Drug Channels Institute’s (DCI’s) latest analysis finds that participants in the specialty pharmacy market continue to get more diverse—although revenues remain highly concentrated.
We have identified nearly 1,800 dispensing sites with specialty pharmacy accreditation—about 40% of which are owned by hospitals, physician practices, and other healthcare providers.
Alas, specialty pharmacies owned by the three largest pharmacy benefit managers (PBMs) have the most brass in their pocket, as they accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs.
Read on for DCI’s latest overview of the 2023 marketplace and revenues of the biggest market participants, along with key specialty pharmacy trends.
Drug Channels delivers timely analysis and provocative opinions from Adam J. Fein, Ph.D., the country's foremost expert on pharmaceutical economics and the drug distribution system. Drug Channels reaches an engaged, loyal and growing audience of more than 80,000 subscribers and followers. Learn more...
Tuesday, April 16, 2024
Friday, April 12, 2024
How Patient Engagement Can Reduce Brand Launch Risks
Today’s guest post comes from Jessica Lens, Chief Patient Experience Officer at CareMetx.
Jessica discusses the challenges of patient nonadherence. She then outlines how manufacturers can build adherence into their patient services program to increase patient engagement.
To learn more about enhancing patient engagement and adherence, download CareMetx's new report: Driving Brand Success: Minimize Risk and Capture Missed Value from Patient Engagement and Adherence.
Read on for Jessica’s insights.
Jessica discusses the challenges of patient nonadherence. She then outlines how manufacturers can build adherence into their patient services program to increase patient engagement.
To learn more about enhancing patient engagement and adherence, download CareMetx's new report: Driving Brand Success: Minimize Risk and Capture Missed Value from Patient Engagement and Adherence.
Read on for Jessica’s insights.
Labels:
Guest Post,
Sponsored Post
Tuesday, April 09, 2024
The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead
Three is still the magic number for pharmacy benefit managers (PBMs).
For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group.
Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the industry changes that will shift these shares over the next few years.
For 2023, nearly 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the Optum Rx business of UnitedHealth Group.
Read on for Drug Channels Institute’s (DCI’s) latest market share figures, along with a preview of the industry changes that will shift these shares over the next few years.
Monday, April 08, 2024
SAVE THE DATE: Drug Channels Leadership Forum, March 17-19, 2025
I am pleased to announce the inaugural Drug Channels Leadership Forum! This unique, new event will be held from March 17 to 19, 2025, at the Turnberry Resort and Spa in Miami.
The Leadership Forum will be an executive gathering where drug channel leaders can network and discuss key issues and challenges facing the commercial healthcare system. We intend to bring together people from the entire drug channel: pharmaceutical manufacturers, pharmacy benefit managers (PBMs), health plans, insurers, and plan sponsors, wholesalers and distributors, pharmacies, providers, buying groups, government officials, and more.
I’m personally assembling the agenda, which will be a mix of one-on-one fireside chats with industry leaders combined with hard-hitting, topical panel discussions. And of course, I'll be there to moderate the entire event and lead the fireside chats. Thanks to DCI’s partnership with HMP Global, we can bring this novel event to the drug channels community.
To maximize the value of networking and learning, the event will have a limited number of attendees. Click here to request an invitation.
We will also have a very limited number of sponsors. Click here to learn more about sponsorship opportunities.
Read on for the full press release. Hope you can join us!
The Leadership Forum will be an executive gathering where drug channel leaders can network and discuss key issues and challenges facing the commercial healthcare system. We intend to bring together people from the entire drug channel: pharmaceutical manufacturers, pharmacy benefit managers (PBMs), health plans, insurers, and plan sponsors, wholesalers and distributors, pharmacies, providers, buying groups, government officials, and more.
I’m personally assembling the agenda, which will be a mix of one-on-one fireside chats with industry leaders combined with hard-hitting, topical panel discussions. And of course, I'll be there to moderate the entire event and lead the fireside chats. Thanks to DCI’s partnership with HMP Global, we can bring this novel event to the drug channels community.
