Drug Channels News Roundup, June 2023: Humira Price War and Mark Cuban, Formulary Exclusions, Oncology Drug Benefits, and Our Wonderful Healthcare System

Happy 247st birthday, America! Before you launch your July 4 festivities, Drug Channels offers some fireworks of our own:

• My $0.02 on the Humira price war—and the role of cost-plus pharmacy pricing

• Fresh evidence that formulary exclusions hurt patients

• Disturbing oncology drug benefit management

Plus, an entertaining explanation of why the U.S. healthcare system is so hard to explain.

P.S. Join my more than 42,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,500 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter.)

Informa Connect’s Health Systems & Pharma Partnering Summit

Informa Connect’s Health Systems & Pharma Partnering Summit
August 14-16, 2023 in Boston, MA
www.informaconnect.com/health-systems-partnering
Drug Channels readers save 10% with code 23DRCH10*

View the agenda for Health Systems & Pharma Partnering 2023 to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/health-systems-partnering for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to July 28, 2023.*

Join your colleagues on August 14-16, 2023 at the Westin Copley Place for the Health Systems & Pharma Partnering Summit to optimize strategic partnerships and improve quality, manage costs and enhance patient outcomes. This is a critical opportunity to navigate these complex yet beneficial partnerships with both health systems and life science companies together.

When you join Informa for this groundbreaking think-tank, you’ll find yourself in the company of experts from health systems, pharma/biotech manufacturers, integrated delivery networks, payers, and providers to hear novel case studies, regulatory updates and innovative models aimed at developing and maintaining collaborative, patient-centered partnerships.

Topics being covered include overcoming pharmacy challenges, collaboration strategies across the industry, operational priorities to deliver value-driven engagement, healthcare priorities for lawmakers, impact of the Inflation Reduction Act, legal challenges and financial impact related to 340B, deep dives into challenges related to biosimilars, 340B, white bagging, population health, payer-provider and supplier-partner collaboration, challenge of new therapy development and market access and more.

View the agenda for Health Systems & Pharma Partnering 2023 to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/health-systems-partnering for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to July 28, 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.

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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 State of Employers’ Pharmacy Benefits: A Review of 2022 and the 2023 Outlook for Copay Programs (rerun)

This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here to see the original post from January 2023.

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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.

How Discount Cards Work: A Primer on GoodRx and Its Competitors (rerun)

This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here to see the original post from May 2023.

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In my March video webinar, I explored how the rapid expansion of patient-paid prescriptions—via cash-pay pharmacies and discount card vendors—is transforming the prescription market.

Below, I follow the dollar when a patient uses a discount card to pay for a generic drug prescription.

As you’ll see, a discount card can save money for consumers by leveraging several quirks of U.S. retail pharmacy pricing. Such cards also enable novel profit streams for both pharmacy benefit managers (PBMs) and the card vendors themselves.

For a deep dive into patient-paid prescriptions, see Sections 4.3. and 12.4.3. of our 2023 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Four Trends That Will Pop the $250 Billion Gross-to-Net Bubble—and Transform PBMs, Market Access, and Benefit Design (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here to see the original post from April 2023.

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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 $223 billion for patent-protected brand-name drugs in 2022. If we include brand-name drugs that have lost patent protection and face competition from generic equivalents, the bubble was even higher, at $256 billion. Our latest data appear below.

Four crucial trends will deflate the gross-to-net bubble—thereby disrupting market access strategies, altering pharmacy benefit manager (PBM) profit models, and changing plan sponsor benefit designs. Perhaps it’s time to get ready for the day when SpongeBob SquarePants will depart from Drug Channels.

The Inflation Reduction Act: 10 Predictions About Market Access and Drug Channels (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here to see the original post from April 2023.

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Like it or not, the Centers for Medicare & Medicaid Services (CMS) is barreling ahead with its implementation of the Inflation Reduction Act of 2022 (IRA). Last Friday was the last day to submit comments on CMS's initial guidance on the drug price negotiation program.

The IRA will alter many crucial aspects of the Medicare program and the overall drug channel. To help you anticipate what’s ahead, below I highlight 10 predictions on how the IRA will impact drug prices, demand for prescription drugs, Part D plan strategies, rebates, manufacturers’ revenues, retail pharmacies, and more.

While this is a longer-than usual post, I can still only barely scratch the surface of the many far-reaching effects of this legislation. As always, I encourage you to share your own thoughts in the comments below or on social media.

Copay Accumulator and Maximizer Update: Adoption Plateaus as Insurers Battle Patients Over Copay Support (rerun)

I want to wish everyone a happy Juneteenth! This week, I’m rerunning some popular posts while I prepare for this Friday’s live video webinar: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here to see the original post from February 2023.

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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.

Technology’s New Approach: One Gateway to Deliver Comprehensive Patient Support Services

Today’s guest post comes from Derek Berven, Senior Director of Software Engineering at AssistRx.

Derek explains how to streamline patient support services with a modular, scalable technology solution. He then discusses Advanced Gateway, a technology that integrates patient, provider, and manufacturer services.

Click here to learn more about how AssistRx’s Advanced Gateway can impact patient support programs.

Read on for Derek’s insights.

Gross-to-Net Bubble Update: 2022 Pricing Realities at 10 Top Drugmakers

Time for Drug Channels’ annual update on pricing at the largest pharmaceutical manufacturers. This year’s review includes the following 10 companies: Eli Lilly and Company, Genentech, GlaxoSmithKline, Janssen, Merck, Novartis, Novo Nordisk, Sanofi, Takeda, and UCB. You can find links to each company’s data below.

