Drug Channels News Roundup, July 2023: GoodRx + CVS Caremark, Accumulators vs. Patients, Hospitals vs. Taxes, and UnitedHealthcare Prior Auth Humor

Let’s cut through the steamy summer haze with Drug Channels’ refreshing breeze of questions for you to ponder while on your favorite pink beach:

• Why does the biggest PBM need a discount card partner?

• How do copay accumulators affect prescription adherence?

• Do nonprofit hospitals deserve their tax exemption?

Plus, Dr. Glaucomflecken asks: What would happen if UnitedHealthcare hired physicians who practiced evidence-based medicine?

P.S. Join my more than 43,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter, where I have more than 16,600 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. I’m not posting to Threads yet.)

How Prior Auth Solutions Can Empower Patients, Providers and Pharma Field Teams

Today’s guest post comes from Brent Clifton, Vice President of Product Management at CoverMyMeds.

Brent discusses the challenges that patients, caregivers, and providers face when seeking access to medications requiring prior authorization. He explains how an electronic prior authorization solution can reduce delays and help patients start their therapies sooner—especially when patients and brands can play an active role in the process.

Click here to learn about CoverMyMeds’ electronic prior authorization solutions.

Read on for Brent’s insights.

Four Crucial Questions about the Humira Biosimilar Price War

The Humira biosimilar market has arrived!

This month, nine biosimilar versions of adalimumab launched in the U.S. market. As I predicted in 2021, some products launched with list prices that are only slightly lower than Humira’s list price, while others are trying to tempt payers and pharmacy benefit managers (PBMs) with deep list price discounts.

Surprisingly, two PBMs—Express Scripts and OptumRx—will each offer at least one low-list-price biosimilar option on their main national formularies.

Below, I help you understand the current and future market dynamics by posing four questions about drug pricing, rebate walls, patient behavior, the gross-to-net bubble, pharmacy/wholesaler economics, and more.

No biosimilar has the trifecta of being high-concentration, citrate-free, and fully interchangeable. These shortcomings, combined with physician hesitancy, will limit the ability of price to drive adoption. But as I see it, the Humira price war signals that rebate walls will crumble and the gross-to-net bubble will pop. Will payers let Humira go?

Informa Connect’s Medicaid Drug Rebate Program Summit (MDRP)

Informa Connect’s Medicaid Drug Rebate Program Summit (MDRP)
September 18-20, 2023 in Chicago, IL
www.informaconnect.com/MDRP

Drug Channels readers save 10% with code 23DRCH10*

Join Informa Connect and the life science industry on September 18-20, 2023 in Chicago, IL at the 2023 Medicaid Drug Rebate Program Summitto master complex MDRP regulatory guidelines to deliver compliant government pricing and reporting programs.

View the agenda for the 2023 MDRP Summit to see the complete picture – the program, speakers, and more, and visit for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to August 11, 2023.*

This annual event provides you and your team unparalleled access to the government regulators creating the rules, policies and regulations, the industry leaders tasked with interpreting them and the manufacturer experts who will be implementing them.

Hear from more than 90 leading experts representing the Acadia Pharma, Ascendis, AstraZeneca, Bristol Myers Squibb, CSL Behring, Eisai, FTC, Genentech, Genmab, Gilead Sciences, GlaxoSmithKline, Helsinn Therapeutics, Kyowa Kirin, Lundbeck, Lupin Pharma, Novartis, OIG, Optum, Pfizer, PhRMA, Sandoz, Takeda, United Therapeutics, Vaitris and many more.

Sessions include coverage on multiple hot topics, including:

• CMS Stacking Rule
• Everything IRA and 304B
• FSS and Government Contracting
• GTN Best Practices
• State Drug Price Transparency and Reporting
• Value Based Agreements
• Bundling, Acquisitions and Divestitures
• AMP Cap Removal
• Rebates, Disputes and GP Calculations
• OIG Perspective on Prescription Drug Pricing and Payment
• And so much more!

View the agenda for the 2023 MDRP Summit to see the complete picture – the program, speakers, and more, and visit for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to August 11, 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).

New SingleCare Pharma Solutions Help Drugmakers Reach Cash-Paying Patients

Today’s guest post comes from Josh Bliss, SVP of Customer Acquisition and Head of Pharma Solutions at SingleCare

Josh discusses the challenges that pharmaceutical manufacturers face connecting with consumers who could benefit from patient financial support programs. He describes SingleCare's new Pharma Solutions, which offers manufacturers the opportunity to market their copay assistance programs directly to SingleCare's millions of monthly prescription discount users.

To learn more about SingleCare's Pharma Solutions, please visit www.singlecare.com/pharmasolutions.

Read on for Josh’s insights.

EXCLUSIVE: For 2023, Five For-Profit Retailers and PBMs Dominate an Evolving 340B Contract Pharmacy Market

Looks like pharmacy and PBM profiteering within the 340B Drug Pricing Program will never go out of style.

Drug Channels Institute’s (DCI) latest analysis reveals that more than 33,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—act as contract pharmacies for the hospitals and other healthcare providers that participate in the 340B program. Over the past 12 months, the number of pharmacies in the program has grown by more than 1,000 locations, which was the slowest growth rate since DCI started tracking this figure more than 10 years ago.

Consistent with our previous research, five multi-billion-dollar, for-profit, publicly traded pharmacy chains and PBMs—CVS Health, Walgreens, Cigna (via Express Scripts), UnitedHealth Group (via OptumRx), and Walmart—account for 75% of all 340B contract pharmacy relationships with covered entities. These contract pharmacy operators’ total estimated gross profits from the 340B program were nearly $3 billion in 2023.

Manufacturers’ contract pharmacy policy changes have slowed profits at pharmacies and PBMs, while triggering change in hospitals’ pharmacy strategies. Read on for my latest effort to pierce these little webs of 340B opacity.

Optimizing Access: Balancing Speed-to-Therapy and Gross-to-Net

Today’s guest post comes from Sahil Naik, Chief of Staff to the CEO at Phil, Inc.

Sahil discusses how manufacturers can balance patients’ access to therapy with gross-to-net (GTN) goals. Visit https://phil.us/ to learn more about how Phil helps improve the patient experience while managing GTN.

Read on for Sahil’s insights.