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How States are Protecting Health Care Providers from Legal Liability in the COVID-19 Pandemic

Clinicians and policymakers alike are raising the alarm about potential legal liability for following crisis standards of care during the COVID-19 pandemic.

The post How States are Protecting Health Care Providers from Legal Liability in the COVID-19 Pandemic appeared first on Bill of Health.




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When and How to Resume Non-Urgent Care During COVID-19

The question must be: can we accommodate non-emergent/non-urgent care safely or not, and if yes, which care do we address first as we re-open?

The post When and How to Resume Non-Urgent Care During COVID-19 appeared first on Bill of Health.




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Access to Drugs Before FDA Approval: Video Explainer with Christopher Robertson

In this video explainer, Christopher Robertson discusses the Right to Try Act and off-label use of pharmaceuticals with Alison Bateman-House.

The post Access to Drugs Before FDA Approval: Video Explainer with Christopher Robertson appeared first on Bill of Health.




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Hospital Administration and the COVID-19 Pandemic (Part II)

A discussion of administrative decisions hospitals are making during the COVID-19 pandemic, including cutting benefits for employees and furloughing staff.

The post Hospital Administration and the COVID-19 Pandemic (Part II) appeared first on Bill of Health.




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A $100 Million Biotech Deal Is Also A Tale Of Two Executives Facing Their Kids’ Deadly Diseases

“John, I’m very aware of your family’s journey, Twelve years ago I was one of the producers considering bidding on your life rights.”




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For A New Device To Treat Maternal Bleeding, A Young Entrepreneur’s Big Step Was Passing The Torch

This morning, Alydia Health, a tiny Menlo Park, Calif., startup co-founded by a 21-year-old woman, announced that it has secured $10 million in funding to test a medical device to prevent mothers from bleeding to death after childbirth.




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Why Former Novartis CEO Joe Jimenez Joined A Microbiome Startup’s Board

uBiome, a San Francisco startup that sells commercial tests that use DNA sequencing to identify what microbes are in a person's stool or, for one test, in the vagina, has raised $83 million from venture capitalists to fund an entrée into drug development.




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In Blowout, Amarin’s Fish-Oil-Derived Drug Dramatically Cuts Heart Risk In Study

The results, if they hold up, are likely to result in many patients getting the medicine, and could upend decades of orthodoxy among cardiologists.




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Bioclinical, VivaLNK unveil remote patient monitoring technology

The solutions enable continuous remote monitoring of body temperature and other vitals, either at home or in care centers, for clinical trials.




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FDA update on COVID-19 actions and advisements

Over the past week, the agency has issued guidances, taken action to accelerate treatments and put a stop to fraudulent treatments for the pandemic-causing virus.



  • Markets & Regulations

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Butterworth Labs adopts COVID-19 crisis measures

The pharmaceutical analysis firm is continuing its contract analytical laboratory services running, with changes designed to keep people and products safe.




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Veeva launches free remote monitoring

The companyâs SiteVault Free tool, designed to enable collaborating between sites and study monitors, now has a remote monitoring feature.




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CAS open-access dataset to help COVID-19 research

CAS, a division of the American Chemical Society, has released a dataset of chemical compounds with known or potential antiviral capabilities.




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Novartis acquires digital therapeutics specialist Amblyotech

The pharmaceutical firm has purchased the company, which specializes in advancing treatments and diagnostics for ocular disorders.



  • Markets & Regulations

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This week’s FDA COVID-19 news

The agency continues to offer guidance about COVID-19 treatments and testsâand issue warnings to companies that fall out of line.



  • Markets & Regulations

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Almac Discovery collaborates with Merck on DUB targets

The partnership will focus on generating novel small-molecule inhibitors against specific DUB targets for treatment of a range of diseases.




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CDISC launches COVID-19 research standards task force

The group will work to rapidly develop guidance on standardizing COVID-19 research data, with the help of several participating member companies.




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Research collaboration drives to accelerate COVID-19 solutions

Led by Medable, the multi-company effort is geared toward ramping up development of treatments, diagnostics and other solutions for the pandemic-causing virus.




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3M Drug Delivery Systems relaunches as Kindeva Drug Delivery

The launch of the renamed, newly independent company follows its acquisition by Altaris Capital Partners.




