A Game-Changing Shift: Why Pharma Commercial Teams Are Turning to HEOR

Today’s guest post comes from Chris Harvey, Director of Solutions Engineering at Panalgo, and Carolyn Zele, Senior Manager of Solution Enablement at MMIT.

Chris and Carolyn discuss the insights that health economics and outcomes research (HEOR) professionals bring to commercial teams. They explain how that pairing benefits both manufacturers and patients.

For more on how MMIT and Panalgo help pharma manufacturers leverage HEOR and real-world data for commercial strategies, click here to learn about the Patient Access Analytics tool.

Read on for Chris’ and Carolyn’s insights.

Drug Channels News Roundup, April 2022: 340Boom, 340B Profits for Pharmacies & PBMs, Fixing Insulin, Walgreens’ Robots, and Doctors’ Day

Baseball season is in full swing! Oil up your glove, lace up your cleats, and let's run the bases around this month's news stories. Remember: Sometimes you win, sometimes you lose, and sometimes it rains.

In this issue:

• Green Monster: The 340B market hits new highs in 2021

• Not-Free Agents: Big 340B profits for CVS, Walgreens, Express Scripts, et al

• Batter Up: Fixing the insulin market

• Pinch Hitters: Walgreens bets on robots

Plus, Dr. Glaucomflecken helps UnitedHealthcare celebrate Doctors’ Day!

P.S. For my daily pitches on the industry’s hits and misses, join my nearly 27,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 13,800 followers.

Next week, I'll be live and in-person at Asembia's Specialty Pharmacy Summit. During Tuesday's general session, I'll be joining Dr. Scott Gottlieb for a fireside chat at 8:00 AM and will then present my "State of Specialty Pharmacy 2022" at 9:30 AM. Hope to see you there!

Informa Connect’s Patient Support Services Congress

Informa Connect’s Patient Support Services Congress
Hybrid Event | November 8-10 in Philadelphia, PA
www.informaconnect.com/patientsupport

Exclusive Offer – Be sure to use your exclusive promo PSS22DC to save 10% off* of your registration.

A proven industry staple, Patient Support Services Congress is back November 8-10, 2022 and ready to arm industry with next-generation approaches to patient services for optimal program performance. Taking place in a hybrid format in Philadelphia, PA, prepare to join leaders from across industry as they come together for innovative discussions on access strategy, patient interactions, case management, compliance practices and more.

This event unites both compliance and operations teams. You will benefit from collaboration and next-level benchmarking to drive program success. Take advantage of tailored, tracked content featuring detailed case studies on control enhancement and operational excellence to further advance your programming.

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code PSS22DC to save 10% off* of your registration.

In two-and-a-half days, walk away with critical insights on industry standards, forward-thinking strategies to propel program performance, and so much more.

Can’t miss content highlights:

• Industry Address – Dive into Market Trends Impacting Access, Adherence and the Patient Journey
• Enforcement Update – Explore Rising Oversight and High Priority Risk Areas for Patient Services Compliance
• Engage, Educate, Exchange — Optimize Relationship Management between Manufacturers and Patients for Enhanced Outcomes
• The Rise of Technology – Accelerate Enrollment Through AI-Driven Approaches
• Address Disparities in Access Through Patient Support Program Design to Improve Outcomes
• And more!

PLUS! Customize Your Experience with Two Tailored Tracks:

Compliance and Legal

• Implement Internal Controls to Reduce Compliance Risks with Nurse Educators and HCP/Patient Interactions
• Manage Third-Party Compliance to Optimize Patient Interactions
• Enhance Patient Data Monitoring for Greater Strategic Outcomes
• Monitor Virtual Programs and Field Team Compliance for Successful Adaptation
• Create Compliant Bridge and Quick Start Programs for Rare Disease
• And more!

Innovation and Operations

• Discover Hybrid and Alternative Patient Solutions Models to Best Support Patients and HCPs

Build and Maintain Patient Engagement for Rare Disease

Utilize Predictive Analytics to Build a Better Patient Services Program

Streamline Patient Education to Create Meaningful Communication

Enhance Access, Reimbursement and Benefit Support Through Programming

And more!

How Does Hybrid Work?

• ALL ACCESS PASS includes the in-person event November 8-10 AND all benefits of the virtual experience pass
• VIRTUAL EXPERIENCE PASS includes live streaming of select sessions November 8-10 as well as recorded presentations from the in-person events available for 10 business days beginning November 15

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code PSS22DC 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).

Four Reasons Why PBMs Gain As Maximizers Overtake Copay Accumulators (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from February 2022.

