Fascinating interview with
@mcuban
about
@costplusdrugs
and how he is attacking
#pharmacy
&
#PBM
industries
His key point: Manufacturers are not the problem. Big 3 PBMs are distorting
#drug
prices.
Definitely worth watching (start at 4:50)
Hospital-employed physicians love benchmarking U.S.
#drug
prices vs. other countries.
Wake me up when they propose benchmarking their salaries & hospital prices to other countries. 👇 🙄
FYI: U.S.
#healthcare
spending = $3.8 trillion
Drugs ~15% / Hosp+MDs ~60%
#justsayin
From Mark Cuban
@mcuban
: Five Ways that Big
#PBMs
Hurt U.S. Healthcare–And How We Can Fix It (rerun)
A Drug Channels exclusive op-ed from the founder of
@costplusdrugs
It’s hard to have sensible policy conversations about "
#drug
pricing” when politicians won't or can't distinguish between:
1. A drug's list price
2. A drug's net cost to a payer/
#PBM
after rebates & discounts
3. The % of a prescription's net cost that a patient pays out-of-pocket
1 / 4
Just out:
@goodrx
S-1 for its IPO
Wow. Insanely profitable! EBITDA = 40%
Revenue model:
1. Consumer uses GoodRx
2. Pharmacy pays
#PBM
3. PBM pays GoodRx $$$
The following tweets explain how our crazy drug channel system enables this business
Per
@Altarum
, prescription
#drugs
are (and will be) <14% of total U.S.
#healthcare
spending
Updated lesson: Pharmaceuticals account for 14% of U.S. healthcare spending, but absorb 99% of the political heat.
#facts
#data
Thoughtful commentary from the one and only Mark Cuban
@mcuban
on core problems with
#PBM
market from today's
@WhiteHouse
listening session. Worth watching! (Link starts at 49:47)
From Mark Cuban
@mcuban
: Five Ways that Big hashtag
#PBMs
Hurt U.S. Healthcare–And How We Can Fix It
A Drug Channels exclusive op-ed from the founder of
@costplusdrugs
==>
Wow! Per new
@Health_Affairs
article,
#pharmaceuticals
are (on average) responsible for 35% of total increase in U.S. life expectancy
Drugs made an even greater contribution for
#HIV
(76%), heart disease (52%), and breast
#cancer
(60%)
Outstanding op-ed: "Regeneron wasn’t paying ‘kickbacks.’ It was helping people pay egregious
#Medicare
copays"
@statnews
I hope the pharma industry’s many critics think hard about the arguments that
@PeterKolchinsky
makes here.
Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A 2022 Update
My updated look at the state of U.S. drug channels
==>
Fun fact for your weekend: Hospitals and physicians (not pharmaceuticals) are key drivers of higher healthcare costs in the U.S. vs. other countries
Latest data from
@KFF
@PetersonCHealth
👇
Yet policy focuses only on benchmarking
#drug
spending 🤷
FYI,
#GrossToNetBubble
is alive and well for GLP-1s. 👇 For 2024, Novo Nordisk will pay rebates of 49% to CVS Caremark for obesity drugs used in North Carolina, i.e., these drugs will sell for half of their list price.
Nice find,
@brianreid
==>
Wow.
#Pharmacy
benefits are broken. For 2020:
1.
#PBMs
paid
@GoodRx
$GDRX $488 million (+34% vs. '19) 👇
2. GoodRx = ~$3.4 B of U.S.
#prescription
revenues (~1% of total
#Rx
mkt)
3. 70% of consumers had comm'l ins. or Medicare - but used GoodRx anyway!
Still Not Skyrocketing: New CMS Data Reinforce the Truth About U.S.
#Drug
Spending
Read ==>
Drug spending remains a small—and shrinking—share of the $4.1 trillion spent on U.S. healthcare.