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Advarra purchases IRBco

The institutional review board and research technology solutions provider has acquired IRBco to expand its reach and presence in North America.



  • Mergers and Acquisitions

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Medidata analysis shows COVID-19 impact on trials

The companyâs global analysis from thousands of studies and sites indicates dramatic shifts in enrollment across several countries since the pandemic began.




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People on the Move: May 2020

This monthâs new hires and promotions include executive appointments at Advarra, Eversana, Signant Health, Endpoint Clinical and other companies.



  • Markets & Regulations

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Weekly FDA COVID-19 update

The agency continues to remain busy overseeing and approving potential treatments and tests for the virus behind the global pandemic.



  • Markets & Regulations

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Informa Connect-CBI’s Patient Support Services Congress

RESCHEDULED: This event has been rescheduled for November 11-13, 2020. Click here to learn more.


Informa Connect-CBI’s Patient Support Services Congress
June 16-18, 2020 | The Westin Princeton at Forrestal Village | Princeton, NJ
www.informaconnect.com/patient-support-services-congress

Informa Connect-CBI’s Patient Support Services Congress is a comprehensive meeting for insightful and engaging dialogue around navigating compliance hurdles while strengthening and innovating patient-oriented programs.

Visit www.informaconnect.com/patient-support-services-congress for more information. Drug Channels readers will save $500 off the standard registration rate when they use code BNP667*.

Download the agenda here and see in-depth coverage on industry trends and next-generation patient services, such as:
  • Critical Regulatory Updates and Effective Strategies for Monitoring & Oversight
  • Novel Approaches to Services, Program Architecture and Operational Management
  • The pros and cons of different support service models
  • Measuring the Success of Patient Support Programs
  • Innovation, AI, Changing Distribution Models and Market Mergers
  • Transparency with Charitable Organizations
Create Your Own Customized Learning Experience for 2020!

Choose from Two In-Depth Tracks
  • Legal and Compliance
  • Innovation and Operations
Plus! Four Tailored Summits
  • Summit A: Patient Adherence – Educate, Engage and Collaborate to Enhance Outcomes
  • Summit B: Case Management for Novel and Innovative Therapies
  • Summit C: Strategic Planning for Product Launch
  • Summit D: Primer Course for Partnering with Patients

Leading Perspectives from Industry Trendsetters:
  • Robert Britting, Director, Patient Services and Strategic Solutions, Teva Pharmaceuticals
  • Stella Vnook, Chief Executive Officer, Diverse Biotech
  • Katherine Chaurette, Vice President healthcare Law and Compliance, Blueprint Medicines
  • Kimberly Goldberg, Director, U.S Data Privacy Counsel, Novartis
  • Imtiaz Hussain, Senior Director, Patient Services, Bayer
  • Cory Potomis, Associate Director, Ethics & Compliance Operations, Novo Nordisk, Inc.
  • And so many more!

Visit www.informaconnect.com/patient-support-services-congress for more information. Drug Channels readers will save $500 off the standard registration rate when they use code BNP667*.

*Offer applies to standard rates only and may not be combined with other offers, category rates, promotions or applied to an existing registration. Offer not valid on workshop only or academic/non-profit registrations.


The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

        




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The Drug Channels Coronavirus Industry Impact Survey

It’s a unique and troubling time. We are all of course concerned about the coronavirus and its disruption to our personal and professional lives.

I presume that life will return to normal later this year. But what happens then? Will there be long-term changes to how the drug channel operates? Will we see permanent changes in behavior, policy, and industry structure?

To answer these questions, I want to tap the collective insights of Drug Channels’ 30,000+ audience.


This survey should take 10 minutes or less. I will provide a full review of the results next week on Drug Channels. The survey will close on March 20.

You can respond anonymously. Any information you provide will be kept confidential. Per Drug Channels' long-standing policy, I never publish, release, or disclose any personal data without your permission.

Thanks in advance for sharing your insights.

Regards,
Adam

        




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Informa Connect-CBI’s 22nd Annual Medicaid and Government Pricing Congress

Informa Connect-CBI’s 22nd Annual Medicaid and Government Pricing Congress
May 19-21, 2020 | Orlando, FL
www.cbinet.com/medicaidandgovernment

Exclusive Offer: Register by April 10th and save $500* (mention promo code MDCDC5).

