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.
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.
One follow-up to this rerun: Kroger’s participation as a preferred pharmacy declined significantly due to its Express Scripts relationship. Based on early 2023 enrollment data, Kroger is preferred in plans that enrolled only 11.8 million people—a decline of 33% from the 2022 figure. See Exhibit 154 of our new 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
Today, I examine the seven largest retail chains’ 2023 participation in the 22 major 2023 Part D preferred networks that the eight largest plan sponsors will offer. As always, I offer you a handy table for scoring each chain’s participation and changes from 2022 to 2023.
As you’ll see, Kroger’s decision to exit Express Scripts commercial pharmacy networks has had negative ramifications for its Part D position. Kroger will be out-of-network—not just non-preferred—in the major Part D networks for which Express Scripts acts as the PBM. That will be a key factor behind its $1+ billion revenue hit.
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.
This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook. Friday's webinar will include my latest thoughts on a key trend discussed in todays rerun: how plan sponsors are incorporating patient-paid prescriptions—cash-pay prescriptions and discount cards—within pharmacy benefits.
Last week, GoodRx announced that it would become the exclusive prescription discount card provider for the commercial beneficiaries of Cigna’s Express Scripts. Links below.
The rise of discount card pricing within pharmacy benefit plans is a positive development. Patients get access to market prices that can be lower than their PBM’s contracted rate. All out-of-pocket spending with a discount card counts toward a patient's deductibles, and all prescription activity gets captured.
However, I suspect few people understand that placing discount cards within the pharmacy benefit enables a PBM to monetize a new fee stream from the card vendor. Below, I walk through this booming business and highlight some of the conflicts and contradictions underneath the coconuts.
Today’s guest post comes from Logan Melchione, Senior Director of Account Management at Paysign.
Logan discusses the financial impacts of copay accumulators on manufacturers and patients. She describes how to reduce the strain on manufacturers' programs while also increasing patient access. Click here to learn about the Paysign Solution.
Email affordability@paysign.com to set up a meeting with Paysign at Asembia’s Specialty Pharmacy Summit, April 30-May 4.
Spring is here in sunny downtown Philadelphia, worldwide headquarters of Drug Channels. The vernal equinox has brought us an unexpected bounty of noteworthy news:
Thoughts on the recent insulin price cuts by Lilly, Novo, and Sanofi
AbbVie gets tougher on alternative funding programs
Optum quietly adds a new drug channel role
A novel partnership emerges to modernize the 340B program
Plus, a celebration of pharmacists’ activities during the COVID-19 pandemic.
Exclusive Offer for Drug Channels Readers: Register Now to SAVE 10%* using promo code 23DC10
Informa Connect’s 19th Annual Commercial Contracts & Chargebacks Congress, taking place May 16-17 in Washington, DC, offers crucial updates on policy changes and contracting best practices to increase efficiency, reduce revenue leakage, and streamline chargeback excellence. This annual event has become a must-attend for pricing and contracting professionals in the life sciences industry with seasoned leaders and forward-thinking strategies on display. Join industry stakeholders, including manufacturers, wholesalers, GPOs and more, for a robust two-day event offering extended content and actionable strategies in key interest areas in the ever-evolving contracting landscape.
Featured Faculty Driving the Conversation:
Rosalind Davis, Government Pricing & Contracts Director, Vifor Pharma, Inc.
Stephani Kupski, Director, U.S. Pricing & Government Reporting, CSL Behring
Mallory O’Connor, Public Policy Executive Director, Mallinckrodt
Cad Snyder, Director, Global Finance Shared Services, Cardinal Health
Beth Stevens, Associate Director, Contracts and Pricing, Tolmar Inc.
Roxana Santiago, Director Controlling Revenue Accounting, Fresenius Kabi USA LLC
Jennifer Plemmons Crosswell, Director, Contracts & Pricing, Accounting, Azurity Pharmaceuticals
Hight Impact Topics Transforming the Market Include:
Commercial Contract Model Landscape
Assessing the Impact of IRA on Product Calculations
340B Drug Discount Program — Ongoing Monitoring of 340B Program Risks & Best Practices
Multi-Stakeholder Panel — Membership and Class of Trade
Updated Review and Interpretation of the Inflation Reduction Act
GTN Forecasting Across Different Channels
PLUS! — Customize Your Learning by Choosing Between Two Thought-Provoking Tracks:
Contracts and Chargebacks Excellence
Analytical and Technology Innovation
and more!