#facts
Wow. Secretary Becerra's
@SecBecerra
testimony was painful to watch, because he was deeply misinformed about the facts and seemed to directly misrepresent
@HHSGov
actions on
#accumulators
. Shameful. Kudos to
@RepBuddyCarter
Watch for yourself:
Congratulations to
@AltoPharmacy
for again being named to the
@CNBC
Disruptor 50 list! I'm glad to be involved with this innovative business and the Altoids who work there.
The GoodRx-Kroger Blowup: Spread Pricing,
#Pharmacy
Margins, and the Future of Discount Cards
My $0.02 on
@GoodRx
's $GDRX surprising dependence on
@kroger
$KR, the
#PBM
impact, and some follow-the-dollar insights on discount card economics
Depressing study of prior authorization faced by
#oncology
patients
- Delays of 2+ weeks
- 63% eventually approved - others changed treatment or paid out of pocket
- Multiple PAs for same
#cancer
care!
How is this OK???? 😠
==>
Useful report on
#biosimilar
landscape from
@Healthcare_ABC
$ABC
My $0.02: Adoption rates growing quickly, competition increasing, prices falling. The biosim market is finally beginning to fulfill its promise.
People who claim to want "affordable
#drugs
" should focus on (or at least acknowledge) the crazy discrepancy in patients' out-of-pocket exposure to the costs of prescription
#drugs
vs. hospital care
Excellent new
@Amgen
#biosimilar
trend report finds prices dropping and adoption accelerating
Lots of good data and charts. Highly recommended! 👍👍
@ScottGottliebMD
was right. Market forces work.
#NoTowel
Full report (free) ==>
Surprise! Brand-Name Drug Prices Fell (Again) in 2020
An update on the only part of US
#healthcare
where prices have declined--and why it's happening
#facts
Great observation in
@Health_Affairs
:
"Medicines represent roughly 15 percent of US health care expenditures, yet they are the focus of almost half of published cost-effectiveness analyses..."
@Altarum
@TuftsCEVR
@SchaefferCenter
Big PBMs say “Drugmakers alone have the power to set prices.”
Then how is that the same PBM set five different prices for the same drug, at the same pharmacy, on the same day, where the delta between the bookends had an over 10x difference?
Our latest:
Latest study of
#hospital
buy-and-bill profiteering finds huge
#cancer
#drug
markups: +120% to +630%
Hospitals earn more $$/unit than pharma companies!
"[H]ospitals that administer cancer drugs and inflate their prices do not create additional value."
Per
@SSRHealth
: Brand-name
#drug
prices have been dropping for 2 years! For 2020Q2:
- WAC list prices up +3.6%, but net prices down -5.1%
- Net prices = 49.9% of list prices
Crazy that patients still pay coinsurance and deductibles based on list
(Sorry, no link for full report)
Seriously?!?
@UHC
$UNH new copay
#accumulator
policy requires
#physicians
and other healthcare professionals to rat out patients who use copay coupons for
#medical
benefit
#drugs
So, doctors now must enforce punitive benefit designs? Boo. 👎👎
Ugh.
@GoodRx
highlights retail
#drug
*list* prices vs. *net* prices in US healthcare
Should have used comparable
@BLS_gov
data. Journalists: Don't fall for this sloppy, misleading “research”!
I know GoodRx is hyping its billion-dollar IPO, but still...
Great quote from
@mcuban
@costplusdrugs
: "If the big three
#PBMs
, which also own the insurance companies, lose five of the top 15 non-PBM Fortune 50 companies, their business practices are going to change.”
#capitalism
==>
Kudos on a clever analysis!
My $0.02: Patients who cover their own costs will shop for cheaper prescriptions. Rather than harness these market forces, Medicare plans overcharge for common, low-priced generics but make seniors pay excessive OOP costs for rare specialty drugs.🙄
Seriously?!? Ronny Gal from Sanford C. Bernstein reports
@OptumRx
$UNH is trying to structure
#PBM
contract terms that would punish manufacturers for lowering
#drug
list
#prices
and "force drug makers to rethink price reductions." See excerpt below.