When rebates and discounts were factored in, brand-name drug prices again declined—or grew slowly—in 2022. However, some companies had net price gains. Consistent with our previous analyses, rebates and discounts reduced the selling prices of brand-name drugs at the biggest drugmakers to less than half of their list prices.

For the eight companies with multiple years of data, the gross-to-net difference in price changes was the smallest gap in six years. See the second chart below.

As I have noted, powerful industry forces may trigger the gross-to-net bubble to deflate. But for now, the 2022 data provide fresh inconvenient facts for the drug pricing flat earthers (#DPFE).

Patient assistance funding accounts for a significant portion of gross-to-net differences. Learn about the future of these programs during my upcoming live video webinar, PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding, on June 23, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Helping Patients Ease Medication-Affordability Anxiety

Today’s guest post comes from Kristina Crockett, VP, Product Management at CoverMyMeds.

Kristina shares the story of Shanette, a single mother who faced sticker shock at the pharmacy counter. Kristina then explains how manufacturers can increase patient access and affordability with a comprehensive affordability strategy.

Click here to learn about CoverMyMeds’ medication access solutions for pharma.

Read on for Kristina’s insights.

Pharmacist Salaries and Employment in 2022: The Good Times Roll for Retail Pharmacists

Time for the annual update to the Drug Channels Institute (DCI) analysis of pharmacist salaries and employment.

Pharmacist employment in retail settings rebounded to its pre-pandemic levels, while non-retail settings—hospitals, physician offices, outpatient centers, and home healthcare—continued to add positions. For 2022, nearly half of pharmacists now work in non-retail practice settings.

Average base salaries for retail pharmacists grew for the first time in three years, to about $124,000. What’s more, retail salaries grew at the fastest rate in years—reflecting the post-pandemic employment environment. Pharmacists employed by hospitals and other non-retail settings also saw higher salaries, which averaged about $139,000. Full salary data below for your enjoyment or sorrow.

The post-pandemic period has been unexpectedly positive for the salaries of retail-employed pharmacists. But I expect the retail pharmacy shakeout to resume. As Bob Marley noted: “The good times of today are the sad thoughts of tomorrow.”

Be sure to join me for my new live video webinar, PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding, on June 23, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

thINc’s Specialty Networks and Patient Support Services Summit

thINc’s Specialty Networks and Patient Support Services Summit
In-Person Event | August 29-30, 2023
Lowes Philadelphia, Philadelphia, PA
www.thinc360.com/specialty

Early rates are in effect. Use promo code DC5123 to save an additional $100 off the early rates. Register Today!

View the Agenda Snapshot

Enhance Patient Service, Network Design, and Channel Strategies to Improve Patient Access and Support

In its 8th year, the Specialty Network and Patient Support Services Summit is an important event for senior leaders in patient access, trade, channel, market access, brand and account strategy. Join peers this August to discover the evolving specialty pharmacy marketplace, build multi-stakeholder partnerships, and explore frameworks to inform your 2024 distribution and patient service strategies. Hear directly from specialty pharmacies, payers, PBMs, government agencies, health systems, and industry leaders to:

• Gain insights into patient perspectives
• Explore specialty trade and distribution trends and the state of the channel
• Discover policy and regulatory reform impacting trade and channel distribution
• Analyze patient service programs that provide patient support, ensure affordability, and optimize channel strategies
• Understand the outlook on value-based agreements and contracting strategies
• Delve into partnership opportunities in the specialty marketplace
• Implement actionable strategies that establish an optimal network design and distribution model
• Uncover the evolving state of cell and gene therapies and biosimilars

Summit Chairperson: Ray Tancredi, VP, Pharma Relations and Specialty Pharmacy Development, Walgreens

SPECIAL PRE-EVENT SESSION: Explore the Intersection between 340B and Specialty Pharmacy

• Leverage 340B eligibility to create a specialty pharmacy service model
• Improve patient access and affordability
• Understand the importance of patient specialty interventions and patient follow-up

PLUS! Two Dedicated Tracks for Your Focus Area: This Summit includes tailored content on specialty network design and patient services to customize the learning experience as well as shared content to maximize collaboration and knowledge-sharing

View the detailed online agenda and register today.

Taking place the same week with the Specialty Networks and Patient Support Services Summit: Covered Entities’ and Manufacturers’ 340B Summit
Demonstrate Compliance, Implement Strategies for Successful Audits, and Address the Financial Impact of 340B Programs on Covered Entities and Manufacturers
In-Person Event | August 28-29, 2023 in Philadelphia, PA
https://thinc360.com/340B

All registrations subject to review by the thINc team. Cannot be combined with other offers, promotions or applied to an existing registration. Other restrictions may apply.

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Sponsored guest posts are bylined articles that are screened by Drug Channels to ensure a topical relevance to our exclusive audience. These posts do not necessarily reflect our opinions and should not be considered endorsements. To find out how you can publish a guest post on Drug Channels, please contact Paula Fein (paula@DrugChannels.net).

The Drug Discount Ecosystem’s “Mission Critical”

Today’s guest post comes from Vishali Amin, Chief of Staff to the Office of the President and Senior Director of Customer Success at Kalderos.

Vishali discusses the persistent challenges of duplicate discounts between the 340B Drug Pricing Program and the Medicaid Drug Rebate Program. The Inflation Reduction Act of 2022 will further complicate duplicate discount issues.

To learn more, sign up now for priority access to Kalderos’ 2023 annual report: Mission Critical: Bringing Drug Discount Stakeholders Together so Patients Win. The 2023 report will be released on June 13, 2023.

Read on for Vishali’s insights.