EXCLUSIVE: A Record Number of Specialty Pharmacies Now Have Accreditation

It’s time for Drug Channels Institute’s annual update on the accreditation of specialty pharmacies. Our spooky research team (pictured at right) is back! We have counted every pharmacy location that has achieved accreditation by an independent organization. Our exclusive findings: The number of specialty pharmacies with accreditation expanded again in 2017. We identified 729 unique pharmacy locations that by the end of 2017 had achieved accreditation from the three major independent accreditation organizations. The 2017 figure is almost double the 2015 figure. For the second consecutive year, pharmacy locations owned by healthcare providers—such as hospitals, health systems, physician practices, and … Continue reading EXCLUSIVE: A Record Number of Specialty Pharmacies Now Have Accreditation

Drug Channels News Roundup, March 2018: Copay Accumulators, Cancer Drug Costs, Physician Employment, and Insurer Profits

It’s technically spring here at Drug Channels’ worldwide headquarters in lovely downtown Philadelphia. While the last snowdrifts melt into memory, please enjoy this month’s selection of noteworthy news stories. You’ll learn: Why copay accumulators are making national news How hospitals are doubling cancer drug costs Fun facts about the massive shift to hospital-employed physicians Plus, a joke (I think) about how a major health insurer makes money. P.S. Join the nearly 5,400 people who follow me at @DrugChannels on Twitter. I share links to crucial news and reports that you should know about. Read more » Copyright © 2006-2018 Pembroke … Continue reading Drug Channels News Roundup, March 2018: Copay Accumulators, Cancer Drug Costs, Physician Employment, and Insurer Profits

Plan Sponsors Prefer Specialty Pharmacies Over Retail Drugstores

Top ‘o the morning to you! Let’s take a wee look at the Pharmacy Benefit Management Institute’s (PBMI) new 2018 Trends in Specialty Drug Benefits. (Free download with registration.) It’s a great resource for understanding how plan sponsors manage specialty drugs. The new report contains fascinating data showing how sponsors of employer-based health plans view dispensing channels for specialty drugs. As you will see below, employers believe that the capabilities of specialty pharmacies are superior to those of retail pharmacies. They also think that over the past few years, specialty pharmacies’ performance gap has widened for crucial clinical and patient … Continue reading Plan Sponsors Prefer Specialty Pharmacies Over Retail Drugstores

The Top 15 Specialty Pharmacies of 2017: PBMs and Payers Still Dominate

Below is our exclusive Drug Channels Institute list of the 15 largest pharmacies, ranked by estimated 2017 revenues from dispensing specialty pharmaceuticals. The battle for control of the specialty market accelerated in 2017, though pharmacies owned by pharmacy benefit managers (PBMs) continued to capture most of the market share. The top four specialty pharmacies are all owned or co-owned by a PBM. They accounted for about two-thirds of prescription revenues from pharmacy-dispensed specialty drugs. Vertical integration M&A has been in the news. But as our data shows, the integration of PBMs and specialty pharmacies has already happened. Read more » … Continue reading The Top 15 Specialty Pharmacies of 2017: PBMs and Payers Still Dominate

Cigna-Express Scripts: Vertical Integration and PBMs’ Medical-Pharmacy Future

Wow. Yesterday, Cigna announced that it would acquire Express Scripts. See the links below. Though Cigna was an unexpected acquirer, the deal confirms the importance of pharmacy and medical benefit integration. It also reinforces the role that pharmacy benefit management (PBM) plays in the drug channel. PBMs are now linked closely to the expensive specialty drugs that treat smaller patient populations, not to the primary care blockbusters of yesteryear. The strategic logic, however, is much more compelling for Express Scripts than it is for Cigna. Perhaps that’s why the stocks reacted so differently yesterday. Express Scripts’ stock closed up 9%, … Continue reading Cigna-Express Scripts: Vertical Integration and PBMs’ Medical-Pharmacy Future

UnitedHealthcare’s Point-of-Sale Rebate Announcement: What’s Next?

Did I just hear the gross-to-net bubble deflate a little bit? This week, UnitedHealthcare announced that it would provide point-of-sale (POS) rebates to 7 million people enrolled in its fully insured commercial group benefit plans. Click here to read the press release. UnitedHealthcare’s action is a big win for patients, though not (yet) a black swan event for pharmacies and pharmacy benefit managers (PBMs). As I explain below, it’s a small but significant move that will trigger new questions about drug prices, patients’ out-of-pocket costs, and channel economics. I’m sure that SpongeBob SquarePants, honorary mascot of the gross-to-net bubble, is … Continue reading UnitedHealthcare’s Point-of-Sale Rebate Announcement: What’s Next?

The Top 15 U.S. Pharmacies of 2017: Market Shares and Key Developments For The Biggest Companies

Next week, Drug Channels Institute will release our 2018 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. It’s the ninth edition of our popular examination of the U.S. pharmacy distribution and reimbursement system. The exhibit below—one of 160 in our new report—provides a first look at the 15 largest pharmacies, ranked by total U.S. prescription dispensing revenues for calendar year 2017. I also highlight crucial market changes that affected our ranking. As you will see, the big got bigger in 2017. For a sneak peek at the complete report, download the free overview. If you would like to preorder … Continue reading The Top 15 U.S. Pharmacies of 2017: Market Shares and Key Developments For The Biggest Companies

Exclusive Express Scripts Data: Most People Have Very Low Out-Of-Pocket Prescription Costs

In New Express Scripts Data: The Drug Spending Slowdown Is Real, I analyzed the latest drug trend report from pharmacy benefit manager (PBM) Express Scripts. To complement our earlier analysis, Express Scripts was kind enough to provide Drug Channels with an exclusive analysis showing the distribution of out-of-pocket costs for nearly 26 million people. Despite consumer surveys complaining about “high drug prices,” the reality is that most people don’t pay much for their prescriptions. In 2017, about 95% of people with commercial insurance had less than $40 per month in out-of-pocket prescription costs. About half of them paid nothing, because … Continue reading Exclusive Express Scripts Data: Most People Have Very Low Out-Of-Pocket Prescription Costs

New Express Scripts Data: The Drug Spending Slowdown Is Real

Last week, Express Scripts released its 2017 Drug Trend Report. (Free download.)  Consider it an early Valentine’s Day present for pharma wonks like your friendly neighborhood blogger. The latest data confirm the slowdown in drug spending. For 2017, drug spending increased by only 1.5% for Express Scripts’ commercial plan sponsors. What’s more, drug spending declined for nearly half of commercial payers. Medicare, Medicaid, and exchange plans also saw very modest increases. Below, I dive deep into the data on cost and utilization growth. By now, there can be no debate that pharmacy benefit costs are growing more slowly than every … Continue reading New Express Scripts Data: The Drug Spending Slowdown Is Real

Specialty Distributors’ Customer Mix Changes As Physician Buy-and-Bill Fades

In A Lesson from McKesson: How Specialty Pharmacy Growth Is Hurting Wholesalers, I explained the challenges to wholesalers’ profits from the growth of patient-administered specialty pharmacy drugs. Today, I provide a complementary look at the changing customer mix of wholesalers’ specialty distribution businesses for provider-administered drugs. As you will see below, the latest data show that specialty distributors’ revenues from independent physician offices and clinics have eroded significantly. These customers now account for less than half of specialty distributors’ business. This change mirrors the ongoing disruption of the buy-and-bill market, where higher-cost hospital outpatient settings have been crowding out lower-cost … Continue reading Specialty Distributors’ Customer Mix Changes As Physician Buy-and-Bill Fades