#rebates
#GrossToNetBubble
A shameful top 10:
#Hospitals
that spend the least on charity care and community investment vs. value of their "non-profit" tax exemptions
Extra irony: Most are
#340B
covered entities, too 🙄
@lowninstitute
Thought provoking comparison via PhRMA:
#Drug
prices for cardiovascular disease have plunged, while surgical prices have skyrocketed.
As
@PeterKolchinsky
says:
#Hospitals
don't go generic, but drugs can.
Huh?
@CVSHealth
$CVS
#PBM
admits "plan sponsors will benefit from significant savings" of
#biosimilars
Sorry, patients!
#Amjevita
(list price -55% vs.
#Humira
) is non-preferred, i.e., not lowest cost for patients with deductibles or coinsurance
Yuck.
Must read article on fixing
#340B
by linking discounts to beneficiary, not covered entity
340B analogy: Imagine if SNAP funds went to restaurants & supermarkets instead of low-income families.
Well done,
@DrDiGiorgio
& Wayne Winegarden 👏👏👏
==>
Is this how "medical" insurance should work?
Per recent
@Health_Affairs
paper, health plans' step therapy rules are more stringent than clinical recommendations
Full study:
(See Appendix Exhibit E)
Graphic :
@garykarr
@RealChemistry_
Really, Peter?!? We could benchmark *any* aspect of U.S.
#healthcare
to international prices and free up a “ton on money.”
Wake me up when
#physicians
propose benchmarking their salaries to other countries’ pay scales.
Data from
@Medscape
(sorry, no direct link)
In
@bopinion
I wrote abt
@SpeakerPelosi
drug price negotiation bill. It frees up ton of money that could improve health, and improves Rx adherence, curtails drug development only minimally. Legit question whether society better off with it or status quo
Clarification:
After further research,
@Amazon
$AMZN is *not* as disruptive to
#pharmacy
as I initially thought.
Instead, Amazon Pharmacy is an in-network mail pharmacy. Prime offering disrupts
@GoodRx
$GDRX fees, but not overall card model.
More on Drug Channels soon...
Highly recommended! New
@Amgen
2022
#Biosimilars
Trend Report (free)
Loads of neat data by therapeutic class.
In big categories, ASPs are now down -60% or more
Hmm.
#Telehealth
visits have plummeted since reopening began. Down from 70% of total ambulatory visits in April to only 21% in July.
I wonder how much telehealth will remain when things really get back to normal. 10%? 15%?
Source: Epic Systems
Wow! Nearly all (90%+) of economic value from HCV cures were "health benefits to patients and net cost-savings to society." Manufacturers got a small % of total economic value.
Lesson: "Big Pharma" critics were wrong. GLP-1 rethinking next, IMHO.
==>
Big
#biosimilar
news: Ronny Gal
@AB_insights
calculates that
#biosimilar
savings are now $6.5 billion (annualized) and growing 👇
Spending down -31% for reference molecules
@ScottGottliebMD
was right. We shouldn’t give up on biosimilars
#notowel
(Sorry, no link to full report)
Venture capitalist Bruce Booth
@LifeSciVC
lays out many uncomfortable truths about
#drug
pricing, innovation, R&D, policy,
#GrossToNetBubble
, & more
@Forbes
Well done and very timely given nonsensical talking points from our politicians. Kudos, Bruce.
Weekend reading: Fantastic article describing the history and channel roles of
#PBMs
. Nice discussion of tradeoffs between (1) addressing market failures vs. (2) protecting other channel participants.
@joeymattingly
@GeBaiDC
My latest: Why
@GoodRx
—Not
@amazon
—May Be the True
#PBM
Disrupter
Some thoughts on how and why discount cards could upend PBMs’ pharmacy benefit economics, plan sponsors’ decisions, and the entire generic market.
Hey,
@pcmanet
! If you (misleadingly) complain that "drug companies set the prices of the products they make and sell," you should also explain why plans &
#PBMs
limit access to
#biosimilars
with lower prices, e.g., Semglee, Amjevita
Surprise! Brand-Name Drug Prices Fell (Again) in 2020 (rerun)
No other part of U.S.