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More than four years ago, I warned about the emerging trend of copay accumulators and outlined the costly consequences for patients.

The latest data reveal that copay accumulator adjustment programs are now in the word list for a growing share of pharmacy benefit designs. What’s more, adoption of copay maximizers now exceeds that of copay accumulators. Maximizers avoid the brutal patient adherence problems of accumulators, while allowing plan sponsors to extract even more patient support funds.

Despite this impressive growth, you may not yet have considered PBMs’ business model for these tools. Below, I outline why PBMs have incentives to prefer maximizer programs over accumulators and alternatives such as specialty carve-out programs.

I look forward to hearing your thoughts on these developments in the comments below or on social media: LinkedIn (preferred) or Twitter.

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

This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from October 2021.

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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.

Five Takeaways from the Big Three PBMs’ 2022 Formulary Exclusions (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from January 2022.

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For 2022, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)— increased the number of drugs they excluded from their standard formularies.

Each exclusion list contains 400 to 500 products. Growth in the number of excluded drugs slowed, due partly to the fact that so many drugs have already been dropped from PBMs’ formularies.

Below, I highlight five observations about this year’s lists, including unexplainable differences in how PBMs handle specialty drugs, biosimilars, and insulin.

I also offer some thoughts on non-medical switching and what we still don’t know about how exclusions affect patients.

Let me know what you think by commenting below or on social media.

Why PBMs and Payers Are Embracing Insulin Biosimilars with Higher Prices—And What That Means for Humira (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBM Industry Update: Trends, Controversies, and Outlook.

Click here to see the original post and comments from November 2021.

An ironic postcript: Less than two months after my article was published, Cigna CEO David Cordani bragged about the cost savings from "aggressive adoption" of biosimilars. Anyone want to tell him about the Express Scripts formulary for insulin biosimilars?

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The Food & Drug Administration (FDA) recently approved the first interchangeable biosimilar insulin product: the insulin glargine-yfgn injection from Viatris. Read the FDA’s press release.

Alas, I’m sad to report that the warped incentives baked into the U.S. drug channel will limit the impact of this impressive breakthrough.

Viatris is being forced to launch both a high-priced and a low-priced version of the biosimilar. However, only the high-list/high-rebate, branded version will be available on Express Scripts’ largest commercial formulary. Express Scripts will block both the branded reference product and the lower-priced, unbranded—but also interchangeable—version. Meanwhile, Prime Therapeutics will place both versions on its formularies, leaving the choice up to its plan sponsor clients.

Consequently, many commercial payers will adopt the more expensive product instead of the identical—but cheaper—version. As usual, patients will be the ultimate victims of our current drug pricing system.

Below, I explain the weird economics behind this decision, highlight the negative impact on patients, and speculate on what this all could mean for biosimilars’ future. Until plan sponsors break their addiction to rebates, today’s U.S. drug channel problems will remain.

Informa Connect’s PAP – Patient Assistance & Access Programs

Informa Connect’s PAP – Patient Assistance & Access Programs
Hybrid Event | June 28-30 in Parsippany, NJ
www.informaconnect.com/pap

Exclusive Offer – Be sure to use your exclusive promo code 22DCPAP10 to save 10% off* of your registration.

Informa Connect is pleased to announce that PAP – Patient Assistance & Access Programs will return as a hybrid event June 28-30 in Parsippany, NJ and virtually through the ConnectMe platform. As the barriers for medication assistance become increasingly significant and out-of-pocket costs and the number of uninsured and functionally uninsured patients increase, it is essential for stakeholders to collaborate on how to further access to care, understand current changes in legislation and policy, and optimize PAPs for better patient outcomes. This event unites pharma, foundations, health clinics and more. Do not miss this opportunity to benchmark on industry standards and stay on top of evolving trends to propel program performance.

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code 22DCPAP10 to save 10% off* of your registration.

Whether you choose to attend in-person or virtually, PAP will deliver unparalleled strategies to drive patient assistance and affordability. Ensure you are at the table with leaders from across industry as they collaborate on and discuss the most timely and crucial topics, including industry standards for patient assistance, changing legal trends, tools and technologies to empower patients to better manage OOP costs, next-generation models for assistance, and so much more.

