need to be read in order. (Really!) There are loads of internal hyperlinks to help you navigate the document and customize it to your specific interests and priorities.

• We are offering the option to download an additional PowerPoint file with images of all 136 exhibits. This popular option helps you share the insights and data with others in your organization. (The PowerPoint file option is available only with the purchase of a corporate license.)

• There are an astonishing 482 (!) endnotes, most of which have hyperlinks to original source materials. These source materials offer a handy way to build your knowledge base beyond what’s included in the full report.

• As usual, I have reluctantly stripped out the corny jokes and pop culture references.

If you have any questions (before or after reading the report), please email me.

Enjoy!

Informa Connect-CBI’s 6th Edition Drug Pricing Transparency Congress

Informa Connect-CBI’s 6th Edition Drug Pricing Transparency Congress
November 16-17, 2020 | Virtual Event
www.informaconnect.com/drug-pricing-transparency

Drug Channels Readers: View the complete agenda and register today. Be sure to use your exclusive promo DRUG30 to save $300*

As the election nears and with the recent flurry of regulatory activity surrounding drug pricing transparency, bio/pharma manufacturers must continuously stay ahead of the ever-evolving changes. Join Informa Connect-CBI’s 6th Edition Drug Pricing Transparency Congress to discuss how current and future drug pricing transparency regulations will impact commercialization, reimbursement, pricing and compliance practices. Assess how companies are planning internally for these changes, hear updates post-election impacting drug pricing transparency and gain a preview of what’s to come in 2021.

Unlike a webinar or zoom training, Drug Pricing Transparency Congress serves as a full virtual 2-day conference experience. Experts from Nestle Health Science, Sidley Austin LLP, Covington & Burling LLP, Chiesi USA, Inc., Sandoz, King & Spalding LLP, Amneal Pharmaceuticals, Novo Nordisk, ClassOne Insights, BIO, PhRMA, and more will lead robust discussions on topics, including:

• Unpack Price Increase Transparency Requirements
• Analyze Price Disclosure Requirements to Health Care Providers (HCPs)
• State of The Industry — Drug Pricing Transparency Landscape Address
• Status Report on New Drug Pricing Reporting Requirements
• Keep a Pulse on New Legislation and Current Industry Efforts
• Explore Developments in Pricing Investigations and Enforcement Action
• Keys for Success and Traps for the Unwary — A Roadmap for Compliance
• Uncover Operational Realities and Recommendations to Maximize State Transparency Reporting
• Leverage Proactive Approaches and Resources for Operational Readiness
• Federal Initiatives for Pricing Transparency
• Update on the Price Increase Advance Notice Requirements

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

Drug Channels Readers – View the complete agenda and register today– Be sure to use your exclusive promo DRUG30 to save $300*

Informa Connect-CBI will see you there!

*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. 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.

Discriminatory Reimbursement Practices by PBMs Represent a Threat to Public Health: A Perspective from Community Health

Today’s guest post comes from Shannon Stephenson, CEO of Cempa Community Care.

I am publishing this opinion piece to share a perspective from a community health provider that is eligible for the 340B Drug Pricing Program as a Ryan White clinic and as a Federally Qualified Health Center Look-Alike. As I noted last week in my September news roundup, I generally consider federal grantees to be the good guys of 340B.

Shannon outlines her view that pharmacy benefit managers (PBMs) have reduced reimbursement to her facilities. This reduces the value of the 340B program to Cempa. It also transfers funds to PBMs and their plan sponsor clients.

Read on for Shannon’s insights on this highly controversial issue.

The Booming Biosimilar Market of 2020

The biosimilar market is finally beginning to fulfill its promise.

The latest data show that provider-administered biosimilar drugs are successfully displacing their reference biological products. As I predicted last year, newer biosimilars are being adopted quickly, and their prices are declining rapidly. What’s more, manufacturers of reference products are cutting drug prices to defend their market shares.

Last year, Dr. Scott Gottlieb, a former FDA commissioner, argued that we shouldn’t give up on biosimilars and prematurely regulate prices. As you will see below, Dr. Gottlieb was right.

Patient Support Services Congress

Patient Support Services Congress
October 27-29, 2020 | VIRTUAL EVENT (All-Digital Format)
www.informaconnect.com/patientsupportservicescongress

Informa Connect-CBI’s Patient Support Services Congress is a comprehensive meeting for insightful and engaging dialogue around strengthening and innovating patient-oriented programs while remaining compliant.

Exclusive Offer for Drug Channels readers — Save $300 off the standard registration rate with promo code AHC685*. Register today.

Download the agenda here and see in-depth coverage on industry trends and next-generation patient services, such as:

• Critical Regulatory Updates and Effective Strategies for Monitoring & Oversight
• Novel Approaches to Services, Program Architecture and Operational Management
• The Pros and Cons of Different Support Service Models
• Measuring the Success of Patient Support Programs
• Transparency with Charitable Organizations
• Adapting to a Virtual World ― Strategies for Field Team Compliance and Virtual Monitoring

Choose from Two In-Depth Tracks and Interactive Roundtables on:

• Legal and Compliance
• Innovation and Operations

Critical Insights on Overcoming the Challenges and Complexities Amid a Shifting Industry from:

• Evan Panich, Assistant United States Attorney, U.S. Attorney’s Office, District of Massachusetts
• Katherine Chaurette, Vice President Healthcare Law and Compliance, Blueprint Medicines
• Kelley Allison, Vice President of Patient Access, Rare Disease, Horizon Therapeutics
• Robert Britting, Director, Patient Services and Strategic Solutions, Teva Pharmaceuticals
• Matthew Werner, Vice President, Chief Compliance & Privacy Officer, Bio-Rad Laboratories
• John Kelly, Member, Bass, Berry & Sims PLC
• Jenny Alonso, General Counsel and Chief Compliance Officer, Neurelis, Inc.
• Doug Donaldson, Senior Director, Product Solutions and Patient Services, Mylan
• And so many more!

Comprehensive Content and Dynamic Features Include:

• 3 days of live content from industry thought-leaders
• 10+ on-demand sessions, tailored to both access and compliance
• Over 4 hours of live speaker Q&A
• AI-powered virtual networking with colleagues and counterparts
• Private meeting and chat rooms
• Access to live and on-demand content for 30 days post-event

Exclusive Offer for Drug Channels readers — Save $300 off the standard registration rate with promo code AHC685*. Register today.

*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.

Bridging Data Insights Across the Patient Journey to Inform Your Commercialization Strategy

Today’s guest post comes from Jenna Mitby-Manning, Senior Director of Commercial Strategy & Insights, Access & Adherence at RxCrossroads by McKesson.

Jenna explains how data-driven solutions accelerate time to therapy, improve patient outcomes, and allow biopharma companies to make informed strategic decisions.

Click here to learn more about RxCrossroads' therapy access and adherence solutions.

Read on for Jenna’s insights.