Drug Channels News Roundup, October 2023: CVS & Humira Biosimilars, GLP-1 G2N Bubble, 340B Abuses, Rite Aid's Endgame, Mark Cuban Update, and an Epic Meetup

Zoinks! It's time for a super-sized Halloween roundup of wicked Drug Channels’ tales. This month’s tricks and treats:

• Spooky! CVS Health frightens all but one Humira biosimilar maker away from its formulary.

• Creepy! The gross-to-net bubble for anti-obesity GLP-1 drugs walks among us.

• Grotesque! Penn Medicine gorges on the 340B program.

• Vampiric! Rite Aid’s many management missteps finally put a stake in the company’s heart.

• Eerie! Mark Cuban Cost Plus Drug Company conjures a partnership with Alto Pharmacy.

Plus, an epic meetup with two of my favorite drug channel experts.

P.S. For my daily haunting, join the zombie horde who shamble after me on LinkedIn. You can also find my ghostly rantings at @DrugChannels on Twitter/X. (I recommend LinkedIn for maximium scares. Alas, I’m still spooked by Threads.)

thINc’s Value-Based Care Summit

thINc’s Value-Based Care Summit
Accelerating Healthcare’s Shift in the Move from Volume to Value
In-Person Event | December 5-6, 2023 in Washington, DC
www.thinc350.com/VBCS

Use promo code VBCDC to save $100. Register Today.

View the Agenda Snapshot

As healthcare stakeholders continue to prioritize the move to value-based care and aim to provide equitable access to care for all, health plan, provider, and pharma leaders must develop novel approaches to empower the patient and ensure effective risk-sharing strategies.

The Value-Based Care Summit, produced by The Healthcare Innovation Company (thINc), brings together health care providers, health plans, pharmaceutical companies/manufacturers, and regulatory and legislative leaders to discuss novel approaches, innovative models, and mutually beneficial partnerships that drive care delivery transformation and accelerate the transition to value-based care.

Can't miss content highlights including:

• Risk-Sharing and Value-Based Contracting: Examine outcomes-based strategies and innovations in value-based contracting arrangements
• Policy and Regulations: Understand key updates from CMMI, ICER (Institute for Clinical and Economic Review), and policy experts on value-based payment models
• Value-Based Digital Solutions: Explore case studies on how to test, design, and scale digital services and ensure technological innovations that support outcomes improvement, preventive care, and cost containment
• Cross-Stakeholder Partnerships: Foster stakeholder partnerships to optimize patient support and care delivery
• Population Health and Value-Based Care: Leverage real-world data and understand social determinants of health to build predictive value-based care solutions for populations
• Care Delivery Transformation: Adopt a personalized approach to understand patient needs and implement a value-based care delivery model
• Data and Evidence: Harness real-time patient data and population health metrics to determine medication adherence and identify trends to mitigate major health issues

Must-attend keynotes include:

CEO Keynote Panel: Making Value-Based Care a Reality: Progress, Promise, and the Path Forward

• Eric Gallagher, CEO, Ochsner Health Network (OHN)
• Lee Handke, PharmD, CEO, Nebraska Health Network
• Stacy Meyr DC, President, Saint Alphonsus Health Alliance
• Moderator: Josh Berlin, CEO, rule of three, LLC

Leadership Perspectives to Accelerate the Move to Value Based Healthcare Transformation

• Thomas McGinn MD, MPH, System EVP, Physician Enterprise, CommonSpirit Health
• Rachel Thornton MD, PhD, VP and Enterprise Chief Health Equity Officer, Nemours Children's Health
• Will Shrank, MD, Venture Partner, Andreessen Horowitz
• Mark Steffen MD, MPH, SVP, Medical Management and Chief Medical Officer, Blue Cross and Blue Shield of Minnesota
• Moderator: Ceci Connolly, President and Chief Executive Officer, Alliance of Community Health Plans (ACHP)

Align Incentives to Strengthen Payer-Provider Partnerships and Contract Arrangements

• Josh Patten, Executive Director, National Value Based Development, Aetna, CVS Health Company
• Janet Pogar, Market Leader, SW Florida, Florida Blue
• Elisa Wetherbee, CEO, IPA; VP, Clinically Integrated Network, Rose Medical Group and HealthONE Physician Partnership; VP, Population Health, UCHealth
• Moderator: Debbie Welle-Powell, CEO, DWP Advisors; Adjunct Faculty, Denver Business School, University of Colorado

PLUS! Two Dedicated Tracks for Your Focus Area:

• Value-Based Contracting Strategies for Manufacturers
• Contracting and Networking Design Strategies for Health Plans and Providers

View the current Speaker Faculty and register today.

