Drug Channels News Roundup, November 2023: My $0.02 on Express Scripts’ Cost-Based Pricing, Mark Cuban vs. PBMs, Dual-WAC Strategies, Pharmacy Shakeout, and Adam vs. Rocky

I hope everyone enjoyed the Thanksgiving holiday. Now that you’ve stretched your stomach, it's time to stretch your mind with some food for thought. In this issue:

• A reality check on Express Scripts’ purported “cost-based” pharmacy network

• Mark Cuban explains how and why the PBM market will change

• Why two drug prices are better than one

• Pharmacists sing the retail pharmacy shakeout blues

Plus, two Philly legends meet at a cardiology conference!

P.S. Join my more nearly 49,000 LinkedIn followers for daily links to neat stuff. You can also find my daily posts at @DrugChannels on Twitter/X, where I have more than 17,000 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.)

Do you want to know even more about key healthcare trends? Then join me for my upcoming live video webinar, Drug Channels Outlook 2024, on December 15, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Simplify and Accelerate Benefits Verification with a Fully Integrated, Adaptable Platform

Today’s guest post comes from Maria Kirsch, President of Patient Services at EVERSANA.

Maria discusses the challenges patients and healthcare providers face accessing specialty therapies. She introduces us to ACTICS^® eAccess, EVERSANA’s technology platform for electronic prior authorization and benefits verification that can be used for both the pharmacy benefit and the medical benefit.

To learn more about EVERSANA’s technology solution, schedule a live demo here.

Read on for Maria’s insights.

Medicare Part D in 2024: Mapping Large Chains' Position in 2024’s Preferred Pharmacy Networks

In Medicare Part D in 2024: The Seven Largest Companies' Preferred Pharmacy Networks and the Coming Collapse of the PDP Market, I documented how those networks now dominate stand-alone Medicare Part D prescription drug plans (PDPs) and have become a major presence in Medicare Advantage prescription drug (MA-PD) plans.

Today, I examine the seven largest retail chains’ participation in the 20 major 2024 Part D 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 2023 to 2024.

As you’ll see, these companies all maintained strong positions in the major PDP’s preferred networks. Walmart has the highest participation, while Rite Aid has the lowest. In an upcoming post, I’ll delve into how smaller pharmacies will participate in the 2024 Part D plans, by examining the pharmacy services administrative organizations (PSAOs).

Speaking of 2024, please join me for my upcoming live video webinar, Drug Channels Outlook 2024, on December 15, 2023, from 12:00 p.m. to 1:30 p.m. ET. Click here to learn more and sign up.

Drug Channels Outlook 2024 (NEW Live Video Webinar)

It’s time for our most popular event of the year!

Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, invites you to join him for DCI’s new live video webinar:

Drug Channels Outlook 2024
This event will be broadcast live on
Friday, December 15, 2023
12:00 p.m. to 1:30 p.m. ET.

This post describes the event, outlines the pricing options, and explains how to purchase a registration. (Or, just click here to order.) The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

This event is part of The Drug Channels 2023 Video Webinar Series. (Please note that our December 2023 webinar is *not* included with next year’s 2024 Video Webinar Series.)

WHAT YOU WILL LEARN

Join Dr. Fein as he helps you and your team get ready for 2024 by outlining key issues and uncertainties that will surely affect your planning. This event can be both a capstone of your annual learning and a touchpoint for the future. DCI’s Outlook webinars have proven to be reliable and informative guides to crucial aspects of the ever-evolving healthcare industry.

During the event, Dr. Fein will share his latest thinking and projections on a wide range of topics, including:

• Commercial implications of the Inflation Reduction Act

• Vertical integration and consolidation trends

• Update on Humira biosimilars

• PBM strategies and the outlook for state and federal legislation

• What’s next for discount cards and cash-pay pharmacies

• Impact of anti-obesity GLP-1 agonist medications

• 340B Drug Pricing Program update and outlook

• Specialty drug costs and accumulators, maximizers, and alternative funding

• The retail pharmacy shakeout

• Gross-to-net bubble predictions

• The evolving oncology market

• Coming controversies and threats

• And much 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. He will draw from exclusive information found in DCI's economic reports.

Read on for full details on pricing and registration.

Four Trends That Are Shaping the Future of Market Access

Today’s guest post comes from James Pisano, Partner, Market Access at The Dedham Group and Dinesh Kabaleeswaran, SVP of Insights & Advisory Teams at MMIT.

James and Dinesh offer four trends that they predict will shape medication access in the coming years. Click here to learn about consulting services from MMIT and its sister company The Dedham Group.

Read on for James’ and Dinesh’s insights.

Vertical Integration Lessons: The Economics and Strategies of Hospital-Owned Specialty Pharmacies

As many of you know, hospitals and health systems have emerged as significant participants in the specialty pharmacy industry. A new American Society of Hospital Pharmacists (ASHP) survey provides fresh insights into these specialty pharmacies.

Below, I review key findings on the economics and operations of these specialty pharmacies. I then highlight how hospitals steer prescriptions to their internal specialty pharmacies.

As you’ll see, hospitals use network strategies that would make any pharmacy benefit manager (PBM) proud—especially when combined with the prescribing activities of hospital-employed physicians.

Vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels gets most of the attention. But a parallel vertical integration has been occurring among hospitals, specialty pharmacies, and physicians. Manufacturers and payers must adapt to the growing power and market tactics of hospital-owned specialty pharmacies.

Is Your Hub Partner Missing the Therapeutic Area Expertise You Need?

Today’s guest post comes from Greg Morris, Chief Strategy Officer at CareMetx.

Greg highlights the value of therapeutic area expertise in enhancing the performance of hub services. He explains how CareMetx's hub used its experience in the retina space to improve a new brand-name product’s launch.

To learn more about the impact of hub service on brand launch success, download CareMetx’s latest report: Patient Service Trends Point the Way to Better Hub/ Provider Partnerships.

Read on for Greg’s insights.