The Mysteries of Pass-Through Status: Why Medicare and Seniors Are Now Paying More for Lower-Cost Biosimilars at Hospitals

An unanticipated combination of government policy changes has led to a truly bizarre circumstance: The Medicare program and individual Medicare patients are paying more for lower-cost biosimilars. Further, hospitals are earning windfall profits from these lower-cost biosimilars, though physician offices can’t access the same financial benefits. Sound bonkers? You bet. To understand this strange turn of events, I delve into the vagaries of Medicare Part B reimbursement and the recently implemented outpatient prospective payment system (OPPS) rule for drugs acquired under the 340B Drug Pricing Program. As I explain below, the Centers for Medicare & Medicaid Services (CMS) recently made … Continue reading The Mysteries of Pass-Through Status: Why Medicare and Seniors Are Now Paying More for Lower-Cost Biosimilars at Hospitals

More New Drugs and Generics Reshape Pharma Markets

Amidst all the outrage over surging pharma prices, the continued growth in generic drug prescribing has moderated overall spending on medicines, cooling the political heat on industry. Generics now account for nearly 90% of prescription drug use in the US due to policies facilitating their devel Powered by WPeMatico Continue reading More New Drugs and Generics Reshape Pharma Markets

Remicade: A Case Study in How U.S. Pricing and Reimbursement Curb Adoption of Biosimilars (rerun)

This week, I’m rerunning some popular posts during the pre-holiday week. Click here to see the original post and comments from September 2017. This post is good reminder that biosimilar products have unanticipated channel dynamics. CMS’s policy change will further alter the 2018 market. Effective January 1, 2018, each biosimilar will have its own J-code. See Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year 2018. Drug Channels will return on January 3. Until then, have a great holiday and happy new year! The Centers for Medicare & Medicaid Services (CMS) has just released … Continue reading Remicade: A Case Study in How U.S. Pricing and Reimbursement Curb Adoption of Biosimilars (rerun)

Five Industry Trends for U.S. Drug Wholesalers in 2018

Modern Distribution Management recently published my article 2017 MDM Market Leaders | Top Pharmaceuticals Distributors. It is an excerpt from our 2017–18 Economic Report on Pharmaceutical Wholesalers and Specialty Distributors. Below, I republish the section of the article highlighting five significant industry trends affecting the U.S. drug wholesaling industry. I think Drug Channels readers will enjoy this summary as we look toward an eventful 2018. Click here to download a free overview of the full report. Many of the trends highlighted below have been headwinds for the wholesalers. They may help you understand why H.D. Smith sold its drug wholesaling … Continue reading Five Industry Trends for U.S. Drug Wholesalers in 2018

Drug Channels News Roundup, October 2017: FTC Workshop on PBMs, HDHPs, OOP Spending, Hospital Profits, and FDA Biosimilar Cartoons

Eeek! Time for my Halloween roundup of Drug Channels news stories. In this issue: Spooktakular! An FTC competition workshop will include a terrifying panel on pharmacy benefit managers (PBMs) Scary! The pros and cons of frightful high-deductible health plans Creepy! JPMorgan Chase conjures up surprising new data on consumer out-pocket costs Spooky! Ghastly hospital markups on outpatient drugs Plus, the FDA treats us to a new educational campaign on biosimilar drugs—complete with groovy shareable GIFs for millennials. P.S. For a daily haunting, join the zombie horde who shamble after me here: @DrugChannels on Twitter. (ICYMI: Over the past week, I have sent multiple tweets … Continue reading Drug Channels News Roundup, October 2017: FTC Workshop on PBMs, HDHPs, OOP Spending, Hospital Profits, and FDA Biosimilar Cartoons

Remicade: A Case Study in How U.S. Pricing and Reimbursement Curb Adoption of Biosimilars

The Centers for Medicare & Medicaid Services (CMS) has just released the Average Sales Prices (ASP) reimbursement data for the fourth quarter of 2017. You can download the drug pricing files here. Below, I use these data to explore the reimbursement and payer dynamics behind the relatively slow adoption of Inflectra, the first biosimilar of Remicade. The introduction of Renflexis, a second biosimilar, will offer additional insights about pricing and channel strategies. The U.S. biosimilar market is highly underdeveloped compared with our European counterparts. As this case study shows, it’s pretty, pretty, pretty hard to launch a biosimilar. Read more … Continue reading Remicade: A Case Study in How U.S. Pricing and Reimbursement Curb Adoption of Biosimilars

Pharm Exec’s 2016 Pipeline Report

Falling enterprise values have defined the life sciences landscape during these waning days of 2015, accompanied by a storm cloud of negative headlines on industry pricing practices. This, in turn, has fueled the ire of skeptical payers, politicians, and the public at large. Will Powered by WPeMatico Continue reading

Pharm Exec’s 2016 Pipeline Report