*All registrations subject to review by the thINc team. Promo codes not applicable for vendors/solutions providers. Discount codes are only applicable to NEW registrations.

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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).

GoodRx Announces New Way for Consumers To Access Sanofi’s Lantus for $35 at Over 70,000 Pharmacies Nationwide

Today’s guest post is from Dorothy Gemmell, Chief Commercial Officer at GoodRx.

Dorothy explains the innovative new collaboration between GoodRx and Sanofi. Under the program, the out-of-pocket cost for Sanofi's Lantus will be capped at $35 at any pharmacy that accepts GoodRx. This program will increase affordabiliy and broaden access for people living with diabetes.

Click here to learn more about GoodRx access and affordability solutions like GoodRx Assist, a point-of-sale (POS) rebate program that attracts cash-paying patients who require additional financial assistance to start and stay on medication.

Read on for Dorothy’s insights.

Medicare Part D in 2024: The Seven Largest Companies' Preferred Pharmacy Networks and the Coming Collapse of the PDP Market

Open enrollment is under way for the 2024 Medicare Part D plans. Our exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals that preferred cost sharing pharmacy networks will maintain their dominance as a component of Part D benefit design.

For 2024:

• 94% of stand-alone Medicare Part D prescription drug plans (PDP) will have a preferred network.

• 51% of Medicare Advantage prescription drug (MA-PD) plans will have a preferred network.

Below, I provide historical data on preferred networks’ growth and update the seven top companies’ 2024 offerings. I also update our analysis of the prevalence of preferred networks in three different types of MA-PD plans. In upcoming articles, I’ll delve into chain and independent pharmacies’ participation in the major 2024 preferred networks.

The 2024 data provide early evidence of a shrinking PDP market. Chalk it up to yet another unintended consequence of the Inflation Reduction Act of 2022 (IRA), which will make PDPs less economically viable and drive even more seniors into Medicare Advantage plans.

Informa Connect’s Trade and Channel Strategies

Informa Connect’s Trade and Channel Strategies
December 11-13, 2023
DoubleTree By Hilton | Philadelphia, PA

Exclusive Offer–Be sure to use your exclusive promo code 23DC10 to save 10% off* of your registration.

Trade and Channel Strategies is back and we have a lot to talk about! With regulation and policy changes, specifically surrounding the DCSCA, IRA and serialization, the loss of exclusivity wave, adoption of low-WAC products affecting GTN and the rise of alternative distribution models, there has never been a more important time for industry to unite. A program driven by market dynamics and led by champions of channel strategy, join now to master the complexities of pharmacy and distribution models to accelerate market access –It's all happening December 11-13, 2023.

Exclusive Offer–Download the agenda and register today–Be sure to use your exclusive promo code 23DC10 to save 10% off* of your registration.

Why should you attend this pivotal event?

The challenges of keeping up with shifting market dynamics in the midst of maximizing market access while also meeting business objectives remains a deep concern and brings about many questions for trade and channel professionals.

Have you properly prepared for the DSCSA to take effect and what should you expect post implementation? How is health policy affecting the distribution channel? How are product archetypes and market expansion influencing the physical channel and what does that mean for your organization?

In just three days, walk away with answers to these questions and more from experts from across the industry. Do not miss your chance to join seasoned leaders, your peers and leading solution providers as they dive into the top trends for innovative distribution, integrated pharmacy models and the future of trade.

What can you expect?

Vital insights from some of the industry’s leading pharmacy and distribution experts, including:

• Bill Roth, General Manager and Managing Partner, Blue Fin Group, An IntegriChain Company
• Jeff Henderson, Vice President, Head of Global Market Access, Reimbursement and Distribution, VectivBio
• David T. Foell, Director, Specialty Channel Operations, Ultragenyx
• Chris Rocco, Senior Director, Market Access Data, Reporting and Analytics, GSK
• Spencer Miller, Director, Market Access, National Accounts, Trade & Distribution, Bayer
• Dana Dickens, Senior Director, Trade, Gilead Sciences
• Rena Goins, Executive Director, Global Distribution, Regeneron Pharmaceuticals, Inc.
• Eduardo De La Calle, Director of Regional Supply, AstraZeneca
• Shefali Shah, Global VP, Market Value and Commercial Effectiveness, MindMaze
• And more!