To maximize the value of networking and learning, the event will have a limited number of attendees. Click here to request an invitation.
We will also have a very limited number of sponsors. Click here to learn more about sponsorship opportunities.
Read on for the full press release. Hope you can join us!
Friday, April 05, 2024
Tales of the Unsurprised: U.S. Brand-Name Drug Prices Fell for an Unprecedented Sixth Consecutive Year—And Will Fall Further in 2024 (rerun)
This week, I’m rerunning some popular posts while I prepare for today’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.
One important update: In the article below, I suggested that the IRA will make high-list/high-rebate products less attractive to Medicare plans. But this appears not be accurate, as I explain in Surprise! Thanks to the IRA, Part D Plans Will Prefer High-List, High-Rebate Drugs.
Click here to see the original post from January 2024.
It's time for Drug Channels’ annual reality check on U.S. drug pricing.
For 2023, brand-name drugs’ list prices again grew at mid-single-digit rates. However, net prices dropped for an unprecedented sixth consecutive year. What’s more, after adjusting for overall inflation, brand-name drug net prices plunged by more than 7%. Details below.
Employers, health plans, and PBMs determine whether patients share in this ongoing deflation. Meanwhile, these data challenge drug pricing flat earthers (#DPFE) who remain committed to a false narrative of “skyrocketing” drug prices.
As I discuss below, manufacturers will face ongoing pressure on net prices from both commercial and government payers. They will also have new incentives to limit growth in list prices—and will even reduce list prices on certain drugs (as some are already doing).
Perhaps these factors will finally start to deflate the gross-to-bubble and reduce its negative effect on patients and public policy discussions. Hope has to triumph over experience eventually, doesn’t it?
One important update: In the article below, I suggested that the IRA will make high-list/high-rebate products less attractive to Medicare plans. But this appears not be accurate, as I explain in Surprise! Thanks to the IRA, Part D Plans Will Prefer High-List, High-Rebate Drugs.
Click here to see the original post from January 2024.
It's time for Drug Channels’ annual reality check on U.S. drug pricing.
For 2023, brand-name drugs’ list prices again grew at mid-single-digit rates. However, net prices dropped for an unprecedented sixth consecutive year. What’s more, after adjusting for overall inflation, brand-name drug net prices plunged by more than 7%. Details below.
Employers, health plans, and PBMs determine whether patients share in this ongoing deflation. Meanwhile, these data challenge drug pricing flat earthers (#DPFE) who remain committed to a false narrative of “skyrocketing” drug prices.
As I discuss below, manufacturers will face ongoing pressure on net prices from both commercial and government payers. They will also have new incentives to limit growth in list prices—and will even reduce list prices on certain drugs (as some are already doing).
Perhaps these factors will finally start to deflate the gross-to-bubble and reduce its negative effect on patients and public policy discussions. Hope has to triumph over experience eventually, doesn’t it?
Thursday, April 04, 2024
Vertical Integration Lessons: The Economics and Strategies of Hospital-Owned Specialty Pharmacies (rerun)
This week, I’m rerunning some popular posts while I prepare for tomorrow’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.
For updated data on hospital-owned specialty pharmacies, see Chapter 3 of DCI's new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
Click here to see the original post from November 2023.
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.
For updated data on hospital-owned specialty pharmacies, see Chapter 3 of DCI's new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
Click here to see the original post from November 2023.
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.
Labels:
340B,
Benefit Design,
Hospitals,
Narrow Networks,
Pharmacy,
Specialty Drugs
Wednesday, April 03, 2024
The Big Three PBMs’ 2024 Formulary Exclusions: Biosimilar Humira Battles, CVS Health’s Weird Strategy, and the Insulin Shakeup (rerun)
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.
The 2024 formularies described below should boost biosimilar adoption. As a new Biosimilar Council report shows, Humira retained 99% of market share in late 2023, despite being more expensive than its biosimilars.
Click here to see the original post from January 2024.
