Sophia’s Story: Student, Daughter, Marketing Professional, Person Living with Crohn’s

Today’s guest post comes from Megan Marchal, Clinical Pharmacist at CoverMyMeds.

Megan shares the story of Sophia Garland, a young professional who is living with and learning to manage a chronic medical condition that requires specialty medication.

To learn more about technology and access to specialty medications, read the CoverMyMeds Medication Access Report: Complex Care & Specialty Edition.

Read on for Megan’s insights.

Drug Channels News Roundup, October 2021: PBMs’ Oncology Exclusions, Biosimilar Boom, BCBS vs. Hospitals, U.S. vs. the World, and CRISPR Comedy

Fortunately, Halloween can’t be scarier than any other day this year. So grab your pillow case and stuff it with treats from the great Drug Channels pumpkin patch:

• Spooky! PBMs are conjuring a terrifying number of formulary exclusions for oncology drugs

• Eerie! Brrr..did you hear that? It’s the biosimilar boom!

• Creepy! Scream as Blue Cross Blue Shield frightfully overpays hospitals

• Shocking! Believe it or not, U.S drug spending shambles into the middle of the herd

Plus, The Onion summons the only humorous article about CRISPR.

P.S. Please join the more than 12,700 consumers of my daily commentary and links to neat stuff at @DrugChannels on Twitter. You can also find my daily posts on LinkedIn, where I have more than 20,000 followers.

Recent posts have covered: Walgreens’ new direction; controversary over independent pharmacy counting; insurer consolidation; retail pharmacy M&A; drug pricing policy; Prime Therapeutics; 340B contract pharmacy litigation; pharmaceutical antitrust; oncology care model; and Peter Bach’s nuptials.

Follow the Vial: The Buy-and-Bill System for Distributing and Reimbursing Provider-Administered Outpatient Drugs

By reader request, we present below a channel flow chart illustrating the buy-and-bill process for provider-administered drugs. This chart complements Follow the Dollar: The U.S. Pharmacy Distribution and Reimbursement System for Patient-Administered, Outpatient Brand-name Drugs.

To further help you understand this channel, I have also included a brief video to explain the buy-and-bill system. The video is excerpted from my recent Drug Channels Update: Buy-and-Bill Trends video webinar.

This post is adapted from Chapter 3 of our new 2021–22 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Machine Learning, AI, and Platform Technology: Drug Discount Management’s Big Leap Forward

Today’s guest post comes from Scott Johnsen, VP of Product at Kalderos.

Scott discusses the advantages of using artificial intelligence and machine learning to efficiently process reimbursement data and avoid duplicates.

Learn more about Kalderos’ solutions to solve drug discount management challenges at scale during a free webinar on November 17: The Power of the Platform: How a Trusted Network Delivers Outcomes That Are a Win for All.

Fresh Evidence: How Health Systems Steer Prescriptions to Their Own Specialty Pharmacies

Hospitals and health systems are rapidly expanding their internal specialty pharmacies—and they’re using questionable tactics to boost revenues and profits.

A new American Society of Hospital Pharmacists (ASHP) survey of health system pharmacies offers fresh insights into how these systems steer prescriptions to their internal specialty pharmacies:

• For most health systems' in-house specialty pharmacies, more than 90% of specialty prescriptions are written by system-employed physicians.

• Nearly two-thirds of the larger health system specialty pharmacies operate as the exclusive pharmacy within self-insured health systems’ networks.

See below for data and details.

The 340B Drug Pricing Program’s explosive growth plays a crucial role in the economics of the health system specialty pharmacy channel. As manufacturers challenge external 340B contract pharmacies, health systems will become even more aggressive about guiding volume to their internal pharmacies.

P.S. I'll be presenting my "State of Specialty Pharmacy 2021," live and in-person at next week's Asembia Specialty Pharmacy Summit. (I'm speaking at 8:15 AM on 10/27 during the "Post-Pandemic Outlook for Specialty Pharmacy" session with Doug Long.) Hope to see you there!

What to Expect at This Year’s Asembia Specialty Pharmacy Summit (Guest Post)

Today’s guest post comes from Jayne Hornung, Chief Clinical Officer at MMIT.

Jayne discusses changes in the life science and specialty pharmacy industries since the COVID-19 pandemic began. She highlights three key trends that pharma companies, plan sponsors, and others will consider as we head to the upcoming Asembia Specialty Pharmacy Summit (October 26 to 29 in Las Vegas).

To learn more, schedule a meeting with one of MMIT's experts at the upcoming Asembia Specialty Pharmacy Summit.

Read on for Jayne’s insights.

White Bagging Update: PBMs’ Specialty Pharmacies Keep Gaining on Buy-and-Bill Oncology Channels

Payers have long sought to disrupt the buy-and-bill channel.

Coming out of the pandemic (maybe?), specialty pharmacies—via white, brown, and clear bagging—continue to displace buy-and-bill distribution channels for provider-administered oncology drugs. Check out the latest 2021 data below.

The battle for the specialty patient pits hospitals against insurers—and their respective specialty pharmacies. As you will see, UnitedHealthcare has been especially aggressive in accelerating channel change.

White bagging can boost profits and revenues for PBM-owned specialty pharmacies while increasing payers’ control over hard-to-manage medical benefit drugs. Hospitals, however, lose profits and face higher costs. Look for more drama as this squid game plays out.