Tackle the hottest topics facing industry right now, including:

• Keynote: The State of the Channel — Overview of Current and Future Trends Impacting the Channel
• Wall Street Insights — Analyze Market Dynamics and Key Investments in the Healthcare Ecosystem
• Focused Multi-Track Offerings:
• Supply Chain and Distribution Operations
• Pharmacy Model Strategies and Management
• Data, Innovation and Analytics
• Supply in Crisis—How Can We Better Prepare
• How to Maximize GTN Impact for Channel Strategy
• Diversity, Equity and Inclusion Summit
• Interactive Working Groups Based on Product Type:
• Branded Products
• Specialty, Orphan and Rare
• Generics and Biosimilars
• The Flavors of Retail Pharmacy—Exploring Various Models in the Marketplace
• The State of the IRA and Navigating What Comes Next
• Thought-Provoking Workshops by Role Type:
• Trade 101 for Existing Products
• Portfolio Management and Launch Strategy
• Executive Trade Directors Exchange
• Distribution for Digital Therapeutics
• And more!

Exclusive Offer–Download the agenda and register today–Be sure to use your exclusive promo code 23DC10 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.

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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).

How Centralized Prescription Fulfillment Allows Pharmacists to Better Help Patients

Today’s guest post comes from Melanie Christie, VP of Product Management at CoverMyMeds.

Melanie discusses how the nationwide shortage of pharmacy technicians affects pharmacists. She argues that centralized prescription fulfillment can provide pharmacists with more time to care for patients while also reducing medication errors and accelerating time-to-treatment. Melanie explains how such fulfillment tools also increase a pharmacy’s revenues and lowers its costs.

Click here to learn about CoverMyMeds’ automated central fill solutions.

Read on for Melanie’s insights.

The Battle for Oncology Margin: How Private Equity Enables Vertical Integration by Pharmaceutical Wholesalers

In case you haven’t noticed, private equity firms have displaced hospitals and health systems as the major acquirers of community oncology practices. These financial firms have assembled significant oncology practice management companies that are primed for purchase by drug channel participants.

Below, I review recent M&A trends and then examine the strategic objectives behind the acquisition of private-equity-backed OneOncology by AmerisourceBergen (Cencora) and another financial buyer. As I explain, AmerisourceBergen (Cencora) gains significant strategic advantage from this transaction, which echoes a historical McKesson deal.

The Federal Trade Commission’s (FTC) has a newfound interest in the roll-up transactions that are creating practice management companies. Nonetheless, I expect this consolidation activity to continue—enabling a new round of vertical integration in the drug channel.

FYI: Today’s article is adapted from Section 6.3. (Future Trends for Buy-and-Bill Channels) of our new our 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, now available to download at special launch pricing.

Informa Connect’s PBM Contracting Summit

Informa Connect’s PBM Contracting Summit
December 5-6, 2023 in Chicago, IL
Drug Channels readers save 10% with code 23DRCH10*

Join your peers for a unique opportunity to navigate the complex PBM landscape and gain unparalleled strategies to improve patient care and manage costs. The PBM Contracting Summit December 5-6, 2023 in Chicago, focuses on innovative and practical contracting strategies, improving patient care management and rising costs, the current legislative issues impacting contract negotiations and so much more. If you can’t attend in-person, there are virtual registration options available, too!

View the agenda the 2023 PBM Contracting Summit to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pbm-contracting for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to November 10, 2023.*

Sessions include coverage on multiple hot topics, including:

• A regulatory update on the changing legal environment in healthcare
• The latest on the 340B drug pricing program
• A review of the AMP Cap removal project in relation to insulin and rebates
• Understand copay maximizer and patient assistance programs in relation to PBM contracting
• Combatting spread pricing with optimal PBM contracting and pricing
• Take a deep dive into financial acceptance and consequences of biosimilars and specialty therapeutics
• Strengthen the PBM-Payer partnership and strategize cost management
• Develop an understanding of vertical integration and the consolidation of PBMs and the impact of offshore rebate aggregation entities
• Hear about measuring value-based care and contracting, patient access priorities and PBM relationship, the expanding role of data, healthcare M&A, market access and pricing strategies and more!