For 2024, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again each excluded 600 or more drugs from their standard formularies. You can find our updated counting below.
This year, Humira and its 14 biosimilars will provide the most intriguing formulary drama. Unfortunately, the gross-to-net bubble will remain a fixture for this category, despite a price war led by almost half of the biosimilars. CVS Health will lean into the craziness with an unusual Humira strategy.*
There are also unusual formulary developments for insulin products, many of which experienced massive list price cuts for 2024.
Read on for my deep dive into these two therapeutic categories. I also highlight recent research that raises troubling questions about the patient impact of these ever-growing exclusion lists. As always, I welcome your comments below or on LinkedIn.
The 2024 formularies described below should boost biosimilar adoption. As a new Biosimilar Council report shows, Humira retained 99% of market share in late 2023, despite being more expensive than its biosimilars.
Click here to see the original post from January 2024.
For 2024, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)—have again each excluded 600 or more drugs from their standard formularies. You can find our updated counting below.
This year, Humira and its 14 biosimilars will provide the most intriguing formulary drama. Unfortunately, the gross-to-net bubble will remain a fixture for this category, despite a price war led by almost half of the biosimilars. CVS Health will lean into the craziness with an unusual Humira strategy.*
There are also unusual formulary developments for insulin products, many of which experienced massive list price cuts for 2024.
Read on for my deep dive into these two therapeutic categories. I also highlight recent research that raises troubling questions about the patient impact of these ever-growing exclusion lists. As always, I welcome your comments below or on LinkedIn.
Labels:
Benefit Design,
Biosimilars,
Gross-to-Net Bubble,
PBMs,
Specialty Drugs
Tuesday, April 02, 2024
What CVS Pharmacy’s New Cost-Plus Reimbursement Approach Means for PBMs, Pharmacies, Plan Sponsors, and Prescription Prices (rerun)
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.
For more on acquisition cost reimbursement for pharmacies, see Sections 8.4. and 12.3.4. of our new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
Click here to see the original post from December 2023.
Is the world ready for new ways to price pharmacy and pharmacy benefit manager (PBM) services? CVS Health thinks so, as evidenced by two new initiatives that it announced yesterday. Below you'll find details and links to source documents.
I commend CVS Health for attempting to address key economic challenges facing the retail pharmacy industry and for tackling the hidden complexities of PBM pricing models. As I explain, a shift to cost-based pharmacy reimbursement could stabilize CVS Health’s retail business by improving its dispensing profits.
Nonetheless, CVS Pharmacy’s cost-plus model has some notable shortcomings for plan sponsors and is far less “disruptive” than the company would like us to believe. Mark Cuban should be flattered—but not fearful.
What's more, other large pharmacies will likely follow CVS with attempts to force payers and PBMs to accept some form of cost-plus reimbursement. (Et tu, Walgreens?) If that happens, expect higher prescriptions prices, less efficiency, and a slowdown in the inevitable retail pharmacy shakeout.
For more on acquisition cost reimbursement for pharmacies, see Sections 8.4. and 12.3.4. of our new 2024 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.
Click here to see the original post from December 2023.
Is the world ready for new ways to price pharmacy and pharmacy benefit manager (PBM) services? CVS Health thinks so, as evidenced by two new initiatives that it announced yesterday. Below you'll find details and links to source documents.
I commend CVS Health for attempting to address key economic challenges facing the retail pharmacy industry and for tackling the hidden complexities of PBM pricing models. As I explain, a shift to cost-based pharmacy reimbursement could stabilize CVS Health’s retail business by improving its dispensing profits.
Nonetheless, CVS Pharmacy’s cost-plus model has some notable shortcomings for plan sponsors and is far less “disruptive” than the company would like us to believe. Mark Cuban should be flattered—but not fearful.
What's more, other large pharmacies will likely follow CVS with attempts to force payers and PBMs to accept some form of cost-plus reimbursement. (Et tu, Walgreens?) If that happens, expect higher prescriptions prices, less efficiency, and a slowdown in the inevitable retail pharmacy shakeout.