#healthcare
has seen its prices drop year after year. Politicians, journalists, and academics who focus on list prices distort the truth about
#drug
prices.
#facts
Hooray! For the first time ever,
@HRSAgov
has posted
#340B
covered entity purchases on its website 👏👏👏
I presume HRSA finally got tired of my FOIA requests 😉
P.S. Historical data by CE on Drug Channels:
#RegulatoryCapture
A personal note: I want to acknowledge Tashara C, a
#pharmacy
technician at
@cvspharmacy
at 1919 Market St in Philly. She handled a complex issue with my prescription—and did so with a smile and a great attitude. Always a pleasure to meet people like her in a pharmacy.
We still have
#GrossToNetBubble
problem:
1. Humira's list price skyrockets
2. Net price received by
@abbvie
$ABBV grows slowly b/c of
#PBM
#rebates
3. Plans use $$ to reduce premiums for healthy
4. Patient OOP grows along with list--not net--price (reverse insurance)
Crazy!
How to get to > $20,000,000,000 per year:
The
#1
drug—Humira—had a price increase from $2,914 to $5,174 over the past 5 years, largely thanks to the 611% jump by the abominable pharmacy benefit managers. Leading to a near doubling of what the patient pays
Another independent, credible source uncovers massive
#340B
grift & greed.
#FacesOf340B
= Zero transparency, no accountability, financial diversion, and outright fraud
When will Congress fix the out-of-control, unregulated
#340B
program?
Today, Congress took a huge step towards shining a light on the pharmaceutical industry’s shadowy middlemen. Thank you to
@GOPoversight
for allowing me to speak at this important hearing.
Ugh. Misleading, deceptive "research" via
@GoodRx
:
- Compares
#drug
*list* prices to net
#healthcare
prices
- Falsely claims patients paying more (not true per CMS NHE stats)
- Ignores BLS index flat since 2018
Hope its SEC filings are more accurate!
Excellent new 2022
@Amgen
#biosimilar
trend report:
1) Biosim prices decreasing at 9% to 22% *per year*
2) Avg share=74% (in thera areas w/biosims launched in last 3 years)
Market forces at work!
#NoTowel
Full report (free):
Great op-ed by Bret Stephens
@nytimes
: The Story of
#Remdesivir
@GileadSciences
$GILD
"Just as there are no atheists in foxholes, there should be no big-pharma haters in pandemics." 👍👍
ICYDK:
@AARP
relies for its funding on United Healthcare
@UHC
$UHC, not on seniors.
Since 2007, AARP has received an estimated $8.2 BILLION in tax-free revenue from UnitedHealth. Wow.
U.S.
#healthcare
craziness: For *same* specialty
#drug
, the *same* health plan has *different* step therapy requirements for
#Medicare
Advantage vs. commercial
Also: unexplained diffs between plans for the same drug
What a mess.
@AJMC_Journal
==>
Warped incentives update: 55% of
#generic
#drugs
on non-generic tiers in
#Medicare
#PartD
@avalerehealth
- 20% on "Preferred Brand" tier (huh?)
- 29% "Non-Preferred" (vs. equivalent brand?)
- DIR/rebates? Net costs?
Need to fix Part D benefit design!
Ridiculous analysis. U.S. should figure out value for
#healthcare
products & services. Outsourcing to countries w/ vastly different economies/systems/standard is lazy & illogical.
We don't benchmark MD salaries and hospitals to international prices, despite TRILLIONS in savings.
International reference pricing in HR3 could save Medicare $83.5B, 52.3% of net spending.
In other words, even if we were to raise the price cap above 120% IPI, there’s still *huge* savings to be had. 💰
Nice study by
@RANDCorporation
Yikes. Many people misunderstand basic insurance terms.
% who can't correctly define:
Deductible: 45%
Copayment: 46%
Coinsurance: 77% (!)
Yet 85% are very/somewhat happy with their insurance plan ¯\_(ツ)_/¯
Source:
@Forbes
survey of 2,000 Americans