With a volatile healthcare system combined with an election year upon us, the stakes are incredibly high for life sciences manufacturers. Staying on the pulse of industry trends, policies and regulations has never been more critical. The 22nd Annual Medicaid and Government Pricing Congress delivers critical updates and industry best practices to effectively contract, report and comply with state and federal healthcare programs. Gain timely, up-to-the-minute insights on:
  • State Invoicing and Disputes
  • GTN Models
  • Innovative Contracting Strategies
  • State Price Transparency and Reporting Requirements
  • 340B Oversight and Compliance
  • Preparing, Negotiating and Implementing FSS Contracts
  • Bona Fide Service Fees and FMV
  • And many other critical topics
Download the complete program agenda.

The 2020 agenda features 75+ speakers and 50+ sessions customizable by company type and size, as well as 10 hours of dedicated networking. Bio/pharma, regulatory and government experts representing HHS, Pfizer, Daiichi Sankyo, Sobi, Maryland Department of Health, BMS, Jazz, Novartis, Amneal, J&J, Sunovion, Gilead, VA, Granard, Insmed, UCB, Alnylam, Louisiana Department of Health, AstraZeneca, CMS, CSL Behring, Astellas, Lilly, Oklahoma Healthcare Authority, Theravance, Indivior, Sandoz, Alvogen, Takeda, OIG, AMAG, Aimmune, Exelixis, South Dakota Department of Healthcare Services, Regeneron, Sun Pharma, Teva and many others are set to drive the dynamic dialogue.

Drug Channels readers can register today and use promo code MDCDC5 to save $500.

*Discount offer valid through 4/10/2020; applies to standard rates only and may not be combined with other offers, categories, promotions or applied to an existing registration. Offer not valid on workshop-only or non-profit registrations.


The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

        




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Coronavirus Industry Impact: Patients, Pharmacies, and Wholesalers (Part 1)

I hope you are staying healthy and are managing to navigate your work-at-home mandates.

Last week, I tapped the collective insights of the Drug Channels’ audience. Nearly 700 readers shared their perspectives and projections for how the coronavirus pandemic could ultimately affect behavior, policy, and industry structure. Thank you to everyone who took the time to respond.

I will share the results over three articles this week:
  • Today, in Part 1, I will review the responses relating to patient behavior, pharmacies, and wholesalers. 
  • In Part 2 (tomorrow), I’ll focus on expectations for pharmaceutical manufacturers and third-party payment. 
  • In Part 3 (Thursday), I’ll examine how the coronavirus may affect the public perception of the industry’s participants.
P.S. A special shout out to the respondent who hoped that the coronavirus would not impact the quality of Drug Channels memes. Never fear, dear readers: Drug Channels will remain the internet’s top destination for pharmaceutical-related humor!
Read more »
        




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Coronavirus Industry Impact: Manufacturers, Public Policy, and Payers (Part 2)

Today’s post is the second in our three-part investigation of the ultimate impact of the coronavirus on the drug channel. Here is a link to the first part of our survey analysis: Coronavirus Industry Impact: Patients, Pharmacies, and Wholesalers (Part 1). That article includes details about the methodology and respondents.

Today, I review how people in the industry think coronavirus will affect:
  • Federal drug pricing legislation
  • FDA new drug approvals
  • Public support for single-payer health insurance
  • Third-party payment for prescription drugs
I also highlight survey respondents’ comments on whether the current situation will bring overseas pharmaceutical manufacturing back to the United States.

Tomorrow, I’ll examine survey responses that address how the coronavirus may affect the public’s perception of the industry’s participants. In the meantime, remember that every day is no pants day when you work from home.
Read more »
        




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Coronavirus Industry Impact Survey: Winners and Losers (Part 3)

Today is the final installment of our three-part investigation into the coronavirus’ ultimate impact on the drug channel.

