Drug Channels delivers timely analysis and provocative opinions from Adam J. Fein, Ph.D., the country's foremost expert on pharmaceutical economics and the drug distribution system. Drug Channels reaches an engaged, loyal and growing audience of more than 100,000 subscribers and followers. Learn more...
The era of artificial-intelligence chatbots has arrived! I am pleased to report that this month’s Drug Channels news roundup was most definitely not written by ChatGPT. No promises about future articles. (See our forecast to the right.)
In this issue:
Mark Cuban explains his anti-PBM strategy
What physicians think about Humira biosimilars
States go after PBMs
HHS is confused about 340B transparency
Plus, The Onion tests your knowledge of United Healthcare’s policies.
Today’s guest post comes from Matt Hall, President of Patient Solutions at CareMetx.
Matt shares three key findings from CareMetx’s exclusive new survey on patient support services for specialty pharmaceuticals. To learn more, download CareMetx’s free 2022 Report - Patient Services Trends.
Is the gold rush in copay accumulators and maximizers slowing down?
Our latest update finds that for 2022, about 40% of commercial lives have adopted these benefit designs. Accumulator adoption has plateaued, while maximizer use has overtaken accumulators. Patients who take a single-source, brand-name specialty drug for autoimmune conditions, multiple sclerosis, and oncology increasingly face these benefit designs. Check out the plan and patient data below.
Patients are caught in the middle of a complex battle among insurers, PBMs, and drugmakers. They are rightfully unhappy that their plans are grabbing the copay support funds. That’s why legislation, lawsuits, and patient advocacy are growing. Manufacturers are also pushing back on plans’ copay games.
These reactions will slow the financial windfall for plans and PBMs—and raise the risk that plans will push the ethical boundaries even farther.
On March 14, 2023, Drug Channels Institute will release The 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This report—our fourteenth edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system.
12 chapters, 480+ pages, 241 exhibits, 900+ endnotes: There is nothing else available that comes close to this valuable resource.
We are providing you with the opportunity to preorder this thoroughly updated, revised, and expanded 2023 edition at special discounted prices. This means that you can be among the first to access our new report. Those who preorder will receive a download link before March 14.
Special preorder and launch pricing discounts will be valid through April 3, 2023.
The 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers is a definitive, nonpartisan resource that includes the most current information about pharmacy dispensing channels, third-party payers, pharmacy benefit managers (PBMs), patients’ financial contributions, government regulations, and much more.
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. Throughout the report, we have added new industry data, deepened our coverage of many topics, and added more trending information. Material that addresses COVID-19 and its impact on the pharmacy and PBM industries has been integrated into our analyses throughout the report.
This 2023 edition includes substantial new material. A new Section 12.5. addresses the Inflation Reduction Act of 2022. In Subsection 12.5.1., we summarize the key provisions of the law that relate to the topics in this report. In Subsection 12.5.2., we highlight potential implications of the IRA for the drug channel.
The chart below illustrates the depth and breadth of the 2023 edition. The numbers indicate the report chapter that corresponds to, explains, and analyzes each channel flow.
[Click to Enlarge]
Thank you for your interest in our work. If you have any questions before purchasing a license to the report, please email me. Enjoy!
This Valentine's Day, what could be more romantic than a deep dive into the relationships between manufacturers of specialty drugs and the pharmacies they choose for their limited and exclusive specialty pharmacy networks.
Below, we rely on a unique database to provide you with some never-before-published benchmarking data on manufacturer-defined networks for 290 specialty drugs.
As you’ll see, a typical network contains only five specialty pharmacies. However, this average disguises substantial variability in network size. More than one in four specialty products have an exclusive network, while some have as many as 25 participants.
Manufacturers almost always say “be mine” to pharmacy benefit manager (PBM) affiliated partners, but they also swipe right with unaffiliated specialty pharmacies. Alas, PBM and plan strategies can still make smaller pharmacies feel lonesome.
As you've surely heard, Amgen has just launched Amjevita, the first non-interchangeable biosimilar of Humira. Our crazy drug channel led Amgen to launch both a high-list/high-rebate and a low-list/low-rebate version of the drug. Its strategy echoes the pricing of the first interchangeable insulin biosimilars—as I predicted in 2021.
Unfortunately, we should expect most PBMs and plan sponsors to embrace the high-list/high-rebate version. The plans that adopt the higher-priced biosimilar will get bigger rebates, while patients with coinsurance and deductibles end up paying more out-of-pocket.
As Mark Twain said: “History doesn’t repeat itself—but it often rhymes.” So, below, I revisit the surprising market dynamics for the interchangeable insulin biosimilars and highlight Amgen’s experience lowering the list price of its PCSK9i product. The story is more complex than you might expect, so perhaps there is hope that low-list-price versions will connect.
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We would like to introduce to you Access USA, industry’s resource for accelerating access, partnerships and collaboration to deliver superior patient outcomes.
What is Access USA? Access USA will unite PAP – Patient Assistance & Access Programs, Hub and Specialty Pharmacy Models East and Rare Disease Innovation & Partnership Summit, three industry-leading access conferences under one roof for one week of collaborative discussions and opportunities to expand your network and establish powerful partnerships.
Who will be there? Join leading bio/pharma manufacturers, impactful non-profit organizations, top-tier hospitals, foremost health clinics, top-notch PBMs, inspiring advocates, prominent specialty pharmacies, highly regarded academics, leading solution providers and more as they unite to tackle the barriers of patient access and take the necessary steps toward ensuring no patient worry about access to care.
What does that mean for you? In one week, meet with hundreds of key stakeholders across the access landscape and benchmark with, learn from and network with leaders paving the way in patient access. Just choose your preferred event and prepare to walk away inspired and armed with the knowledge necessary to drive patient access forward.
Here are just a few can’t miss content highlights from PAP – Patient Assistance & Access Programs. View the full agenda here.
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
Manufacturer PAP Spotlight: Gain Insight on Best Practices and Industry Standards
Customizable Track Programming by PAP Legal & Policy, Patient Adherence Strategies or Technology, Innovation & Automation
Workshop Breakout – Advocacy Insights to Enhance Patient Care or Partnership and Development to Optimize Patient Access
Here are just a few can’t miss content highlights from Rare Disease Innovation & Partnership Summit. View the full agenda here.
Navigate FDA Updates on Rare Disease Product Development
Establish and Navigate the Relationship between Industry and Advocacy
Advancing Rare Disease Research with Patient Centrality and Precompetitive Approaches – A Screen4Care Case Study
Rare Disease Awareness – Delivering Authentic Lived Experiences in a Challenging Regulatory Landscape
The 4Ps of Precision Medicine – Patients, Providers, Partners and Pharma
Breakout into Tracks – Access and Reimbursement Strategies, Investing and Partnering, and Drug Development and Clinical Innovation
Here are just a few can’t miss content highlights from Hub and Specialty Pharmacy Models East. View the full agenda here.
Policy Address – State of the 2023 Industry and Payer Landscape for Industry Trend Updates
Hubs Stakeholder Showcase – Opportunities and Challenges in Accelerating Patient Access with Manufacturer, SPP and Consultant Perspectives
Copay Landscape – Changes in the Accumulator/Maximizer Landscape and How to Prepare
Enforcement Panel – Explore Evolving Regulatory Reform in the Patient Support Services and Hub Models Space
Customizable Tracked Programming by Patient Support & Engagement or Digital & Technological Innovation
Exclusive Offer – Choose your preferred event and register today – Be sure to use your exclusive promo 23AUSA10 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.
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).
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