Drug Channels News Roundup, March 2022: UM and Health Equity, Insurers ♥ White Bagging, Biosimilar Boom, A New Angle on Copay Support, and the Pharmacy Metaverse

Ah, it’s finally spring in downtown Philadelphia, our home base. (Photographic evidence on your right.) Along with sunshine and fine weather, this vernal equinox has ushered in a crop of new and noteworthy stories:

• Health inequities in utilization management

• Insurers compute big white bagging savings

• The biosimilar boom accelerates

• The patient upside of manufacturers’ copay support

• Whoa. CVS Health takes the red pill.

P.S. Join my more than 26,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I am approaching 13,700 followers.

Register for my new video webinar, PBM Industry Update: Trends, Controversies, and Outlook. This event will be broadcast live on April 22, 2022, from 12:00 p.m. to 1:30 p.m. ET.

PBM Industry Update: Trends, Controversies, and Outlook (NEW Live Video Webinar)

Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for a new video webinar:

PBM Industry Update: Trends, Controversies, and Outlook
Broadcast live on April 22, 2022, from 12:00 p.m. to 1:30 p.m. ET

The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia. This page describes the event and explains how to purchase a registration to participate in the event.

This event is part of The Drug Channels 2022 Video Webinar Series. Anyone who registered for the entire series will receive an email with a link to access the April event.

WHAT YOU WILL LEARN

Join Dr. Fein as he helps you and your team stay on top of the latest trends, market data, and strategies for pharmacy benefit management. He will draw from exclusive information found in our new 2022 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

During the event, Dr. Fein will cover a wide range of topics, including:

• The industry position and strategies of the largest PBMs, including DCI’s exclusive market share data

• The emergence and strategies of PBM-owned purchasing groups

• The opportunities and challenges for insurer/PBM/specialty pharmacy/provider organizations

• DCI’s latest data on PBMs’ position in the specialty pharmacy market

• How PBM compensation models are evolving

• PBMs’ battle for specialty benefit management and the risks from specialty carve-out vendors

• Our latest insights on copay accumulators and maximizers

• Risks from disruption of 340B contract pharmacies

• Prospects for smaller PBMs

• Assessment of state and federal PBM legislation

• And more!

PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions.

As always, Dr. Fein will clearly distinguish his opinions and interpretations from the objective facts and data.

Read on for full details on pricing and registration.

Informa Connect’s Medicaid & Government Pricing Congress

Informa Connect’s Medicaid & Government Pricing Congress
Hybrid Event
In-Person: May 23-25, 2022, Philadelphia, PA | Virtual: June 1-2, 2022
www.informaconnect.com/medicaid-government-pricing

Don’t miss the Medicaid & Government Pricing Congress, coming up May 23-25, 2022 (in-person in Philadelphia) and June 1-2, 2022 (virtually)! You'll be part of the important discussions surrounding the critical policy updates and approaches to effectively contract, report and comply with state and federal healthcare programs.

Visit www.informaconnect.com/medicaid-government-pricing for further details and to register. Drug Channels readers will save 10% off when they use code 22DRCH10 and register prior to April 29, 2022.*

The 2022 format includes 3 days of in-person programming, plus a virtual offering of select sessions and recorded presentations available on-demand for 10 business days. Both the in-person and virtual options will include networking opportunities to connect with industry peers and colleagues.

The Medicaid & GP Congress features coverage on the hottest topics impacting you today, from speakers representing United Therapeutics, AstraZeneca, Pfizer, Gilead, GSK, Eisai, Novartis, Vertex and more!

• A block of sessions covering the CMS 2023 Medicare Advantage and Part D Proposed Rule and potential Federal Drug Pricing Changes under what’s currently called the Build Back Better Act
• Updates to the Mandated OIG Prescription Drug Studies
• Portal User Sessions – Step-by-Step reviews of some of the most frequently used portals for managing government reporting with representatives from Gainwell Technologies and Magellan AND MDP System Updates: The Mechanics, Changes and Processes from the new CMS Portal
• An in-depth interactive session on Product Unit of Measurement and Understanding NDC Numbers in the MDRP
• FSS and Government Pricing and Contracting Strategies for Combination Products, Duals, Med Device and MedTech
• And more!

View the agenda to see the complete picture – the program, speakers, and more!

Visit www.informaconnect.com/medicaid-government-pricing for further details and to register. Drug Channels readers will save 10% off when they use code 22DRCH10 and register prior to April 29, 2022.*

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category 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. To find out how you can promote an event on Drug Channels, please contact Paula Fein (paula@drugchannels.net).

The Evolving Medical Benefits Landscape—Are you Ready for It?