FYI: The material in today’s article is adapted from Section 3.1. of our new 2021–22 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, available at special introductory pricing until October 15.

Conducting Patient Access in an Evolving Market

Today’s guest post comes from Bill Dupere, Practice Lead and VP of Market Access Solutions and Eric Willis, VP of Operations Hub and Reimbursement Services at TrialCard.

Bill and Eric discuss the complexities of digital patient support program technologies and introduce TrialCard’s integrated suite of solutions.

To learn more, please contact Trialcard at sales@trialcard.com or visit them in booth #416 at the upcoming Asembia Specialty Pharmacy Summit from October 26 to 29, 2021.

Read on for Bill’s and Eric’s insights.

NEW: The 2021–22 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

I am pleased to announce our new 2021–22 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, available for purchase and immediate download.

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

• New Drug Channels Institute Study: Biosimilars Are Delivering Higher Profits for Drug Distributors (press release)

We’re offering special discounted pricing if you order before October 15, 2021!

The 2021–22 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors—our 12th edition— remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry.

This 2021-22 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.

The notable new material in this 2021-22 edition includes three new sections:

• Section 4.2.5. analyzes how marketplace dynamics of provider-administered biosimilars affect wholesalers’ gross margins. (Section 4.4. in this edition introduces our estimates of these profits.)

• Section 7.4.4. reviews AmerisourceBergen’s entry into the European distribution market. (We consider McKesson’s exit from Europe in Section 9.4.3.)

• Section 6.1.5. summarizes key aspects of the wholesalers’ national opioid settlement.

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, lawyers, consultants, and more. So, you can find out what your customers, partners, and competitors are reading.

The 2021–22 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors is the only resource of its kind available anywhere. It offers 142 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 142 exhibits. This popular option helps you share the insights and data with others in your organization. (The exhibits appear in all license versions. The PowerPoint file option is available only with the purchase of a corporate license.)

• There are an astonishing 537 (!) 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’s Rare Disease Innovation & Partnering Summit

Informa Connect’s Rare Disease Innovation & Partnering Summit
Hybrid Event
In person: December 6-10 | Boston, MA
Virtual: December 9-10
www.informaconnect.com/raredisease

Exclusive Offer – Be sure to use your exclusive promo code DC4RARE10 to save 10% off* of your registration

After over a year apart, Informa Connect is pleased to announce that Rare Disease Innovation & Partnering Summit will return this Winter as a hybrid event, in-person December 6-7 in Boston, MA and virtually December 9-10. Driven by industry, advocacy, policy and investor insights, the Rare Disease Innovation & Partnering Summit convenes diverse stakeholders to discuss opportunities for continued innovation, advancement of impactful patient advocacy and acceleration of commercial strategy success.

Join multi-stakeholders as they gather and discuss novel approaches to optimize value, access and commercial strategy, deliver insights on maximizing engagement and innovation through data, research and technology and dive into best practices for driving therapeutic progress and creating purposeful partnering. Do not miss this opportunity to advance your organization forward. In such trying times, 2021 is a must-attend.

Exclusive Offer – Download the agenda and register today – Be sure to use your exclusive promo code DC4RARE10 to save 10% off* of your registration

Whether you choose to attend in-person or virtual (or both!), Rare Disease Innovation & Partnering Summit is sure to deliver impactful discussions, inspiring leaders and meaningful connections that will help advance the rare community forward. Tackle to most pressing challenges surrounding patient access, reimbursement, commercialization, launch, partnering and more with experts from across the industry.

Can’t Miss Content Highlights:

• PANEL: Fostering Effective Relationships Between Industry and Advocacy
• Leverage Genetic Testing for Value for Rare Disease Patients
• Harness the Power of Data to Drive Progress
• TECHNOLOGY SPOTLIGHT: Developing and Scaling Digital Therapeutics for Rare Diseases
• Reverse Engineering for Drug Development in Rare Diseases
• REGULATORY SPOTLIGHT: Navigate FDA Updates on Rare Disease Product Development
• Risks and Rewards of Rare Disease Drug Development — Highlight Opportunities and the Way Forward

PLUS! Tailored Breakouts for Customizable Learning:

• Patient Driven Progress
• Reimbursement, Value and Access
• New Launch and Commercialization
• Partnering, Investment and Portfolio Strategy

How Does Hybrid Work?

ALL ACCESS PASS includes the in-person event December 6-7 AND the virtual experience December 9-10

VIRTUAL EXPERIENCE PASS includes recorded presentations from the in-person event, as well as daily live streaming content December 9-10 (plus, 30-day portal access)

Exclusive Offer – Download the agenda and register today – Be sure to use your exclusive promo DC4RARE10 to save 10% off* of your registration
Informa Connect will see you there!

*Cannot be combined with other offers, promotions or applied to an existing registration. 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. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

Supporting Patient Adherence Through Electronic Prior Authorization and First Fill Copay Programs

Today’s guest post comes from David Fidler, Senior Director of Product Innovation at ConnectiveRx. David discusses how electronic prior authorization (ePA) and first-fill, buy-down programs can boost patient adherence to specialty therapies.

On November 3rd at 1:00 pm ET, ConnectiveRx will host First Fill, No Wait: How to Make it Happen, a free webinar about copay ePA. Click here to register.

Email inquiries@ConnectiveRx.com with any questions.

Read on for David’s insights.