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The initial fallout from the Valeant-Philidor kerfuffle has hit the pharmacy industry. Over the past few weeks, the major pharmacy benefit managers have begun dropping pharmacies from their networks. Some PBMs are also reminding retail pharmacies that they are prohibited from acting as mail pharmacies…I highlight the high-profile network pruning by the top three PBMs—Express Scripts, the Caremark PBM business of CVS Health, and the OptumRx business of UnitedHealthcare. I also speculate on the factors that would lead a PBM to clash with a pharmacy in its network…An as-yet-unanswered question: If PBMs routinely monitor their networks, why did it take a highly publicized pharmacy meltdown before PBMs finally cracked down?

Michael Zeglinski, vice president of Specialty Pharmacy Operations at BriovaRx, discusses the alignment between specialty pharmacies and ACOs.

David D'Altorio, PharmD, senior vice president of health services at MedImpact Healthcare Systems, Inc, discusses how the ACA has impacted the specialty landscape.

..pharmacist Russell Reitz…agreed to sell his pharmacy (R&O Pharmacy), in a quiet suburban office park, to the group (East Coast investors) for $350,000…he continued as manager, Reitz began finding his store's name and his national pharmacy license number on an avalanche of prescriptions nationwide…a torrent of insurers' money started flowing to his small shop…on pace to equal $230 million a year…Reitz now finds himself at the center of the national scandal enveloping Valeant…In the last two months, Reitz has filed papers in two Los Angeles courthouses laying out details of what he and his lawyer call "a massive fraud."…Until Reitz's court filings…few people knew about Valeant's close ties to Philidor...Reitz detailed how he had discovered that Philidor was using his national pharmacy identification number on prescriptions being filled at other pharmacies — and even on some that were filled and billed before he signed the agreement to sell R&O…Reitz said he believes that Philidor had targeted his pharmacy because it needed access to his licenses, which he has in California and 33 other states, as well as to the contracts he had negotiated with insurers.

...the largest U.S. managers of private prescription drug benefits have cut off at least eight pharmacies that work closely with drugmakers, intensifying scrutiny of a system that helps inflate drug prices…The terminations come from payers who together manage drug benefits for more than 100 million Americans…Express Scripts, the nation's largest pharmacy benefits manager, has changed the algorithms it uses in its audits to find pharmacies focused heavily on one drug manufacturer and has cut ties with half a dozen such pharmacies...Independent pharmacies and their drugmaker partners counter that Express Scripts, CVS and OptumRx together control more than two-thirds of the market through their own mail-order operations. The specialty pharmacies say that the benefit managers are trying to curb the explosive growth of smaller, independent players.

The ongoing debate over specialty drugs — reflecting conflicting motives of buyers and sellers — neglects important insights about the impact of these new technologies, their value to society, and the economics of medical R&D.  We here disentangle the facts from the myths surrounding these products…“Specialty drugs” is a term that has entered common vocabulary to categorize a class of drugs that are clinically unrelated, but are increasingly grouped together due to their high cost.  They have come under scrutiny lately from payers, policymakers, and physicians and exemplify the most significant, recurring challenge in modern health care:  how to balance effective innovation with fiscally viable pricing.  Unfortunately, solutions are elusive because of pervasive myths about these products...Below we debunk the most serious myths impeding an effective policy response..

• Myth:  Growth in Specialty Drug Spending Will Bankrupt Health Care
• Myth: Specialty Drugs Offer Only Incremental Value
• Myth: Profits from Specialty Drugs Sales are Excessive
• Myth: The U.S. Would Benefit from European-style Price Controls
• Myth:  High Prices are the Sole Source of Financial Hardship on Patients
• What’s the Bottom Line?

...interview with Eric Sredzinski, Pharm.D., about improving medication adherence in HIV patients through mobile health technologies... (podcast 19:29)

...latest fallout over the role that specialty pharmacies play in boosting prescription drug sales, Express Scripts has ended a contract with a company that is used by Horizon Pharma to distribute some of its medicines…Express Scripts cancelled its contract with Linden Care after determining the mail-order pharmacy was apparently dispensing drugs that are mostly made by Horizon, according to a spokesman. Express Scripts, which is the nation’s largest pharmacy benefits manager, is scrutinizing what it calls captive pharmacies. Those captive pharmacies appear to sell products for mostly one drug maker…In response, Linden filed a lawsuit accusing Express Scripts of making “a trumped-up charge that Linden Care is mailing drugs out of state purportedly in violation of [its] contract.” The pharmacy also maintains Express Scripts failed to provide adequate notice that the contract was ended. Express Scripts sent its termination notice yesterday, Nov. 10.

Nonadherence carries significant implications for stakeholders throughout the specialty space…There is not a lot of information about primary medication nonadherence, but it could have a huge impact on patients…if the patient doesn’t start on medication … well, the outcome is going to be very poor in those circumstances…reasons for PMN:

• Cost of the drug
• Concern for side effects
• Treatment change
• Perceived need
• Patient forgot or didn’t know

There are also issues that are specific to specialty pharmacy…why patients might delay treatment:

• Cost and copay/co-insurance
• Patient perceptions: they don’t believe the disease is severe enough or they don’t believe in the efficacy of the drug
• Fear of side effects or a fear of injections

Valeant Pharmaceuticals International Inc sought to reassure doctors…that the company's decision to cut ties to a controversial specialty pharmacy would not disrupt doctors' ability to prescribe the company's drugs to patients…In a letter to healthcare professionals…Valeant would pay for the cost of its products through Nov. 8 and make sure patients could fill their prescriptions with no out-of-pocket expenses, wherever possible. Patients on government-run health plans such as Medicare are not eligible…Philidor Rx Services, will file no further insurance claims.