Can’t miss content highlights:

• State of the Industry: Policy Updates and Regulatory Advancements Driving Affordability and Access
• Panel: Current Trends and Industry Benchmarks for PAPs
• Navigate the Legal Underpinnings of Patient Assistance and Gain Insight on OIG Oversight
• Foundation and Advocate Insights: Collaborating to Evolve PAPs and Accelerate Patient Access
• Ensuring the Continuity of Care Across the Patient Journey
• Patient Perspective Fireside Chat
• Three Customizable Tracks by Company Classification
• Bio/Pharma Manufacturers
• Patient Advocates
• Hospitals/Clinics/Health Systems
• Diversity, Equity and Inclusion Summit: Advance Advocacy and Innovation to Achieve Health Equity
• Part One: Racial and Income Disparities in Healthcare
• Part Two: Explore Proactive Approaches to Increase Access to Healthcare
• Emerging Best Practices and Industry Trends in Free Drug Programs
• And more!

PLUS, 2022 EXCLUSIVE:

PAP will be co-located with Hub & Specialty Pharmacy Models! That’s right – Benefit from shared learning, extended networking opportunities and the option to pick your favorite sessions and move between conferences if desired at no additional cost (and that includes access to the Hub & Specialty Pharmacy Models virtual platform as well)!

How Does Hybrid Work?

• ALL ACCESS PASS includes the in-person event June 28-30 AND all benefits of the virtual experience for PAP AND Hub & Specialty Pharmacy Models East
• VIRTUAL EXPERIENCE PASS includes live streaming of all general sessions June 28-30 as well as recorded presentations from the in-person events available for 10 business days beginning July 5

Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promo code 22DCPAP10 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).

Kristy’s Story: Navigating Specialty Medication Challenges

Today’s guest post comes from Megan Marchal, Director of Specialty Pharmacy Strategy at CoverMyMeds.

Megan discusses the access and affordability challenges faced by specialty therapy patients. She describes how CoverMyMeds’ centralized technology solutions—paired with experts familiar with each therapy—help patients navigate these challenges. And, she shares one patient’s personal journey.

To learn more about CoverMyMeds’ technology solutions, visit Booth 229 at the Asembia Specialty Pharmacy Summit in Las Vegas, May 2-5, 2022.

Click here to sign up for CoverMyMeds’ Asembia Specialty Pharmacy Summit recaps.

Read on for Megan’s insights.

Who Will Pay for Prescription Drugs in 2030? (Hint: It’s Us)

The econowonks at the Centers for Medicare & Medicaid Services (CMS) recently released the latest projections for U.S. spending on healthcare. (See links below.) These data provide our first official look at post-pandemic U.S. healthcare spending.

As you will see below, outpatient prescription drugs dispensed by retail and mail pharmacies are projected to remain a small share (8.4%) of total U.S. healthcare spending. What’s more, taxpayers—via Medicare and Medicaid—will continue to crowd out the private insurance market. One bright spot: consumers will account for an ever-smaller share of drug spending.

Thus, the government actuaries expect that pharmaceuticals will not be the key driver of U.S. healthcare spending growth. Will someone tell our elected officials?

Speaking of prescription drug payment, be sure to sign up for my new live video webinar, PBM Industry Update: Trends, Controversies, and Outlook, on April 22, 2022, from 12:00 p.m. to 1:30 p.m. ET.

Informa Connect's Life Sciences Commercial Contracts & Chargebacks 2022 Hybrid

Informa Connect's Life Sciences Commercial Contracts & Chargebacks 2022 Hybrid
May 24-25, 2022 | Philadelphia, PA
www.informaconnect.com/contracts-chargebacks
Save 10% by using code 22DC10

The Life Sciences Commercial Contracts and Chargebacks conference returns as a hybrid event May 24-25 with the options of attending in-person in Philadelphia or virtually.

Visit informaconnect.com/contracts-chargebacks to view the complete agenda, then register using the exclusive Drug Channels discount code 22DC10 to receive 10% off!

Join industry leaders from bio/pharma manufacturers, wholesalers, GPOs and more for interactive dialogues and strategic best practices to optimize commercial contract models, maximize chargeback efficiencies and streamline eligibility management.

The content-rich agenda boasts an incredible speaking faculty joining the event, including experts from Ingenus Pharmaceuticals, McKesson, Hikma Pharmaceuticals, Cardinal Health, Teva Pharmaceuticals, Tolmar Pharmaceuticals, FFF Enterprises, IntegriChain, Mallinckrodt Pharmaceuticals, UCB Pharma, Chronicled, Fresenius-Kabi USA, Premier Inc., NS Pharma, and Atrium Health, to name a few.

