Here at our worldwide headquarters in Philadelphia, Eagles Super Bowl fever has landed. The police are already getting extra Crisco for the light poles. (Yes, really.)
Before you start training to gorge at your game day party, tackle this month’s selection of notable news stories, intercepted for you from the Drug Channels gridiron:
Offsides: My $0.02 on the latest moves by Amazon and OptumRx
Trick play: OptumRx attacks alternative funding programs
Offensive line: Shocking Wall Street Journal expose of 340B abuses
Touchdown! Accumulators and maximizers go mainstream
Today’s guest post comes from Saket Patel, Consultant, Advisory Services at MMIT.
Saket discusses market access and contracting strategies for medical benefit products when pharmacy benefit biosimilar therapies launch. He then describes how to automate formulary and medical policies to protect manufacturers from overpayment.
Now that 2023 is underway, let’s review employer-sponsored coverage for prescription drugs and speculate on what’s ahead.
Below I examine the latest data on pharmacy benefits: cost sharing tier structures, copayment vs. coinsurance, and out-of-pocket obligations. As you will see, pharmacy benefit designs again increased the use of coinsurance for specialty and fourth-tier drugs.
These designs significantly raise patients’ out-of-pocket obligations—and contribute to the controversy over copay accumulator adjustment and copay maximizers. In 2023, employers’ savings and PBMs’ profits from these programs will decline—which will trigger a coming crackdown on specialty drug benefits. Beneficiary beware!
P.S. As usual, you will also enjoy some terrible Drug Channels tiers/tears puns.
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The last thing a patient should worry about is access to care. With growing demand for patient assistance, accelerating prescription access and affordability is as crucial as ever. PAP – Patient Assistance & Access Programs is back March 20-22 and bringing together key stakeholders to collaborate and strategize on methods to meet that growing demand and navigate the access and reimbursement barriers faced daily.
Join your peers, leading experts and top solution providers for unparalleled networking opportunities and fresh perspectives on how to further access to care, understand current changes in legislation and policy and optimize PAP programs for better patient outcomes. Industry standards are evolving. Secure your spot now to ensure you and your organization are not left behind.
Do not miss this opportunity to unite with pharma, foundations, health clinics and more and benchmark on industry standards and stay on top of evolving trends to propel program performance. Can’t miss content highlights include:
State of the Industry: The Changing Landscape of Healthcare Coverage and Access
PhRMA Keynote Address
Equity Spotlight: Understanding the Importance of Equitable Healthcare, Education and Partnerships
Patient Perspective
Manufacturer PAP Spotlight: Gain Insight on Best Practices and Industry Standards
Three Customizable Tracks
PAP Legal & Policy
Patient Adherence Strategies
Technology, Innovation & Automation
Two Workshops
Advocacy Insights to Enhance Patient Care
Partnership and Development to Optimize Patient Access
And more!
PLUS, EXTENDED NETWORKING IN 2023!
PAP 2023 will take place as part of Access USA, the access event bringing together three industry-leading conferences under one roof. Benefit from robust networking opportunities with all Access USA participants (that is an expected 600+ access professionals!) and expand your network and establish powerful partnerships.
Exclusive Offer – View the agenda and register today – Be sure to use your exclusive promocode 23DCPAP10 to save 10% off* 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.
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).
Today’s blog post comes from Andrew Duncan, Vice President of Business Operations and Analytics at PHIL.
Andrew discusses how manufacturers can use data-driven strategy to understand utilization, increase patient access and adherence, and optimize gross-to-net.
Consolidation has brought together large, economically significant insurer/PBM/specialty pharmacy/provider organizations within U.S. drug channels. At least half of all U.S. healthcare spending flows through these seven familiar entities: Blue Cross Blue Shield, Centene, Cigna, CVS Health, Elevance Health, Humana, and United Health Group.
In the brief video clip below, I review these businesses and offer some thoughts on their positioning for 2023. As you’ll see, the vertical strategy shakeout is underway.
For 2023, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again increased the number of drugs they exclude from their standard formularies.
Each exclusion list now contains about 600 products. Growth in the number of excluded drugs slowed for the second year, due partly to the fact that so many drugs have already been dropped from PBMs’ formularies.
Below, I highlight four takeaways from this year’s lists, including a look at biosimilar insulin and the forthcoming biosimilar competition for Humira. I also note some troubling research on the patient impact of exclusions—although much remains unknown.
As always, I welcome your comments below or on social media.
Time for the Drug Channels annual reality check on drug pricing. The data once again tell a different story than you might read in your favorite politician’s Twitter feed or misleading news reports.
For 2022, brand-name drugs’ net prices dropped for an unprecedented fifth consecutive year. What’s more, after adjusting for overall inflation, brand-name drug net prices plunged by almost 9%.
The factors behind declining drug prices will remain in the coming years—and become even stronger due to forthcoming changes in Medicare and Medicaid. Employers, health plans, and PBMs will determine whether patients will share in this ongoing deflation.
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