Category: Pharmacy, PBMs, and Pharma costs

Oct
1

Will WalMart change US healthcare?

Posted by Joe Paduda on Monday, October 1st, 2007 | Comments

When WalMart introduced the $4 prescription program, my commentary headline was “much ado about not much”. In retrospect, too strong a statement that early on.
The initial program covered less than 1% of the scripts filled at WalMart, and was widely seen as a more of a marketing ploy than major new program. To WalMart’s credit, they quickly increased the number of drugs covered and participating stores; before the latest news fully one-fifth of scripts filled at wallyworld were for $4 drugs.
With the benefit of hindsight, it looks like the program has had two rather significant effects – dramatically reducing drug costs for some individuals, and (possibly) driving down drug costs nation-wide.
Now I’m thinking this may just be the start of a major expansion of WalMart into the health care sector.

Continue reading Will WalMart change US healthcare?

Sep
21

Consolidation in the third party biller business

Posted by Joe Paduda on Friday, September 21st, 2007 | Comments

Here’s another one of those posts that is really really interesting to very very few people.
Third party billers are factors – they buy WC script receivables from pharmacy chains and try to collect from WC payers.
The two TPBs have been on (and off) the selling block for some time; it now appears they are working on a merger.

Continue reading Consolidation in the third party biller business

Sep
17

The killer drug

Posted by Joe Paduda on Monday, September 17th, 2007 | Comments

Sometimes it takes a few deaths for people to wake up. That appears to be the case with Fentora, the powerful narcotic manufactured by Cephalon. Four deaths have now been linked to Fentora, deaths that are all the more troubling because they appear to be from off-label use of the drug.
I’m not surprised.

Continue reading The killer drug

Aug
27

Pharmacy benefit management in Workers Comp – Survey results

Posted by Joe Paduda on Monday, August 27th, 2007 | Comments

My firm has conducted a survey of pharmacy benefit management in workers comp each year for the past four, and the latest has been completed. Executives in managed care and claims as well as program managers from 20+ payers responded to the Survey, some for the fourth time.
Here are a few of the highlights.

Continue reading Pharmacy benefit management in Workers Comp – Survey results

Aug
24

Off-label usage of Actiq

Posted by Joe Paduda on Friday, August 24th, 2007 | Comments

Here’s a shocker – quoted from a FierceHealthcare piece last November.
“oncologists accounted for only 1 percent of the 187,076 Actiq prescriptions filled at retail pharmacies in the U.S. during the first six months of 2006, The Wall Street Journal reported.”
Actiq is only FDA approved for breakthrough cancer pain.
My firm’s research indicates that Actiq is among the top three drugs in dollar volume dispensed to workers comp patients. The incidence of cancer in WC is so low as to be unmeasurable.

Aug
15

An insider’s view of pharma pricing

Posted by Joe Paduda on Wednesday, August 15th, 2007 | Comments

As part of my ongoing effort to educate myself about pharmaceutical pricing, pricing strategies, marketing, and the various components of the distribution channel, I found PharmaFraud – a relatively new blog ‘penned’ by a self-described whistleblower from within the industry.
And now I know I don’t know squat.
I’m not a fan of anonymous blogs, blog posts, or comments, but PharmaFraud’s author looks to know of what s/he speaks.
For a biting condemnation/explanation of pricing, read PF’s piece on Distribution Channels.

Aug
14

The NY WC Rx Update

Posted by Joe Paduda on Tuesday, August 14th, 2007 | Comments

We’re getting a clearer picture of the implications of NY’s adoption of a (very low) fee schedule for WC prescription drugs. As I’ve noted before, the WCB has clearly stated its opinion that the regs do not allow for reimbursement above the fee schedule.
The initial reaction to the news from several large pharmacy chains (at the National Association of Chain Drug Stores conference in Boston) ranged from disappointed acceptance to belligerent rejection.

Continue reading The NY WC Rx Update

Aug
10

NY’s workers comp fee schedule – further developments

Posted by Joe Paduda on Friday, August 10th, 2007 | Comments

The recent imposition of a work comp pharmacy fee schedule in New York has shaken the industry – and that’s not hyperbole. The latest news out of Albany is likely to intensify the aftershocks.
The preliminary guidance from the State is PBMs cannot charge more than the fee schedule, and cannot pay pharmacies more than the fee schedule.

Continue reading NY’s workers comp fee schedule – further developments