Caught my eye .. This week I am struck by connections between 340B and pharmacy benefit managers (PBMs) in terms of being issue areas that need complete makeovers. A glow up won’t do; we’re beyond that. But the trajectory toward change is very different. PBMs and payers (maybe) benefit from the way PBMs currently work. 340B has grown tremendously over the years and lots of stakeholders (hospitals, contract pharmacies, payers, wholesalers, etc.) in the supply chain can benefit from revenue being pulled into the 340B program. It isn’t that the growth in the program is necessarily bad but there are a lot of gaps in what we know about the program.
Putting legislative guardrails on the 340B program is hard given that these entities and the downstream stakeholders are often large employers in their districts. It has taken years to get the PBM story moving toward potential legislative and marketplace solutions, so it isn’t impossible, but it isn’t easy.
340B: Over $66B in 340B purchases in 2023, up 23% from 2022. This HRSA release even includes top 10 drugs in 340B. The jump in the program size just knocks me over every time. There is no mandate on what the revenue from the 340B program is supposed to be used for (or not used for), which just seems irresponsible.
Independent Pharmacies. The New York Times wrote about the death of independent pharmacies around the country because of PBMs. The zinger line? “To take just one example: For a month’s supply of the blood thinner Eliquis, several pharmacists in different states said, the big three P.B.M.s routinely paid them as much as $100 less than what it cost the pharmacies to buy the medication from a wholesaler.” The first time I heard this years ago, I questioned it because it doesn’t seem like it could possibly be true. But, it is. The PBMs do pay their own pharmacies more but that’s sort of like negotiating with yourself. Even if it was a loss, it is a sleight of hand.
Affordability. If pharmaceutical affordability and patient assistance confuses you – here is your newest resource. While the whole thing is good, the figures/tables are print worthy if you’re new at figuring out how to help out patients.
End game. The New York Times reported on the 12 year old who was the first patient to undergo sickle cell treatment since it was approved. It is a sobering reminder that patients are the heart of treatment and, even if they can get access to a cure, the road to recovery can be hell.
PDAB ROI. Maryland has spent $3 million on its prescription drug affordability board and nothing has been saved so far. I’ve questioned the juice/squeeze but Mark Fendrick gets to the heart of it.