The Law of Holes: Some Independents Skip 2019 Part D Preferred Pharmacy Networks

Last week, I highlighted the largest pharmacy chains that will participate in next year’s Medicare Part D prescription drug plans (PDP). Today, I examine independent pharmacies’ participation via the pharmacy services administrative organizations (PSAOs) that represent these pharmacies in negotiations with plans. This year’s results show a major divergence in strategies. Three of the four biggest PSAOs will participate in a comparable number of Part D networks, as the big chains do. AmerisourceBergen’s Elevate network, however, continues to go its own way and will skip preferred status in the major Part D networks. You will find its reasoning below. Are … Continue reading The Law of Holes: Some Independents Skip 2019 Part D Preferred Pharmacy Networks

Battle Royale: CVS and Kroger Gain, Walgreens Slips in 2019 Part D Preferred Pharmacy Networks

In Humana Triggers a Pullback for Preferred Pharmacy Networks in 2019 Medicare Part D , I highlighted how preferred pharmacy networks will dominate next year’s Medicare Part D prescription drug plans (PDP). Today, I examine chain pharmacies’ participation in 24 major 2019 Part D preferred networks. Some highlights: CVS, for the second year, has strengthened its position as a preferred pharmacy in many 2019 networks. Walmart and Kroger have maintained the strong positions that they have established over the past few years. Walgreens, however, has slipped as the other chains grow. Poor ol’ Rite Aid will again be a preferred … Continue reading Battle Royale: CVS and Kroger Gain, Walgreens Slips in 2019 Part D Preferred Pharmacy Networks

EXCLUSIVE: Humana Triggers a Small Pullback for Preferred Pharmacy Networks in 2019 Medicare Part D (Plus: Top Sponsors and CVS Health’s POS Plan)

The Centers for Medicare & Medicaid Services (CMS) has recently released the initial raw data on the 2019 Medicare Part D plans. Our exclusive analysis of these data reveals that preferred cost sharing pharmacy networks will be slightly less popular next year. For 2019, 92% of Medicare Part D regional prescription drug plans (PDP) will have a preferred network. This figure compares with 99% of plans in 2018. The decline will occur primarily because two Humana plans will switch from preferred to open networks for 2019. Below, I provide historical context on preferred networks’ growth and then discuss the top … Continue reading EXCLUSIVE: Humana Triggers a Small Pullback for Preferred Pharmacy Networks in 2019 Medicare Part D (Plus: Top Sponsors and CVS Health’s POS Plan)

A Lesson from McKesson: How Specialty Pharmacy Growth Is Hurting Wholesalers (rerun)

This week, I’m rerunning some popular posts while I attend Asembia’s 2018 Specialty Pharmacy Summit. Click here to see the original post and comments from February 2018. Last week, McKesson released its quarterly earnings for the fourth calendar quarter of 2017. See the links below. The profit outlook for its distribution business was lower than Wall Street’s expectations, due partly to what management termed “customer and product mix.” Below, I offer my take on the three interrelated mix changes that challenge wholesalers’ profits from the growth of specialty pharmacy drugs. Wholesalers have been trying to alter their conventional pricing and … Continue reading A Lesson from McKesson: How Specialty Pharmacy Growth Is Hurting Wholesalers (rerun)

A Lesson from McKesson: How Specialty Pharmacy Growth Is Hurting Wholesalers

Last week, McKesson released its quarterly earnings for the fourth calendar quarter of 2017. See the links below. The profit outlook for its distribution business was lower than Wall Street’s expectations, due partly to what management termed “customer and product mix.” Below, I offer my take on the three interrelated mix changes that challenge wholesalers’ profits from the growth of specialty pharmacy drugs. Wholesalers have been trying to alter their conventional pricing and contracting approaches to address these pressures, though it’s not clear how successful these efforts have been. The specialty boom may prove to be a mixed blessing for … Continue reading A Lesson from McKesson: How Specialty Pharmacy Growth Is Hurting Wholesalers