You will benefit from learnings on timely topics in an innovative format, including:

• Manufacturer/Wholesaler Team-to-Team Meet and Greets
• Membership Management Optimized and Reimagined
• GPO Leadership: Revolutionary Practices to Adapt and Implement
• Regulatory Highlight: Plan for 2022 and Beyond
• Case Study: MediLedger Network for Data & Trading Partner Alignment as Best Practice for Error Elimination

Visit informaconnect.com/contracts-chargebacks to view the complete agenda, then register using the exclusive Drug Channels discount code 22DC10 to receive 10% off!

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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 Solutions Manufacturers Should Consider For Retail and Specialty-lite Products

Today’s guest post comes from Michael Carr, CoAssist Group Vice President at AssistRx

Michael discusses patient support challenges that are unique to specialty-lite pharmaceuticals. He goes on to describe four new categories of patient solutions and pharmacy models specific to this growing market segment.

To learn more about CoAssist and AssistRx specialty therapy initiation and patient support services, click here to schedule a meeting with AssistRx at the Asembia Specialty Pharmacy Summit on May 2-5, 2022.

Read on for Michael’s insights.

The Top Pharmacy Benefit Managers of 2021: The Big Get Even Bigger

The highly-consolidated PBM market notched another year of increased concentration.

Consider Drug Channels Institute's latest estimates of pharmacy benefit manager (PBM) market share, shown in the chart below. For 2021, we estimate that the three biggest PBMs accounted for 80% of total equivalent prescription claims. Significant business relationships among the largest companies continue to shift market share.

As I explain below, the prospects for market disruption remain low, so the controversial warped incentives of the rebate system will continue to distort the drug channel.

To get a handle on this complex market, join me on April 22 for a new live video webinar, PBM Industry Update: Trends, Controversies, and Outlook. I’ll examine DCI’s latest PBM market data, the emergence of PBM purchasing groups, specialty market developments, PBMs’ evolving compensation models, and much more. Click here for more details.

Informa Connect's Rare Disease Innovation & Partnering Summit

Rare Disease Innovation & Partnering Summit
Hybrid Event
May 17-19, 2022 | Boston, MA
www.informaconnect.com/rare

Don’t miss the Rare Disease Innovation & Partnering Summit, coming up May 17-19, 2022 in Boston, MA.

Visit www.informaconnect.com/rare 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.*

When you join us this spring, you’ll be part of the important discussions surrounding patient access, reimbursement, commercialization, launch, partnering and more. Come together with experts from across the rare disease community, in-person or virtually, to unite in areas of unmet medical need and create life-transforming therapies and breakthroughs.

We’ll cover the hottest topics impacting you today, from speakers representing Alexion, Angelman Syndrome Foundation, bluebirdbio, Cognito Therapeutics, CURECMT4J, Cydan, the FDA, Global Genes, NS Pharma, Rafael Pharma, Sanofi, TaretCancer Foundation, Tremeau Pharma, Ultragenyx, and more.

• Strengthening Patient Relationships Authentically to Enhance Therapeutic Development
• The Search for Novel Funding - Preparing for and Expanding Successful Partnering
• Understanding the Patient Journey
• Clinical Management of Patients with Complex Conditions
• Discovering Patient Support Program Needs for Patients
• Patients and Payers: Perspectives on Developing Gene Therapies for Rare Diseases
• Prioritizing RWE Collection in a New Era of Novel Gene Therapy
• Optimizing Strategic Partnership Models and Investment for Orphan Drug Products
• Developing and Scaling Digital Therapeutics
• Leveraging Genetic Testing for Value
• Fostering Relationships Between Industry and Advocacy
• Uncovering Risk Disclosures for Gene Therapies
• Optimizing Decentralized Trials to Support the Future of Rare Disease Research
• PLUS - Your registration to the Summit includes a complimentary pass to Selections from The DISORDER Channel, an annual viewing of short films addressing the day-to-day challenges and struggles of rare disease patients and their families.

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

Visit www.informaconnect.com/rare 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).

How the Medicaid Copay Accumulator Rule Will Hurt Prescription Affordability

Today’s guest post comes from Fauzea Hussain, Vice President of Public Policy at McKesson.

Fauzea succinctly describes the complicated and contradictory aspects of the Centers for Medicare & Medicaid Services' Final Rule on Best Price, a.k.a. the Medicaid copay accumulator rule. She then outlines how the rule, if implemented, is likely to hurt patients.

For information about the Best Price Rule and how CoverMyMeds can help identify solutions, contact them at: InfoBP@mckesson.com. To learn more about solutions to help patients access, afford and adhere to their medications, read CoverMyMeds’ 2022 Medication Access Report.

Read on for Fauzea’s insights.