Christine Juday on Drug Channels Institute blog

Expanding our Definitions of Out-of-Pocket Costs: Three Imperatives for Biopharmaceutical Manufacturers: Today’s guest post comes from Christine Juday, Head of Market Access at Real Chemistry. Chris discusses new research on how patients perceive out-of-pocket costs. As she explains, many patients and unpaid caregivers consider out-of-pocket costs for medication within the context of their total spending. She then recommends three ways that manufacturers can improve patients' access and affordability. Click here to learn more about Real Chemistry’s suite of market access consulting and payer/IDN marketing solutions. You can also sign up for its weekly Value Report, summarizing the week in drug pricing, access, and value news. Read on for Chris' insights. Read more » © 2006-2024 HMP Omnimedia, LLC d/b/a Drug Channels Institute, an HMP Global Company. All rights reserved. This Feed is for personal non-commercial use only. #pbm #lifesciences #financial

Good news and a win for Pharma and Biotech! CMS released a statement that Best Price stacking will not be in this Final Rule (see below for the full press release). This was a bad proposal and would have been a nightmare to implement (cheers to the life science industry on this win!). Note we are still waiting on the final rule from CMS. Stay tuned for more details. https://lnkd.in/enUjSF7M #GovernmentPricing #MDRP #BestPrice #LifeSciences

Thoughts on this? >> Why PBMs and Payers Are Embracing Insulin Biosimilars with Higher Prices—And What That Means for Humira (rerun with an FTC update) >> Comment below! >>> lqventures.com #strategy #competitiveintelligence #marketing #pharmaceutical #biotech #productmarketing #pharma #healthcare

The impact of drugs on organizations plans is a daily topic of consideration. Check out this recent Marsh McLennan Agency blog article highlighting the impact of drug shortages in the U.S., emphasizing the implications for patient safety, clinical outcomes and cost. #HealthCare #Pharmacy #drugshortage #healthcarecosts #patientsafety

Recent shifts in the adoption of biosimilars are changing the industry landscape. CVS Caremark altered its formulary in early April, removing the blockbuster drug Humira and favoring lower-cost biosimilars like Hyrimoz and Hadlima. As a result, the market share of biosimilar versions of adalimumab jumped from just 5% to 36% in one week, with Hyrimoz alone capturing 93% of all new biosimilar prescriptions. On the surface, this is great for the industry, but the shift reveals a more intricate web of the industry's landscape involving pharmacy benefit managers, health insurers, and manufacturers. CVS Caremark's agreement with AbbVie to co-brand Hyrimoz under the Cordavis subsidiary complicates the competition. Despite the increased cost savings, it ensures clinically significant biosimilars, like Yusimry, offering an even lower price, struggle to gain traction. We're witnessing the rise of vertically integrated stakeholders shaping the market and influencing biosimilar adoption in ways policymakers may not have envisioned. Still, with the right policies in place for biosimilars, the potential for billions in savings is within reach. Regardless of therapy, a competitive landscape that genuinely fosters innovation and increases patients' access to affordable therapies is critical. https://lnkd.in/eiGk-YgF

Thoughts on this? >> Why PBMs and Payers Are Embracing Insulin Biosimilars with Higher Prices—And What That Means for Humira (rerun with an FTC update) >> Comment below! >>> lqventures.com #strategy #competitiveintelligence #marketing #pharmaceutical #biotech #pharma #healthcare #productmarketing

An article I wrote was recently featured on #BenefitsPro. The #pharmacy industry is rapidly changing and specialty drug costs soaring. Staying ahead is key, whether through negotiating prices, navigating stop-loss coverage, or implementing innovative cost-management strategies. Benefits advisors and employers can work together to adapt and find the best way to manage these complexities while still ensuring access to essential treatments for members. I welcome your questions, comments, compliments, and concerns in the comments below. #HealthcareManagement #PharmacyBenefitsOptimizer #RxBenefits #HealthcareCosts

Choosing the right pharmacy benefits manager (PBM) is crucial for managing pharmacy costs and ensuring quality care. In today's complex market, understanding your data and partnering with an effective PBM can lower costs, improve outcomes, and navigate the evolving landscape of drug pricing and therapies. Discover key considerations and red flags in our latest blog. https://lnkd.in/ghUsKxDj

I was alerted to a pretty remarkable case that has been filed by the City of Baltimore against Biogen, for allegedly engaging in an intricate and deliberate scheme to "suppress competition" and maintain "supracompetitive prices" for its multiple sclerosis drug, Tecfidera. The lawsuit exposes the extent to which Biogen—and its partners in the PBM industry—are willing to go to block competition, manipulate markets, and inflate costs for employers and taxpayers. Here’s what the complaint lays out: ▶ $90,000 per year per patient for Tecfidera, while the drug costs Biogen less than $300 per year to manufacture. The lawsuit rightly calls this a 300-fold markup, and labels Biogen’s actions as an attempt to maintain "monopoly profits." ▶ When cheaper, generic versions of Tecfidera were set to enter the market with 90% lower prices, Biogen didn’t innovate—they paid off the nation’s three largest Pharmacy Benefit Managers (PBMs)—Caremark, OptumRx, and Express Scripts—to keep these generics out of reach. The complaint refers to these payments as "kickbacks", and outlines how they were disguised as “rebates” or “fees” to manipulate formularies and block access to the lower-priced alternatives. ▶ These PBMs, controlling the pharmacy benefits for 80% of Americans, willingly played along. The complaint highlights how PBM-affiliated specialty pharmacies were purchasing generic Tecfidera for as little as $180 per month while selling it to health plans for as much as $3,857 per month—a 2,000% markup. ▶ Even worse, the lawsuit states that the PBMs falsely designated generic Tecfidera as a "specialty drug," even though it is a simple, shelf-stable pill, in order to force these outrageous prices onto employers and patients. Biogen’s anticompetitive scheme didn’t stop there. ▶ According to the lawsuit, Biogen knew that it would lose billions in revenue as soon as the generic entered the market, so they devised a plan to launch a “next generation” version of Tecfidera—called Vumerity—that offered no significant medical improvement, but served one key purpose: to avoid automatic substitution with the generic version. As the complaint details, "Vumerity was different from Tecfidera not in a medically important way, but in an economically important way." Baltimore is not just taking on Biogen—they are shining a light on a much larger problem. This case exposes the corrupt relationship between pharmaceutical companies and PBMs, where billions in "rebates" and "fees" are exchanged under the table, while employers and taxpayers bear the cost. As the lawsuit reveals, this is not about "price competition"—it’s about corporate giants collaborating to "restrain, suppress, and eliminate competition." Employers like Baltimore are waking up, surprising even me!!!!!

In Alaska's 2024 legislative session, Tecfidera (Dimethyl Fumarate 240mg), was just one of the drugs presented from the 2022 State of Alaska (SOA) OptumRX data. Image below in comments of what the SOA was charged by OptumRX in 2022 for Tecfidera compared to SB121 max cost (maximum cost) to be charged to SOA using the proposed fair reimbursement calculated by the highest possible NADAC price per unit for the year 2022 + a fair dispensing fee of $13.36 for each RX. If OptumRX didn't steer all prescriptions to their PBM-owned pharmacies and overcharge for profit it would have saved the SOA a lot of money on just this one drug and would have allowed patients to access medications at their local pharmacy and allowed the pharmacy to get fairly reimbursed. Of note: Specialty filling the RX cost the SOA $2 more per tablet. Same exact drug and NDC. Specialty pharmacy is abused by PBMs and gives them the ability to just charge more!