Below, I examine expectations about how the coronavirus will affect the public’s perception of various industry participants. We explore what our survey respondents said about:
  • Pharmacies
  • Pharmaceutical manufacturers
  • Hospitals
  • Wholesalers
  • Pharmacy benefit managers and plan sponsors
  • Insurance companies.
In these early stages of this crisis, my crystal ball is as cloudy as yours. Let’s hope that the country will stabilize within a few months. I may then rerun the survey to determine how (if at all) everyone’s perspective has changed.
Read more »
        




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Expanding How CoverMyMeds Helps Patients Access Their Medications

Today’s guest post comes from David Holladay, President of CoverMyMeds and Austin Raper, Healthcare Writer at CoverMyMeds.

First, David discusses how CoverMyMeds supports medication access. Then, Austin highlights key findings from CoverMyMeds’ 2020 Medication Access Report. This new report includes industry research, patient interviews, novel survey data, and strategies for boosting patients’ medication access.

Read on for David’s and Austin’s insights.
Read more »
        




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Drug Channels News Roundup, March 2020: Sanofi’s Gross-to-Net Bubble, Drug Pricing Findings, Amazon Replaces Express Scripts, and Drug Channels Video

First, let me say thank you to all of the healthcare workers who are putting themselves at risk during this crisis.

As I noted last week, many of the crucial issues for our healthcare system will remain after we all get through this challenging period. In that regard, here’s a look at some noteworthy news from the past month:
  • Sanofi discloses new data about insulin prices
  • Excellent new academic research on list vs. net drug prices
  • Three notable researchers overturn their earlier research on drug costs
  • Amazon switches PBM vendors for some of its employees
Plus, we unveil the teaser trailer for Drug Channels Video!

P.S. Join the more than 9,000 followers of my daily links to neat stuff at @DrugChannels on Twitter. My recent tweets have highlighted such topics as:
  • How GoodRx shares patients’ prescription data
  • 2019 drug trend at Prime Therapeutics
  • Controversy about the independent pharmacy market
  • A new $5 generic mail order program, Medicare Part D reform
  • Retail pharmacy’s future
  • Job openings at Amazon 
  • Frozen cookie dough
  • And much more!
I have also been tweeting many under-the-radar stories about how the coronavirus affects drug channels.
Read more »
        




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The Latest CMS Outlook for Drug Spending—And How COVID-19 Will Change It

ICYMI, the boffins at the Centers for Medicare & Medicaid Services (CMS) recently released their new projections for U.S. National Health Expenditures (NHE). Unfortunately, the coronavirus almost immediately made these predictions obsolete.

It’s still useful to analyze these forecasts for a pre-pandemic examination of U.S. healthcare spending. A few highlights of the 2024 outlook:
  • Total U.S. spending on healthcare was projected to grow, from $3.6 trillion in 2018 to $5.0 trillion in 2024.
  • Spending on hospitals and professional services was expected to grow by a combined $800 billion—more than 60% of CMS’s projected $1.4 trillion increase in U.S. healthcare spending. That’s consistent with historical trends.
  • Net spending on outpatient prescription drugs in 2024 was projected to shrink to less than 9% of total U.S. spending. That would be its lowest level since 2000.
As usual, the actual facts run counter to the popular narrative that drug spending is skyrocketing relative to any other aspect of U.S. healthcare. Of course, the coronavirus will alter these projections. Below, I speculate how COVID-19 and its aftermath will affect healthcare and prescription drug spending.

Prediction is very difficult, especially if it's about the future. Feel free to add your own outlook in the comment section below.
Read more »
        




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Introducing: Drug Channels Video!

In 2006, I launched the Drug Channels website to explore the economics of the U.S. reimbursement and distribution system for prescription pharmaceuticals. More than 30,000 professionals in the pharmaceutical and related industries rely on Drug Channels for timely analysis and provocative, fact-based insights.

Today, I am pleased to announce the launch of our new delivery platform: Drug Channels Video!

You can look forward to:
  • Information and analysis via our new YouTube channel (Never fear. I’ll still be publishing articles on the website every week.)
  • Livestream video webinars (Stay tuned next week for an announcement about our first two events.)
  • Private, live virtual keynotes and remote presentations (Email me to schedule a safe social distancing event for your team.)
  • Online video courses (Coming later in 2020)
Please watch my brief video introduction below. (Click here if you can’t see the video.)



I hope you and your families stay safe and healthy in these challenging times. I look forward to reconnecting with you in person soon.