Today’s guest post comes from Ian Ocilka, Senior VP of Client Solutions at ConnectiveRx.

Ian explains some of the challenges associated with negotiating the medical benefit for both patients and providers. He goes on to describe the need for combining technology solutions and meaningful human connection for improved patient outcomes.

To learn more, join experts from ConnectiveRx on April 26th at 1 pm ET for a free, online panel discussion: The Evolving Medical Benefits Landscape—Are you Ready for It? Email inquiries@ConnectiveRx.com with any questions.

You can also visit ConnectiveRx in booth 411 at Asembia's 2022 Specialty Pharmacy Summit on May 2-4.

Read on for Ian’s insights.

Warped Incentives Update: The Gross-to-Net Bubble Exceeded $200 Billion in 2021

Time for Drug Channels Institute’s annual update on the gross-to-net bubble—the ever-growing dollar gap between sales at brand-name drugs' list prices and their sales at net prices after rebates and other reductions.

We estimate that the gross-to-net bubble reached $204 billion for patent-protected brand-name drugs in 2021. If we include brand-name drugs that have lost patent protection and face competition from generic equivalents, the bubble was even higher, at $236 billion.

Pharmaceuticals are the only part of the U.S. healthcare system in which the difference between list and net prices is monetized as rebates and redistributed via intermediaries to payers. This bubble reflects—and drives—both patients’ affordability problems, intermediaries' warped incentives, and politicians’ misunderstandings of U.S. drug prices.

Read on for our latest data—and a reminder why SpongeBob SquarePants remains a fixture on Drug Channels.

The 340B Noncompliance Data Gap Leaves Drug Manufacturers in the Dark

Today’s guest post comes from Ashwin Mundra, Chief Revenue Officer at Kalderos.

As Ashwin explains, manufacturers face a gap between visible, non-compliant drug discounts and the actual level of non-compliant discounts. He describe Kalderos’ technology-enabled, machine learning-based methods for identifying drug discount non-compliance.

To learn more, register to receive a copy of Kalderos’ annual report, available April 13, 2022: Conquering the “Great Unknown”: Connecting the data gaps that keep us from knowing the true price of drugs.

Read on for Ashwin’s insights.

NOW AVAILABLE: The 2022 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers

I am pleased to announce our new 2022 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 key industry trends, the Table of Contents, and a List of Exhibits)

• New Drug Channels Institute Study Examines Consolidation and Vertical Integration of U.S. Prescription Market (press release)

We’re offering special discounted pricing if you order before March 28, 2022.

The 2022 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers, our 13th edition, provides a comprehensive, fact-based, and non-partisan tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system. The report has been thoroughly updated with the latest data and includes loads of new material and new sections.

The chart below illustrates the depth and breadth of the 2022 edition. The numbers indicate the report chapter that corresponds to, explains, and analyzes each channel flow.

[Click to Enlarge]

12 chapters, 430+ pages, 216 charts/exhibits/data tables, 800+ endnotes: There is nothing else available that comes close to this report.

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 last week. Please contact us if you did not receive the email.

WHAT’S GOING ON

Twice a year, I research and write 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.

FUN FACTS

• The 12 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.

• As always, we have updated all market and industry data with the most current information available, including our annual analyses of the market positions of the largest pharmacies, specialty pharmacies, and PBMs. Many sections and chapters have been expanded and/or reorganized to better cover the latest industry developments. For more details, see the "What’s New in the 2022 Report" section of the report's overview.

• We are offering the option to download an additional PowerPoint file with images of all 216 exhibits. This popular option helps you share the insights and data with others in your organization.

• There are a staggering 814 (!) 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. Sorry, There are therefore zero memes in the 2022 edition.

• Punctuation nerds will enjoy our all-new approach to hyphens and semicolons.

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

Enjoy!

Join me in May at Asembia’s 2022 Specialty Pharmacy Summit

Asembia’s Specialty Pharmacy Summit 2022
May 2 – 5, 2022 | Las Vegas
www.asembiasummit.com

Asembia's Specialty Pharmacy Summit 2022 is back! 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, Dr. Scott Gottlieb, former FDA commissioner and author of Controlled Spread, will deliver the keynote address. (Click here to read my review of Dr. Gottlieb’s excellent book.) Plus, Doug Long from IQVIA and I will again lead the Featured Session, titled The Specialty Pharmacy Industry Update and Outlook.

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

A MESSAGE FROM ASEMBIA: Access Top Pharmacy & Pharma Industry Executives at Asembia’s Annual 2022 Specialty Pharmacy Summit in May

Returning to Wynn & Encore Las Vegas this spring, Asembia’s Annual Specialty Pharmacy Summit will welcome back thousands of industry leaders focused on the rapidly expanding specialty pharmacy channel.

