Shifting Strategies: Tackling Patient Support Program Reverification

Drug Channels News Roundup, May 2024: CVS & Cordavis & Humira, 340Boom, AFP Slowdown, Asembia Wrap-Up, and GLP-1 Humor

Summer unofficially began over the weekend. Let’s turn up the heat with these sizzling news bites, seared to perfection on the Drug Channels grill:

• CVS Health’s Cordavis business seems to want quasi-regulatory oversight of Humira biosimilars

• 340B’s skyrocketing growth continues, but the market is changing

• Plans sponsors' fading interest in alternative funding programs

• A post-Asembia review from DCI’s trip to Las Vegas

Plus, South Park goes after insurance companies and PBMs over GLP-1 coverage.

P.S. Join my nearly 56,000 LinkedIn followers for daily links to neat stuff.

Register now for The 340B Drug Pricing Program: Trends, Controversies, and Outlook, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the June 21 event.

Why the IRA Will Encourage Part D Plans to Prefer High-List, High-Rebate Drugs (video)

In my recent Drug Channel Implications of the Inflation Reduction Act video webinar, I explained the intended and unintended consequences of the Inflation Reduction Act of 2022 (IRA) for the commercial market and drug channel participants.

In the video excerpt below, I walk through a mathematical example to show 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. What’s more, a product with a maximum fair price (MFP) may also raise total costs for the healthcare system—despite the likely political posturing and spin.

If this clip whets your appetite for more, register to watch a replay of the full 90-minute video webinar from April.

Curious about the IRA will disrupt the 340B market? Then register for The 340B Drug Pricing Program: Trends, Controversies, and Outlook, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at the June 21 webinar.

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

The 340B Drug Pricing Program: Trends, Controversies, and Outlook (NEW Live Video Webinar)

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

The 340B Drug Pricing Program:

Trends, Controversies, and Outlook

This event will be broadcast live on

Friday, June 21, 2024, from 12:00 p.m. to 1:30 p.m. ET

This page describes the event and explains how to purchase a registration. The webinar will be broadcast from the Drug Channels studio in beautiful downtown Philadelphia.

This event is part of The Drug Channels 2024 Video Webinar Series.

WHAT YOU WILL LEARN

The federal 340B Drug Pricing Program continues to grow much more quickly than the overall pharmaceutical market. For 2023, total purchases under the 340B program exceeded $124 billion. DCI estimates that 340B discounts equated to more than 17% of total value of gross-to-net reductions for brand-name pharmaceuticals. The 340B program also remains a significant and controversial source of profits for the pharmacy and pharmacy benefit management (PBM) industries.

In this all-new webinar, Dr. Fein will provide a fact-based look at the 340B program, summarize the multiple controversies surrounding the program’s operations, and deliver a clear-eyed outlook for the program’s future. Key topics will include:

• Current operations of the 340B program

• 340B growth trends by dispensing/administration channel and covered entity type

• Following the 340B dollar

• Contract pharmacy controversies

• Impact of CMS’s latest 340B guidance for the Inflation Reduction Act

• PBM and pharmacy profits from the 340B program

• Vertical integration and third-party administrators

• How state Medicaid program reforms are affecting the 340B program

• Manufacturers’ 340B strategies

• State and federal legislative actions and outlook

• 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 at least 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 also draw from exclusive information found in DCI's 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Read on for full details on pricing and registration.

HCP Perspectives: Access Challenges in Treating Diabetes & Obesity

Today’s guest post is from Dr. Preeti Parikh, a practicing pediatrician and VP, Executive Medical Director at GoodRx.

At the recent Publicis Health Media HealthFront event, Preeti hosted a dialogue on the main stage with Dr. Minisha Sood. They discussed new GoodRx research and had a candid discussion about their daily challenges in caring for patients—especially those living with diabetes and obesity.

Click here to watch the full video of the conversation between Drs. Parikh and Sood.

Read on for Preeti’s insights.

Another IRA Surprise: Part B Coinsurance Inflation Adjustments Are Increasing Patient Costs

Contrary to what you may have heard, the Inflation Reduction Act’s (IRA) inflation rebates for Medicare Part B drugs do not always save money for seniors.

As we document below, a growing share of Part B drugs have inflation-adjusted coinsurance rates that have been increasing, not declining. In many cases, the coinsurance rate declines only briefly before rebounding back to the standard 20% rate. What’s more, these fluctuations have triggered huge jumps in patients’ out-of-pocket obligations for some drugs—even when a drug’s costs were falling.