View the agenda the 2023 PBM Contracting Summit to see the complete picture – the program, speakers, and more, and visit www.informaconnect.com/pbm-contracting for further details and to register. Drug Channels readers will save 10% off when they use code 23DRCH10 and register prior to November 10, 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).

Copay Adjustment Programs: What Brand and Hub Teams Need to Know

Today’s guest post comes from Sam Blake, Vice President of Launch Excellence at ConnectiveRx.

Sam discusses the evolving landscape of copay adjustment programs. He explains how pharma brand teams and hub program managers can lessen the impact of accumulators and maximizers on patients’ access and adherence.

To learn more, join Chris Dowd, Senior Vice President of Market Development at ConnectiveRx, for a free webinar on October 26th at 1:00 pm ET: The Battle Over Accumulators and Maximizers: What You Need to Know for 2024.

Read on for Sam’s insights.

NOW AVAILABLE: The 2023–24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors

I am pleased to announce our new 2023–24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors, available for purchase and immediate download.

• Click here to download a free report overview (including a summary of industry trends, the Table of Contents, and a List of Exhibits)

• New Drug Channels Institute Study: U.S. Drug Distribution Industry Gaining from Anti-Obesity Drugs and Provider-Administered Biosimilars (press release)

We’re offering special discounted pricing if you order before October 23, 2023!

The 2023–24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors—our 14th edition—remains the most comprehensive, fact-based tool for understanding and analyzing the large and growing U.S. pharmaceutical distribution industry. No other report on the market today offers the depth, insight and analysis into these channels

This 2023-24 edition contains the most current financial and industry data along with detailed information about the strategies and market positions of the largest companies: AmerisourceBergen, Cardinal Health, and McKesson. It updates our annual analysis of each wholesaler’s business segments and underlying business profitability, based upon our proprietary economic models.

The notable new material in this 2023-24 edition includes:

• New data about commercial pricing and reimbursement for provider-administered biosimilars appears in Section 3.2.2. and Section 6.4.3.

• A new Section 6.2.2. reviews the evolving specialty pharmacy industry and discusses emerging challenges from direct distribution models that bypass wholesale distribution.

• A new Section 6.3.2. analyzes the acquisitions of physician practices by corporate entities and private equity firms

• A new Section 6.5. addresses the Inflation Reduction Act of 2022. In Subsection 6.5.1., we summarize the key provisions of the law that relate to prescription drugs. In Subsection 6.5.2., we analyze the IRA’s likely consequences for wholesalers and the overall pharmaceutical business.

• We provide updated, expanded, and reorganized data about the following markets:
  • Pharmacy services administrative organizations (Section 2.2.4.)
  • Group purchasing organizations for small pharmacies (Section 2.2.5.)
  • Group purchasing organizations for physician practices (Section 3.3.2.)
• Material that addresses COVID-19 and its impact on the wholesale channel has been integrated into our analyses throughout the report. However, we have retained and updated Section 6.1.4., which examines the distribution of COVID-19 vaccines and therapeutics.

• There are 163 exhibits in this 2023-24 edition, compared with 150 in the 2022-23 edition.

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. Please contact us if you did not receive the email.

WHAT’S GOING ON

Twice a year, I research and write two comprehensive, fact-based, and nonpartisan reports on drug channel economics. In some small way, I try to make the world a better and smarter place.

Licenses for our DCI reports are regularly purchased by nearly every entity involved in the drug channel: pharmaceutical manufacturers, wholesalers, pharmacists, pharmacy owners, hospitals, buyers, benefit managers, managed care executives, policy analysts, investors, consultants, and more. So, you can find out what your customers, partners, and competitors are reading.

The 2023–24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors is the only resource of its kind available anywhere. It offers 163 proprietary charts, exhibits, and data tables.

FOUR FUN FACTS

• The 9 chapters are self-contained and do not need to be read in order. (Really!) There are loads of internal hyperlinks to help you navigate the document and customize it to your specific interests and priorities.

• We are offering the option to download an additional PowerPoint file with images of all 163 exhibits. This popular option helps you share the insights and data with others in your organization. (The exhibits appear in all license versions. The PowerPoint file option is available only with the purchase of a corporate license.)