Asembia’s Summit is back on its normal schedule and kicks off with pre-conference continuing education (CE) programming on Sunday May 1, 2022 followed by 3 days of informative business sessions, additional CE programs, collaborative networking opportunities, interactive exhibits, featured presentations and more. For the latest agenda, session & speaker information and other event details, visit www.asembiasummit.com.

As previously announced, a highlight of the upcoming Summit will be Keynote Speaker, Dr. Scott Gottlieb, who takes center stage on Tuesday May 3, 2022 at 8AM to share his expert perspectives on the evolving industry followed by a fireside chat with Dr. Adam J. Fein of Drug Channels Institute.

Dr. Gottlieb is a physician, Former Commissioner of the FDA, Former Senior Advisor to CMS, Contributor, CNBC & CBS’s Face the Nation and New York Times Belling Author of Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic.

“Throughout the pandemic, no one—and I mean no one—has provided a clearer and more correct picture of what was happening to our country than Dr. Gottlieb. All the while he was sought out to provide more advice to decision-makers on all sides of the aisle than anyone. In Uncontrolled Spread, he is doing perhaps the ultimate service in telling the story to us in a gripping, no holds barred, yet highly constructive fashion. This book will be one of the bibles of this era.” — Andy Slavitt, former White House senior advisor for the COVID-19 response

Have a question for Dr. Gottlieb and Dr. Fein to review during their interactive fireside chat? Send it to connect@asembiasummit.com. for consideration.

The Summit will again welcome the full spectrum of organizations working in the pharmacy, life sciences & patient services market. Key decision makers from top pharmaceutical manufacturers and life sciences companies are registering daily along with leading pharmacies, pharmacy benefit managers, digital health companies, health systems, payers, managed care organizations and other key industry stakeholders. To register and join fellow attendees from these companies, visit www.asembiasummit.com today.

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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).

Four Things You Need to Know about Hubs in 2022

Today’s guest post comes from Stacey Little, Senior Vice President of Business Development and Marketing at AssistRx.

Stacey analyzes trends in patient support services and reimbursement hubs.

Learn more about AssistRx’s specialty therapy initiation and patient support services at Asembia's Specialty Pharmacy Summit on May 2-5, 2022. Click here to schedule your meeting.

Read on for Stacey’s insights.

The Top 15 U.S. Pharmacies of 2021: Market Shares and Revenues at the Biggest Companies

Next week, Drug Channels Institute will release our 2022 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the 13th edition of our popular and comprehensive examination of the entire drug pricing, reimbursement, and dispensing system.

The exhibit below—one of 216 in our new report—provides a first look at the 15 largest organizations, ranked by total U.S. prescription dispensing revenues for calendar year 2021.

U.S. prescription dispensing revenues reached a record $501 billion in 2021. The total share of the largest 15 companies decreased slightly compared with their 2020 share, due primarily to below-market growth rates at retail and long-term care pharmacies. As I discuss below, upcoming business changes may reshuffle this list during 2022.

Read on as we cue up our latest update on the booming pharmacy and PBM marketplace.

For a sneak peek at the complete report, click here to download our free report overview (including key industry trends, the table of contents, and a list of exhibits). We’re offering special discounted pricing if you order before March 28, 2022.

Technology Enables Patient Medication Access Support at Critical Touchpoints

Today’s guest post comes from Miranda Gill, Vice President of Network at CoverMyMeds.

Miranda discusses how integrated technology solutions can be used at critical moments in the patient’s journey to increase access, affordability, and adherence to therapies.

To learn more about CoverMyMeds’ prescription decision support tools for the entire care team, visit CoverMyMeds at HIMSS22.

Read on for Miranda’s insights.

Supermarkets Again Dash Past CVS and Walgreens in 2022’s Part D Pharmacy Networks

The Centers for Medicare & Medicaid Services (CMS) has recently released its 2022 data on enrollment in Medicare Part D prescription drug plans (PDPs). Our exclusive analysis of these numbers finds that for 2022, an astounding 99% of seniors are enrolled in the wonderland of PDPs with preferred pharmacy networks.

Below, we use the new enrollment data to examine the major pharmacy chains’ position within the 27 major Part D plans that have preferred networks. For the second year, the big supermarket chains—Albertsons, Kroger, and Publix—outpaced the big three drugstore chains and Walmart.

Supermarket pharmacies gained overall prescription market share in 2021, as we discuss in our forthcoming 2022 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. Expect supermarkets to run even faster in 2022. What a strange world we live in!