New Part D Data: CVS Wins Big in 2018’s Preferred Pharmacy Networks

Just-released data from the Centers for Medicare & Medicaid Services (CMS) confirms that preferred cost sharing networks will continue to dominate Medicare Part D. Our exclusive analysis finds that for 2018, 99.9% of seniors are enrolled in Prescription Drug Plans (PDPs) with preferred pharmacy networks. Below, we use the new enrollment data to analyze the major pharmacy chains’ position within the 22 major Part D plans that have preferred networks. As you will see, CVS looks poised in 2018 to recapture major market share from Walgreens and Walmart. Poor ol’ Rite Aid will once again lag far behind. As long … Continue reading New Part D Data: CVS Wins Big in 2018’s Preferred Pharmacy Networks

How Independent Pharmacies Will Participate (Or Not) in 2018’s Part D Preferred Pharmacy Networks

In a previous analysis (CVS Bets Big: Our Exclusive Analysis of Pharmacy Chain Participation in 2018’s Part D Preferred Pharmacy Networks), I highlighted how the largest pharmacy chains will participate in next year’s Medicare Part D prescription drug plans (PDP). Today, I examine independent pharmacies’ participation in 22 major 2018 Part D preferred networks. Our analysis focuses on the pharmacy services administration organizations (PSAOs) that represent these pharmacies in negotiations with plans. As you will see below, the profit pressures from narrow networks have made smaller pharmacies much choosier about contracting for preferred status. For three of the four largest … Continue reading How Independent Pharmacies Will Participate (Or Not) in 2018’s Part D Preferred Pharmacy Networks

CVS Bets Big: Our Exclusive Analysis of Pharmacy Chain Participation in 2018’s Part D Preferred Pharmacy Networks

In a previous analysis (Preferred Pharmacy Networks Will Dominate 2018 Medicare Part D Plans, I highlighted how preferred pharmacy networks will dominate next year’s Medicare Part D prescription drug plans (PDP). Today, I examine chain pharmacies’ participation in 22 major 2018 Part D preferred networks. Our analysis shows significant changes from last year: CVS has changed strategy and will go all in as a preferred pharmacy in many 2018 networks. It’s also the exclusive chain in some plans.  Walgreens remains an active participant, but CVS has displaced it in some plans. Kroger has raised its bet on being a preferred … Continue reading CVS Bets Big: Our Exclusive Analysis of Pharmacy Chain Participation in 2018’s Part D Preferred Pharmacy Networks

EXCLUSIVE: Preferred Pharmacy Networks Will Dominate 2018 Medicare Part D Plans (Plus: We Review the Top Plan Sponsors)

The Centers for Medicare & Medicaid Services (CMS) has just released the initial raw data on the 2018 Medicare Part D plans. Our exclusive analysis of these data reveals that preferred cost sharing pharmacy networks have officially won. For 2018, 99% of Medicare Part D regional prescription drug plans (PDP) will have a preferred network. This figure exceeds those of the past four years. The three largest open network plans from 2017—CVS Health’s SilverScript Choice and WellCare’s Classic and Extra plans—have given up and will have preferred networks. Below, I provide historical data on preferred networks’ growth and then discuss … Continue reading EXCLUSIVE: Preferred Pharmacy Networks Will Dominate 2018 Medicare Part D Plans (Plus: We Review the Top Plan Sponsors)

What Will Happen to Rite Aid’s Struggling EnvisionRx PBM?

Let’s revisit the Walgreens Boots Alliance—Rite Aid deal. Instead of an acquisition, the revised transaction calls for Walgreens Boots Alliance (WBA) to buy 2,186 Rite Aid stores and three distribution centers for $5.2 billion. WBA will also pay a $325 million termination fee to Rite Aid. If the deal receives regulatory approval, Rite Aid will shrink to a multi-regional pharmacy chain with about half as many stores. It will, however, hold onto EnvisionRx, the pharmacy benefit manager (PBM) that it acquired in 2015. Unfortunately, EnvisionRx remains a small, struggling regional PBM with limited growth. Its revenues in 2017 have been … Continue reading What Will Happen to Rite Aid’s Struggling EnvisionRx PBM?