NEW THIS YEAR! The 2023 Summit is Part of Life Sciences Pricing & Contracting USA
Uniting three industry leading events — Medicaid & Government Pricing Congress, Drug Pricing Transparency Congress and Life Sciences Commercial Contracts & Chargebacks — Life Sciences Pricing & Contracting USA is the industry’s go-to resource for gaining critical insight on regulatory requirements, policy initiatives and best practices to enhance pricing and contracting models. Attend your preferred event and prepare for critical content tailored to your focus area, plus benefit from a more diverse speaking faculty and greater networking opportunities to expand your network and establish powerful partnerships.
ENHANCE YOUR EXPERIENCE!
Attendees of Commercial Contracts & Chargebacks 2023 have the option to add a third day of content to their schedule and join the Medicaid & Government Pricing Congress attendees for their final day. Benefit from a fireside chat, in-depth sessions and learning streams, plus additional networking opportunities!
Drug Channels readers are eligible for an exclusive savings of 10% off* the standard rate by using promo code 23DC10, so download the complete conference agenda and reserve your seat today!
*Expires 5/16/2023; applies to current rate only and may not be combined or applied to existing registrations; 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 guest post comes from Rhiannon Naslund, Chief Marketing Officer at Kalderos.
Rhiannon discusses the growing collaboration between manufacturers and covered entities regarding 340B discount claims. She goes on to describe the Kalderos Discount Hub solution that reviews claims that have a high likelihood of being a duplicate discount.
12 chapters, 480+ pages, 241 charts/exhibits/data tables, 966 endnotes: There is nothing else available that comes close to this encyclopedic resource.
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]
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.
Join the life science industry on May 16-18, 2023 in Washington, DC at the Medicaid & Government Pricing Congress to conquer complex Medicaid regulatory guidelines and evolve strategies to contract, report and comply with federal and state healthcare programs.
View the agenda for Medicaid & GP 2023 to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/medicaid-government-pricing for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to April 7, 2023.*
When you join Informa Connect in Washington, DC, you'll hear from leading GP experts on the latest MDRP trends and strategies that impact you and your business. Some of the companies leading the dialogue include Ascendis Pharma, AstraZenca, Bayer, Blueprint Medicines, Bristol Myers Squibb, CSL Behring, Department of Health & Human Services, Endo, Genentech, Gilead, Mallinckrodt, Neurocrine Biosciences, Novartis, Pfizer, PhRMA, Sanofi, Takeda, Teva, UCB, United Therapeutics, Viatris and more.
Here are just a few of the sessions you'll attend:
Everything Inflation Reduction Act – Both interpretation and implementation guidance
Your Medicaid wish list – 30+ years into the program, what would your recommendations to CMS be?
The latest and greatest 340B litigation and operational updates
Refresh of the inclusion of territories, and hear from Puerto Rico Medicaid on their processes
Panel on market access and pricing strategy considerations for early R&D
Join a senior-level work group on policy reform for Medicaid and government pricing programs
Discuss the intersection of line extensions and AMP cap in-depth
Back by popular demand – Fundamentals of GP, the fireside chat with external counsel, and the state-by-state review of SPTR
Topics on class of trade, strategies for product launch, moving your data to the cloud, intro to blockchain for GP professionals, discussion on bots and automation and much more!
Informa Connect is also thrilled that this year's Congress is part of Pricing & Contracting USA! You'll have the benefit of networking with like-minded executives from across the life science industry as we bring together attendees from three industry leading events (the Medicaid & Government Pricing Congress, the Drug Pricing Transparency Congress and the Commercial Contracts & Chargebacks Summit) in the pricing and contracting arena.
View the agenda for Medicaid & GP 2023 to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/medicaid-government-pricing for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to April 7, 2023.*
*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.
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 guest post comes from Stacey Little, Senior Vice President of Business Development and Marketing at AssistRx.
Stacey discusses digital hubs and the affordability advantages they offer both patients on specialty therapies and their health care providers. To learn more, click here to schedule a meeting with AssistRx at Asembia’s Specialty Pharmacy Summit on April 30 to May 4, 2023.
The exhibit below—one of 241 in our new report—provides a first look at the 15 largest organizations, ranked by total U.S. prescription dispensing revenues for calendar year 2022. U.S. prescription dispensing revenues reached a record $548 billion in 2022.
Not to put too fine a point on it—but they might be giants. The largest 15 pharmacies accounted for more than 75% of total dispensing revenues from retail, mail, long-term care, and specialty pharmacies. The top 15's share dipped slightly compared with their 2021 share, due primarily to the significant revenue losses for Walgreens Boots Alliance’s AllianceRx Walgreens Pharmacy.
This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.