Monday, April 01, 2024
Understanding CVS Health/McKesson and Why Pharmacies Lose Money on GLP-1s (rerun)
This week, I’m rerunning some popular posts while I prepare for Friday’s live video webinar: Drug Channel Implications of the Inflation Reduction Act.
Click here to see the original post from December 2023.
Consider two apparently unrelated drug channel anomalies:
This morning’s announcement of CVS Health’s CostVantage pharmacy reimbursement model reflects the latest attempt to fix the system’s wacky economics. Tomorrow on Drug Channels, I’ll delve into the pros and cons of this new approach.
Click here to see the original post from December 2023.
Consider two apparently unrelated drug channel anomalies:
- In McKesson’s 2023 fiscal year, CVS bought $75 billion in pharmaceuticals from McKesson’s wholesale business—a jump of more than 35% compared with the previous year.
- Despite skyrocketing sales for anti-obesity GLP-1 drugs, many retail pharmacies are losing money on every prescription.
This morning’s announcement of CVS Health’s CostVantage pharmacy reimbursement model reflects the latest attempt to fix the system’s wacky economics. Tomorrow on Drug Channels, I’ll delve into the pros and cons of this new approach.
Labels:
Costs/Reimbursement,
PBMs,
Pharmacy,
Pharmacy Economics,
Wholesalers
Thursday, March 28, 2024
Navigating Market Access Challenges in Life Sciences Commercialization
Today’s guest post comes from Bill Dupere, SVP of Product Development & Partnerships at Mercalis.
Bill discusses specialty therapy access barriers, including payer utilization management techniques and “no coverage” policies. Contact Mercalis to learn about their Patient Support Services.
Read on for Bill’s insights.
Bill discusses specialty therapy access barriers, including payer utilization management techniques and “no coverage” policies. Contact Mercalis to learn about their Patient Support Services.
Read on for Bill’s insights.
Labels:
Guest Post,
Sponsored Post
Tuesday, March 26, 2024
Drug Channels News Roundup, March 2024: My $0.02 of CarelonRx/Kroger & CVS, Provider-Owned Pharmacies, Shady AFPs, 340B Deception, and Lilly’s GLP-1 Ad
It’s finally spring in Philadelphia, home of Drug Channels. Along with sunshine and fine weather, the vernal equinox has ushered in a crop of new and noteworthy stories:
P.S. Join my nearly 54,000 LinkedIn followers for daily links to neat stuff.
- What the CarelonRx/Kroger specialty pharmacy deal means for CVS Health
- Provider-owned specialty pharmacies expand in Medicare
- Payers are not keen on shady alternative funding programs (AFP)
- Hospitals’ association spreads 340B misinformation
P.S. Join my nearly 54,000 LinkedIn followers for daily links to neat stuff.
What’s ahead for the drug channel? Find out during Drug Channel Implications of the Inflation Reduction Act, a new live video webinar with Adam J. Fein, PhD. Click here to learn more and reserve your spot at our April 5 webinar.
Friday, March 22, 2024
Three Digital Intake Strategies For Eliminating Patient Enrollment Forms
Today’s guest post comes from Adam Stotts, SVP of Customer Success at AssistRx.
Adam discusses how patients seeking to access specialty therapies can benefit from a digital intake approach. He then explains three ways that specialty pharmaceutical companies can use digital intake strategies to speed patient enrollment.
To learn about AssistRx’s digital intake solutions, download Digital Intake for Specialty Drug Programs: Q1 2024 Progress Report.
Read on for Adam’s insights.
Adam discusses how patients seeking to access specialty therapies can benefit from a digital intake approach. He then explains three ways that specialty pharmaceutical companies can use digital intake strategies to speed patient enrollment.
To learn about AssistRx’s digital intake solutions, download Digital Intake for Specialty Drug Programs: Q1 2024 Progress Report.
Read on for Adam’s insights.
Labels:
Guest Post,
Sponsored Post