More Thinking Around the Two Big Stories of the Moment: 340B Numbers and PBMs Killing Pharmacy

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The two biggest stories out there today, at least in my mind, are from this weekend: the HRSA 340B numbers and the New York Times piece on how PBMs are killing retail pharmacy. 

So a couple of brief updates on those stories:

First off, Adam Fein published his take, indispensable as always, on the HRSA numbers. Adam’s post has great background, and he throws some well-deserved shade at HRSA in general, but the key element is the way that he integrates IQVIA data into the discussion. 

While the HRSA data gives a snapshot of what hospitals paid for the 340B drugs -- all of the figures are based on the discounted prices -- the report IQVIA put out earlier in the year is based on the invoice price of the drugs, which is (somewhat) reflective of what the providers received in reimbursement for those drugs. 

The delta there is the profit … the cream skimmed off the top of the program. As Adam notes, it’s a lot of C.R.E.A.M. 

(BTW: coverage is still light here. Becker’s has three paragraphs on the HRSA numbers, but reporters seem to otherwise be ignoring the story. The media critic in me is a little surprised here.)

Second, PCMA has a statement on the New York Times story that throws in every argument it has against the idea that PBMs are killing independent pharmacies. The group argues in turn that pharmacies are dying for non-PBM-related reasons, maybe pharmacies aren’t dying at all, chain pharmacies (which are also getting their asses kicked by PBMs) have it worse, and paying pharmacies fairly would hurt cost-sensitive employers.

None of it is very compelling, but I suspect the goal of PCMA is to make a token argument and hope people stop paying attention. I don’t know if that’s a particularly effective approach, but I’m also not sure they have a better option.

This Harvard PORTAL publication in JAMA on ways that providers can help patients access lower drug costs (think copay assistance, savings cards, DTC pharmacy, etc.) is fine as far as it goes. 

But Deborah Williams had a snarky response to this on LinkedIn, noting that 340B is not on the list. And that’s something worth meditating on: we have a “drug discount” program that delivers tens of billions in low-cost medicines and yet … there’s no way for individuals to get those meds? 

It’s not fair to say that there is “no way” to get those medicines. It’s actually possible for providers to give patients ways to access those prices directly, as outlined in this great white paper. And yet -- 98.6% of the time -- providers don’t provide that option. 

ELSEWHERE: 

• This is a fun paper that analyzes who wrote the most popular drug-pricing papers, where those papers were published, and what they were about. Nice snapshot of one very specific corner of the academic world.

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