The rapid expansion of patient-paid prescriptions—via cash-pay pharmacies and discount card vendors—is transforming the prescription market. Join Dr. Fein as he helps you and your team deepen their understanding of this important issue and its crucial implications. He will draw from exclusive information found in DCI's new 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
During the event, Dr. Fein will cover a wide range of topics, including:
What’s driving the boom in patient-paid prescriptions
The warped economics of the generic prescription channel
Cash-pay prescriptions vs. discount cards
Why Usual & Customary (U&C) prices matter
The latest market data on the discount card market and its key participants
The complex economics of discount cards
How PBMs profit from—and are challenged by—patient-paid prescriptions
Pharmacy strategies and reactions
Why and how plans are placing discount cards within pharmacy benefits
Commentary on GoodRx, Mark Cuban Cost-Plus Drug Company, and more
Outlook for disruption of the pharmacy benefit market
Controversies and unresolved questions
And more!
PLUS: During the webinar, Dr. Fein will give participants an opportunity to unmute themselves and ask live questions. The webinar will last 90 minutes to accommodate audience 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. PRICING OPTIONS
You can register for this unique educational opportunity for only $380 per viewing device. Within 24 hours of your purchase, you will receive an email from Zoom with a unique link to access the webinar replay video.
We are offering substantial discounts for multiple registrations from the same organization. We know that many of you may still be working from home, so rates for multiple registrations are as low as $265 per device—a 30% savings. An unlimited number of people may watch at one location if they can watch from a single device.
Click here to order. All discounts will be automatically computed based on the number of registrations you enter in your cart. (You can reset the cart by entering 0 in the quantity field.)
Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.) There is no access via telephone.
We use Zoom technology for this webinar. Every registrant will receive an email from Zoom with a link to watch the event. This link is unique to the registrant and can only be accessed once. We recommend that every registrant download the Zoom client software/app.
Prior to the event, every registrant will receive an email from Zoom with a link to access the event and add it to their calendar. Every registrant will also receive reminder emails from Zoom one week, one day, and one hour before the event.
This event is part of The Drug Channels 2023 Video Webinar Series. If you have already purchased the full series, you should have received an email from no-reply@zoom.us with your unique link to access the event.
Organizations that purchased corporate access for The Drug Channels 2023 Video Webinar Series will receive a custom, branded signup link so employees can easily register. We will automatically refund payments from anyone at a company with corporate access who purchases a single registration using their corporate email account.
Join Informa Connect on May 16-17, 2023 in Washington, DC at the Drug Pricing Transparency Congress to stay on the pulse of federal and state reporting requirements, policy initiatives and strategic best practices for compliance. Experts from across the industry will discuss how current and future drug pricing transparency regulations will impact commercialization, reimbursement, pricing and compliance practices. Plus, assess how companies are internally planning for these changes.
View the agenda for Drug Pricing Transparency 2023 to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/drug-pricing-transparency for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to March 31, 2023.*
Here's just a little sneak peek at what's to come:
You'll hear perspectives from the who's who in drug pricing and transparency, including companies such as Actelion, Ascendis Pharma, BIO, Chiesi, ClassOne Insight, Endo, Gilead Sciences, Hyman, Phelps & McNamara, iContracts, King & Spalding, Latham & Watkins, Mallinckrodt, Maryland Prescription Drug Affordability Board, Model N, Neurocrine Biosciences, Novartis, Novo Nordisk, PhRMA, Porzio Life Sciences, Riparian, Sanofi, Teva, U.S. Attorney's Office for the Districts of MA and NJ, and Viatris
You'll take a deep dive into the hottest topics keeping you up at night, including
Drug Pricing Transparency Pressures
DOJ Drug Pricing Transparency Priorities
Legal Updates on Authorized Generics and the U.S. Drug Pricing of Brand Name Drugs
Resource Allocation for Your Medicaid, Market Access and GP Teams
Updated Review Including CMS Guidance of the Inflation Reduction Act
Implication of Stacked and Value Based Contract Product Agreements on Medicaid Pricing
And much more!
Informa Connect is also thrilled that this year's Congress is part of Pricing & Contracting USA! You'll have the benefit of networking with like-minded executives from across the life science industry as we bring together attendees from three industry leading events (the Medicaid & Government Pricing Congress, the Drug Pricing Transparency Congress and the Commercial Contracts & Chargebacks Summit) in the pricing and contracting arena.
View the agenda for Drug Pricing Transparency 2023 to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/drug-pricing-transparency for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to March 31, 2023.*
*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.
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).
This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: Discount Cards, Cost-Plus Pharmacies, and PBMs: Trends, Controversies, and Outlook.
This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: 
This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: 
This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: 