        




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Industry Update and COVID-19 Impact: Join Me for Two Live Video Webinars (May 1 and May 8)

This May, join Dr. Adam J. Fein, CEO of Drug Channels Institute (DCI) and the author of Drug Channels, for two live video webinars:

You can purchase replays of these events using the links above.

Dr. Fein will help you navigate this challenging time in U.S. drug channels. These 75-minute live events will be broadcast via Zoom from the new Drug Channels Video studio. See details below.


You can sign up for either one of these crucial educational opportunities for only $300 per site per event. We are offering special pricing of $500 if you sign up for both events.

An unlimited number of people may watch at one location. However, we recognize that it may be difficult to gather your team in one location, so we are offering significant discounts for multiple viewing sites. Please contact Paula Fein (paula@drugchannelsinstitute.com) to get special pricing information for 5 or more locations. If you purchase access for multiple sites, we will contact you for the name and email address of a contact person at each location.

Read on for more information about the events.


To help people affected by COVID-19 and the caregivers who are supporting them , DCI will donate 20% of all profits from these events to The Center for Disaster Philanthropy’s COVID-19 Response Fund. This charity has earned a 4-star Charity Navigator rating and is a trusted philanthropic partner of Google, Coca Cola, UPS, Verizon, and many other organizations. The fund supports preparedness, containment, response, and recovery activities for those affected by the coronavirus and for the responders.


WHAT YOU WILL LEARN

We will help you and your team better understand key industry dynamics and how COVID-19 may alter the industry.

Dr. Fein will share DCI’s latest market data and trends from The 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

Topics for Industry Update and COVID-19 Impact: Retail & Specialty Pharmacies:
  • The key trends for retail and specialty pharmacy markets
  • The new normal for prescription demand
  • How COVID-19 will change the U.S. payer mix
  • Will the 340B program be disrupted?
  • What’s next for specialty pharmacies
  • The outlook for prescription profits
  • The future for the drugstores’ front-end profits
  • New opportunities for pharmacists as providers
  • My reflections on life in a pandemic world and beyond

Topics for Industry Update and COVID-19 Impact: PBMs & Payers:
  • The key trends for PBMs
  • An update on the latest prescription data
  • What the changing U.S. payer mix means for PBMs and insurers
  • The outlook for benefit design
  • PBMs' role in Managed Medicaid
  • More on the 340B Drug Pricing Program
  • Disruption to the buy-and-bill channel
  • Promise and perils of vertical diversification
  • Further reflections on life in a pandemic world

PLUS: Dr. Fein will take your questions during the event. CLICK HERE to submit questions to Dr. Fein in advance of the events.

IMPORTANT STUFF TO KNOW
  • After you register, you will receive an email with the information you will need to access our live video webinar and add it to your calendar. We will also send you reminder emails one day and one hour before the event.
  • Watch and listen via any device with a web browser (computer, iPad, iPhone/Android, etc.)
  • After each event, you’ll receive a downloadable PDF with the event slides.
  • If your plans change and you can’t make it on May 1 or May 8, we will provide an opportunity to watch a replay of the live video events. Unfortunately, we are unable to offer refunds.
  • Pembroke Consulting clients receive free access to the webinar. Contact Tamra Feldman (admin@drugchannels.net) for details. We will automatically refund payments from anyone at a Pembroke client who purchases access using their corporate email account.

        




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Four Unexpected Ways that the COVID-19 Medicaid Boom Will Affect PBM and Pharmacy Profits

The U.S. economy is in a medically-induced coma. Unemployment is soaring. Companies are teetering on the brink of bankruptcy. It is unclear when our lives will return to their pre-pandemic state.

One thing seems apparent: As people lose jobs and health insurance, Medicaid enrollment will jump, perhaps by as much as 20% to 30%. This will have profound implications for the drug channel.

Today, I focus on how this increase will affect retail pharmacies and pharmacy benefit managers (PBMs). Below, I review Medicaid enrollment trends, how states manage prescriptions, and the factors driving the coming boom in Medicaid enrollment.

As I explain, many (but not all) retail pharmacies will benefit from Medicaid growth. PBMs, however, will not fare as well. Read on and see if you agree.