Chalk off these coinsurance surprises to yet another unintended consequence of the IRA. Seniors who are expecting to see costs drop may find they are instead being taken for a rollercoaster ride.

Solving Access Barriers in Biomarker Testing: 5 Tips for Manufacturers

Today’s guest post comes from Hannah Baxter, Associate Partner at The Dedham Group; Jen Klarer, Partner, Head of Cell & Gene Therapy at The Dedham Group; and Carolyn Zele, Advisor, Solution Consulting at MMIT.

The authors discuss the access barriers facing patients who need biomarker testing. They discuss five ways manufacturers can prevent these barriers from affecting patients.

To learn more about navigating the complexities of market access, contact MMIT and its sister company, The Dedham Group.

Read on for their insights.

Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A May 2024 Update

It's time for Drug Channels’ annual update of vertical integration among insurers, PBMs, specialty pharmacies, and providers within U.S. drug channels.

Below you’ll find our latest illustration of the major vertical business relationships among the largest companies along with some of the notable activity since our previous update. These organizations continue to exert greater control over patient access, sites of care/dispensing, and pricing, although some have started to unwind their vertical efforts.

The companies face renewed scrutiny from the Federal Trade Commission, the Office of Inspector General, and members of Congress. But until anyone takes action, we will continue to live with the golden rule of the drug channel: Whoever has the gold gets to make the rules.

Bracing for Impact: The Future of Hub, PAP, and Affordability Programs Under the Inflation Reduction Act

Today’s guest post comes from Chris Dowd, Senior VP of Market Development at ConnectiveRx.

Chris explains how the Inflation Reduction Act of 2022 (IRA) will impact hub, patient assistance programs (PAP), and affordability programs. He discusses steps manufacturers can take to accommodate the anticipated budget reductions while maintaining access and affordability for patients.

To learn more, join Chris on June 4 at 1:00 p.m. ET for a free online panel discussion about how brands can continue to offer robust patient support despite IRA challenges.

Read on for Chris’ insights.

Drug Channels News Roundup, April 2024: CVS’s Humira Strategy, White Bagging “Savings,” IRA vs. Part D Plans, Walgreens Specialty Update, Pharmacies vs. GoodRx, and Oncology Fun

April is over, so it's time to hop into this month’s selection of noteworthy news:

• CVS Health’s formulary boosts a Humira biosimilar

• An insurer ditches buy-and-bill to save money for plans—but maybe not for patients?

• My $0.02 on how Medicare Part D plans will react to the Inflation Reduction Act

• Walgreens' unexpected specialty pharmacy strength

• A video deconstruction of my infamous Drug Channels article on GoodRx

Plus, a cartoonist illustrates my recent keynote on the battle for oncology margin.

P.S. Join my nearly 55,000 LinkedIn followers for daily links to neat stuff.

Breaking Down Barriers: Helping Patients Get Therapies Quickly

Today’s guest post comes from Kevin Kettler, President of CoverMyMeds.

Kevin asks: What if there were no barriers across the therapy access and reimbursement process? In his view, eliminating barriers requires a combination of expert insight, actionable data, and simplification of the providers' experiences.

Click here to learn more about CoverMyMeds’ comprehensive technology solutions.

Meet CoverMyMeds in Booth 1305 at the Asembia AXS24 Summit. To keep up with CoverMyMeds and all the action at Asembia, click here to sign up for daily recaps from Asembia.

Read on for Kevin’s insights.

Independents Outshine PBMs in Manufacturers’ Exclusive Specialty Pharmacy Networks

Last week, we documented the substantial concentration of dispensing revenues for specialty drugs. See The Top 15 Specialty Pharmacies of 2023: Market Shares and Revenues at the Biggest PBMs, Health Plans, and Independents.

Today, we examine how manufacturers’ specialty networks contribute to this concentration. In DCI’s exclusive analysis below, we show that specialty pharmacies affiliated with pharmacy benefit managers (PBMs) play an outsized role in manufacturer-designated dispensing networks.

A typical network contains about five specialty pharmacies—but one in three specialty products with a manufacturer-designated network contains only a single specialty pharmacy. In those exclusive networks, independent and smaller specialty pharmacies are the big winners.

Read on for DCI’s updated profile of specialty networks—and ponder why smaller pharmacies are winning the battle for exclusive networks.