• There are more than 660 endnotes, most of which have hyperlinks to original source materials. These source materials offer a handy way to build your knowledge base beyond what’s included in the full report.

• As usual, I have reluctantly stripped out the corny jokes and pop culture references.

If you have any questions (before or after reading the report), please email me.

Enjoy!

Four Ways Digital Intake Can Transform Patient Support Programs, Overcome Access Barriers, and Improve Outcomes

Today’s guest post comes from Michael Carr, Group Vice President, CoAssist Pharmacy at AssistRx.

Michael discusses the challenges that patients and healthcare providers face during the prescription intake and enrollment process. He outlines four key features of solutions that improve digital intake.

To learn about AssistRx’s digital intake technologies, download their case study: Digital Intake for More Meaningful Patient and HCP Interactions.

Read on for Michael’s insights.

The Economics of Copay Accumulators, Maximizers, and Alternative Funding Programs (Video) (rerun)

This week, I’m rerunning some popular posts while I put the finishing touches on DCI's new 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

One important update on copay accumulators since my original post from August 2023: U.S. District Court, District of Columbia struck down U.S. Department of Health and Human Services rule allowing non-grandfathered individual and group plans to exclude manufacturers' copay assistance from deductibles. (Details and industry reactions here.) IMHO, this was a huge win for patients thanks to the HIV + Hepatitis Policy Institute, the Diabetes Patient Advocacy Coalition, and the Diabetes Leadership Council.

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In my most recent video webinar, I explored how plans and PBMs are turning to novel—and highly controversial—benefit design tools that access manufacturers’ patient support spending: copay accumulators, maximizers, and alternative funding programs.

In the video excerpt below, I describe these new approaches that plans offset specialty drug expenses. I then follow the dollar to show how they impact plan, patient, and manufacturer costs when compared with traditional approaches to copay support.

During the full 90-minute webinar, I discussed seven crucial risks that could disrupt this market along with many other aspects of this emerging market. If this clip whets your appetite for more, you can purchase the 90-minute webinar replay and full slide deck here: PBMs and the Battle Over Patient Support Funds: Accumulators, Maximizers, and Alternative Funding.

Click here if you can’t see the video below.

Two recent Drug Channels article on these topics:

• Copay Accumulator and Maximizer Update: Adoption Plateaus as Insurers Battle Patients Over Copay Support

• Employers Expand Use of Alternative Funding Programs—But Sustainability in Doubt as Loopholes Close

Errata: The formulary rebate in the mathematical example that begins at 4:40 should be shown as 16.7%, not 20%. We apologize for the error.

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

This week, I’m rerunning some popular posts while I put the finishing touches on DCI's new 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Click here to see the original post from June 2023.

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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).

Four Crucial Questions about the Humira Biosimilar Price War (rerun)

This week, I’m rerunning some popular posts while I put the finishing touches on our new 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Since I published the article below in July 2023, there have been three notable market develpoments:

• IQVIA has reported that as as of mid-2023, there was almost no adoption of Amgen's Amjevita, the first Humira biosimilar.

• CVS Health launched Cordavis, a new subsidiary that will market a private label, low-list-price version of Sandoz’ Hyrimoz.

• Boehringer-Ingelheim launched an unbranded, low WAC version of its interchangeable biosimilar.

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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?

Five (or Maybe Six?) Reasons that the Largest PBMs Operate Group Purchasing Organizations (rerun)

This week, I’m rerunning some popular posts while I put the finishing touches on DCI's new 2023-24 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors.

Click here to see the original post from May 2023.

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In The Top Pharmacy Benefit Managers of 2022: Market Share and Trends for the Biggest Companies, I shared Drug Channels Institute's analysis showing that three pharmacy benefit managers (PBMs)—the Caremark business of CVS Health, the Express Scripts business of Cigna, and the OptumRx business of UnitedHealth Group—accounted for about 80% of total equivalent prescription claims in 2022.

In recent years, each of these companies has launched new group purchasing organizations (GPOs) to further consolidate the number of covered lives in rebate negotiations with pharmaceutical manufacturers. Today, I examine these PBM-owned GPOs and then speculate on five plausible explanations for their existence. I also highlight a sixth, alleged rationale that is currently the subject of litigation.

The Federal Trade Commission (FTC) has recently started investigating these GPOs. I wonder if this additional focus will deepen the FTC’s ongoing investigation—or slow it down even further?