In early May, Drug Channels Institute will host two live video webinars: Industry Update and COVID-19 Impact: Retail & Specialty Pharmacies (May 1) and Industry Update and COVID-19 Impact: PBMs & Payers (May 8). CLICK HERE TO LEARN MORE AND SIGN UP. DCI will donate 20% of all profits from these events to The Center for Disaster Philanthropy’s COVID-19 Response Fund.

Read more »
        




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Three Early Signs That COVID-19 Could Disrupt the Buy-and-Bill Channel

Will home infusion growth be a long-overdue correction for the buy -and-bill channel or a temporary blip that will soon vanish?

For some time, I have been tracking the evolution of the buy-and-bill system for provider-administered drugs. The data have shown that hospital outpatient departments have been displacing physician offices. Amid this shift, home infusion providers have accounted for a minority of commercial medical benefit spending and a tiny share of Medicare Part B spending.

However, the coronavirus pandemic is triggering new growth in home infusion for buy-and-bill products. Below, I highlight the early signs of a marketplace change. I believe that some of these short-term shifts in the buy-and-bill market will persist even after we have recovered from COVID-19. They may even slow the runaway growth of the 340B Drug Pricing Program.

If not, then I suppose we'll just keep living in a world with limited home infusion over and over.

In early May, Drug Channels Institute will host two live video webinars: Industry Update and COVID-19 Impact: Retail & Specialty Pharmacies (May 1) and Industry Update and COVID-19 Impact: PBMs & Payers (May 8). CLICK HERE TO LEARN MORE AND SIGN UP. DCI will donate 20% of all profits from these events to The Center for Disaster Philanthropy’s COVID-19 Response Fund. Watch my video invitation below.

Read more »
        




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Medication Access During Uncertain Times—Improving Provider Workflows to Help Patients in Need

Today’s guest post comes from Miranda Gill, Senior Director of Provider Network at CoverMyMeds.

Miranda reviews how the pandemic affects the ability of healthcare workers to complete administrative responsibilities like prior authorization. She then outlines how electronic automation is helping patients get needed medications while face-to-face interactions are restricted.

Learn more about healthcare IT solutions for providers and patients in CoverMyMeds’ 2020 Medication Access Report, or schedule a virtual meeting.
Read more »
        




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Drug Channels News Roundup, April 2020: Drug Pricing Outlook, COVID-19 Data Tracker, Community Oncology Clinics, and My Favorite Chart of 2020

Rumor has it that Spring has finally reached our worldwide headquarters here in beautiful downtown Philadelphia. (See photo at right.) While we wait to go outside, please enjoy this month’s selection of noteworthy news:
  • The outlook for drug prices
  • A outstanding (and free!) resource for tracking COVID-19 daily data
  • What’s up with community oncology practices?
Plus, I share my favorite chart of 2020 (so far).

P.S. Join the more than 9,200 followers of my curated links to neat stuff at @DrugChannels on Twitter. My recent tweets have highlighted: Prime Therapeutics new gene therapy offering, AmerisourceBergen’s laudable deal with the Justice Department, the Costco/Instacart deal, Rite Aid’s new CEO, clinical trial trends, vaccine pricing, and much more! I have also been tweeting under-the-radar stories about how the coronavirus is affecting drug channels.

Tomorrow (May 1), Drug Channels Institute will host the first of two live video webinars: Industry Update and COVID-19 Impact: Retail & Specialty Pharmacies. We'll host the second video webinar—Industry Update and COVID-19 Impact: PBMs & Payers—on May 8. CLICK HERE TO LEARN MORE AND SIGN UP. Contact Paula Fein (paula@drugchannelsinstitute.com) for our special promo codes for multiple viewing sites. DCI will donate 20% of all profits from these events to The Center for Disaster Philanthropy’s COVID-19 Response Fund.

Read more »
        




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Elsevier: Challenges and Trends to Watch in 2020 (Guest Post)

Today’s guest post comes from Trygve Anderson, Vice President of Commercial Pharmacy at Elsevier.

Trygve discusses trends and challenges to watch in 2020, including drug pricing transparency, the approval and interchangeability of biosimilars, and stakeholder access to timely and accurate data.

Learn more about Elsevier’s information analytics capabilities from its video: Evaluating Drug Data Yields Business Value.

