February is longer than usual this year, which means that you’ll have extra time to leap into our monthly curated selection of noteworthy news. In this issue:
An update on the retail pharmacy shakeout
Arguing for high drug prices
A leading researcher provides a 340B reality check
Physicians don’t want pharmacists getting uppity
Plus, Dave Grohl fights for your right to…have healthcare price transparency?
P.S. Join my nearly 53,000 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 17,400 followers. (I recommend that you follow me on LinkedIn, because the quality of comments and engagement is much higher than they are on Twitter. Sorry, no Threads.)
Like many of you, I have believed that the Inflation Reduction Act of 2022 (IRA) will encourage Medicare Part D plans to adopt low-list-price products over their high-list/high-rebate counterparts, thereby popping the gross-to-net bubble.
Actually, maybe not.
Below, I explain why the IRA will encourage Part D plans to prefer high-list, high-rebate specialty drugs, even as the government and manufacturers will prefer a low-list-price version. Just another IRA-inflicted hit for biosimilars?
The warped incentives don't stop there. Even more weirdly, both products with a negotiated maximum fair price (MFP) and low-list-price products will raise total costs for the healthcare system and increase beneficiary premiums.
Today’s guest post comes from Gavin Magaha, Senior Director of Value Delivery at Kalderos.
Gavin discusses the problems manufacturers face in accessing and standardizing drug discount data. These data are necessary to avoid duplicate discounts and comply with regulatory requirements.
To learn more about how the Inflation Reduction Act adds to challenges of drug discount programs, download Kalderos’ whitepaper:
It's Valentine’s Day—and commercial plan sponsors remain smitten with copay accumulators and maximizers.
Our latest update finds that as of late 2023, about half of commercial lives were in plans that utilize a copay accumulator and/or a maximizer. These programs’ growth continues to divert the value of a manufacturer’s copay support payments away from patients and toward plans and PBMs. Check out the data below.
Patient advocacy groups and some big legal wins are starting to reverse Cupid’s arrow. But given the money at stake, I suspect that plans will keep looking for love in all the wrong places.
As he explains, manufacturers want hub partners that can take a holistic approach and address each patient’s individual needs. Nasir also discusses how hub selection criteria are evolving.
The boffins at the Centers for Medicare & Medicaid Services (CMS) recently dropped the latest National Health Expenditure (NHE) data, which measures all U.S. spending on healthcare. (Links below.)
As you will see, retail and mail prescription drug spending remain a consistently small share of the $4.5 trillion that we spend on U.S. healthcare.
And contrary to what you might read, drug spending growth was *not* driven by purportedly “skyrocketing” drug prices. In reality, nearly all drug spending growth occurred due to growth in the number of people treated, prescriptions dispensed, and other nonprice factors.
Tomorrow, we’ll be treated to a Senate show trial featuring pharmaceutical company executives. Sadly, pharma industry perma-critics refuse to accept that brand-name drug prices are falling—or that prescription drug spending is a small and stable portion of overall U.S. healthcare expenditures. Will drug pricing flat earthers (#DPFE) ever acknowledge the data?
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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).
Today’s guest post comes from Divya Iyer, SVP of Go-to-Market Strategy at GoodRx.
Divya shares highlights from GoodRx’s new research report: The GoodRx Effect: How GoodRx Improves the Economics of Healthcare. She highlights how GoodRx’s integrated pharma copay cards help to improve medication access, therapy adherence, and overall health outcomes.