Read on for Trygve’s insights.
Read more »
        




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Insurers + PBMs + Specialty Pharmacies + Providers: Will Vertical Consolidation Disrupt Drug Channels in 2020? (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Industry Update and COVID-19 Impact: PBMs & Payers.

Life was very different when I originally published today’s article. 2020 is not turning out to be quite what any of us expected. However, the pandemic has exposed some intriguing pros and cons of vertical consolidation. Click here to see the original post and comments from December 2019.


The largest insurers, PBMs, and specialty pharmacies have now combined into vertically-integrated organizations. As I explain below, these companies have also been rapidly integrating with healthcare providers.

I also provide an updated look at these companies and highlight strategies that they are using—or could use—to control the channel. I believe that these insurer / PBM / specialty pharmacy / provider organizations are poised to restructure U.S. drug channels by exerting greater control over patient access, sites of care/dispensing, and pricing.

If they can effectively coordinate their sprawling business operations, they will pose a substantial threat of disruption to the existing commercial strategies of pharma companies.

Will they succeed by better managing care and costs, or merely by extracting higher profits from our convoluted system?
Read more »
        




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Express Scripts vs. CVS Health: Five Lessons From the 2020 Formulary Exclusions and Some Thoughts on Patient Impact (rerun)

This week, I’m rerunning some popular posts while I prepare for this Friday’s video webinar: Industry Update and COVID-19 Impact: PBMs & Payers.

Today's rerun highlights one of the most effective tactics that PBMs have developed to extract deeper discounts from brand-name drug makers. COVID-19 seems likely shift the U.S. payer mix away from commercial health plans. Expect even tighter formulary management and more restrictions as PBMs work even harder to cut costs for their plan sponsor clients.

Click here to see the original post and comments from January 2020.




For 2020, the two largest pharmacy benefit managers (PBMs)—Express Scripts and the Caremark business of CVS Health—have again increased the number of drugs they have excluded from their standard formularies. The 2020 formulary exclusion lists are available below for your downloading pleasure.

Below, I highlight my key takeaways from the 2020 lists:
  • The number of exclusions
  • Management of specialty drugs
  • Indication-based formularies
  • The slow adoption of biosimilars
  • The PBMs’ patient-unfriendly exclusions in the hepatitis C category
Formulary exclusions have emerged as a powerful tool for PBMs to gain additional negotiating leverage against manufacturers. The prospect of exclusion leads manufacturers to offer deeper rebates to avoid being cut from the formulary. Exclusions are therefore a key factor behind falling brand-name net drug prices.

Read on for a look at this year’s exclusions along with some closing thoughts on what exclusions mean for patients.
Read more »
        




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Astronomers May Have Found the Closest Black Hole to Earth

At just 1,000 light-years away, an object in a nearby star system could be our nearest known black hole—but not everyone is convinced

-- Read more on ScientificAmerican.com




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Did Galileo Truly Say, 'And Yet It Moves'? A Modern Detective Story

An astrophysicist traces genealogy and art history to discover the origin of the famous motto

-- Read more on ScientificAmerican.com




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Comets Prevent Ether from Accumulating in Space

Originally published in January 1859

-- Read more on ScientificAmerican.com




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People Don't Have to Succumb to Anxiety during This Pandemic

That emotion is natural in a situation like this, but there are ways to mitigate it

-- Read more on ScientificAmerican.com




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Government Watchdog Chides FEMA for Lax Flood Enforcement

The agency fell well short of its goal of evaluating local flood control efforts every five years

-- Read more on ScientificAmerican.com




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A Word about Those UFO Videos

I’m an astrophysicist, but that doesn’t mean I have a motivation to debunk them

-- Read more on ScientificAmerican.com




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'Breakthrough' COVID-19 Tests Are Currently Cheap, Fast--and Not Very Accurate

Antigen-based assays could be used in the home, but critics say their error rates are still an issue

-- Read more on ScientificAmerican.com




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The COVID-19 Response Is Failing Communities of Color

To build trust with traditionally underserved groups, health officials need to craft their messaging in a much more culturally sensitive way

-- Read more on ScientificAmerican.com




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Scientist Mothers Face Extra Challenges in the Face of COVID-19

The pandemic is amplifying nearly every disadvantage that women in STEM already face. But institutions and the scientific community can help

-- Read more on ScientificAmerican.com