Alan Pannier, Pharm D,MBA

GoodRx shouldn't exist And in fact, you don't need it Here's how it works: GoodRx aggregates PBM rates Customers filling prescriptions use GoodRx discount cards to access "better" "cash" rates at the pharmacy Pharmacies pay for the privilege of making less money by cutting in the PBM and GoodRx Nothing prevents the pharmacy from charging these prices for cash Oh, well, except for predatory contracting by the PBMs, gag-clauses, and all that horrible fun It's just demand aggregation arbitrage And maybe, just maybe the market knows it... GoodRx FY 2023: $750M revenue ($27M) ops loss ($8.9M) income loss But as always it's about the cash too $138M cash from operations But despite the cash generation, look at share price: $8.63 per share today $56.63 per share Feb. 2021 Now, there is a lot to unpack Including a hefty software capitalization of $60M and increased amortization of $50M and some restructuring to the tune of another $75M But if you love the color rose: $217M Adjusted (made up) EBITDA Nonetheless, GoodRx, a discount card rate aggregator has made $750M off a dysfunctional system It's not been great for shareholders And It's not great for the healthcare system If you want to see why this sausage gets made, tune in the Sunday to The Healthcare Breakdown We're talking about PBMs I know, it's gonna get wild Check it out here: https://lnkd.in/gVRtQGZN See you out there!

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A very interesting analysis on 340B and the impact on that program from PBMs from Avalere. The analysis details how PBMs have a hand in exploiting the 340B program through their business practices. https://lnkd.in/gEQAKczY

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Blue Health Intelligence, a data analytics and software company, undertook an evaluation of almost 170,000 unique GLP-1 users for weight loss, notes less than half of those prescribed stay on the medication for 12 weeks or more. Younger adults were less likely to continue the drug, whereas those who were prescribed the medication by an endocrinologist or obesity medicine specialist were more likely to continue for longer. Indeed, this data states 30% of patients dropped out of treatment after the first four weeks, and 58% at 12 weeks. Those who dropped out are unlikely to achieve clinically meaningful weight loss.  The likelihood of continuance was further exacerbated for those with health inequities or who lived in underserved health regions. The data comes from Blue Cross Blue Shield Association members participating in Plans that provided coverage of these products, from 2014 through to end of 2023. Razia Hashmi, vice president for clinical affairs at Blue Cross Blue Shield wants to ‘…paint a clearer picture of what makes somebody successful.’ The missing piece here is why the patients stopped – side effects, failure to achieve initial weight loss, stigma and discrimination, or coverage issues related to cost and access. My longtime friend, colleague and bariatric surgeon at Stanford University, Dr. Dan Azagury rightly states ‘…The goal is for patients to stay on this for a significant amount of time. Most likely… beyond 12 weeks.’ https://lnkd.in/ediQskQx

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Independent pharmacies have always stood out for their personalized care, community focus, and adaptability. If they want to keep that reputation, it's important to leverage technology like AI that can transform patient care for the better. Here are a few benefits of AI: 1️⃣ Personalized patient care. AI-driven tools can analyze patient data to recommend tailored medication plans, predict potential adverse interactions, or remind patients about refills—helping ensure patients stay on track with their health goals. 2️⃣ Streamlined operations. By automating routine tasks like inventory management or insurance verification, pharmacists can spend less time behind the counter and more time engaging with their patients. 3️⃣ Improved medication adherence. AI-powered systems can identify patients at risk of non-adherence and provide real-time alerts, making interventions more proactive and impactful. It can be a bit of an investment, but it can truly pay off in the long run. #AI #Healthcare #PharmaTech

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𝐋𝐨𝐨𝐤𝐢𝐧𝐠 𝐟𝐨𝐫 𝐏𝐁𝐌 𝐒𝐨𝐟𝐭𝐰𝐚𝐫𝐞? I’ve been reaching out to PBM software companies to learn about their products and what sets them apart. Having worked with five different PBM platforms in the past, I’m very familiar with how these systems operate. If you’re in the market for PBM software, feel free to reach out—I’m happy to share what I’ve learned, free of charge. As a consultant, I focus on building strong relationships in the industry. I believe in the value of helping others because it leads to future opportunities. Whether you’re a small pharmacy, PBM startup, broker, TPA, hospital, or even a large PBM, let's connect. I’ll provide insights on the top players in the space and what differentiates them. If you’re with a PBM software company and we haven’t connected yet, send me a message, and let’s get in touch!

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I know hospital price transparency and reform of the traditional PBM model with rebates is important but I wish more focus was on right drug/precision prescribing incorporating genetic testing (PGx). Studies have shown full panel PGx reduces number of drugs per patient by 1/3, reducing both poly pharmacy costs and resulting adverse events; reducing ER visits, hospital admissions (2.7 million/year for adverse drug events), and outlyer claims (10-30% of most expensive claims annually) for an ROI of 4-8:1 plus elimination of payments for drugs that can’t help the patient such as many mental health medications and high cost specialty drugs with 30-50% failure rates. And of course the 128,000 deaths each year making adverse drug reactions the 4th leading cause of death according to the AMA and FDA.

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With looming Medicare drug cost changes, LTC pharmacies are facing a potential crisis. Eight of the ten drugs currently under negotiation are heavily prescribed to LTC patients. This could potentially lower the cost for the consumer but also be costly for LTC pharmacies. LTC pharmacies already rely on thin margins, and with these potential changes, many are bracing for the impact. To help navigate these challenges, consider the numerous benefits of automating processes within your pharmacy. This can save time and money, lower operational costs, and offset the impact of drug price changes on your margins. Contact us today to streamline and automate your pharmacy before the drug prices take effect. #LTCPharmacy #Automation #CustomSoftware #Pharmacy

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This is HUGE. In the U.S., nearly 80% of prescription claims are processed by three "Pharmacy Benefits Managers (PBMs)" - Caremark (CVS), Express Scripts (Cigna), and Optum Rx (UnitedHealth Group). Together, they dominate the lucrative pharmaceutical supply chain and manipulate it to their financial benefit. Now this - according to STAT News and other media outlets reporting today: "The U.S. Federal Trade Commission filed a lawsuit against the largest pharmacy benefit managers and their group purchasing organizations for allegedly anticompetitive practices that 'artificially inflated' the price of insulin and, consequently, impeded patient access to the life-saving treatment. The administrative complaint accused CVS Caremark, Cigna’s Express Scripts, and UnitedHealth’s OptumRx of creating a “perverse” system of rebates that favored insulin that was sold at higher list prices in order to 'line their pockets' at the expense of patients, who were forced to pay more for the medication." I wish the FTC success, and I implore Congress, the Biden Administration and whoever occupies the White House following the upcoming Presidential election to break the stranglehold 'Big Health' has established on U.S. healthcare. This is a stark example of the harm it causes patients, employers, and our nation's economy. #health, #PBMs, #FTC

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This is quite incredible to see. Very few #CMMI demonstrations can point to any savings at all. And “…MSSP savings go further than savings generated by Medicare Advantage…” #ACO #VBP #Primarycare #MSSP #healthcareinnovation

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The pharmaceutical industry is constantly innovating to improve patient outcomes... but that doesn't mean the industry is without its challenges. Luckily, I think independent pharmacies can provide helpful solutions to some of these problems. One of the most persistent issues that I've noticed in the space is ensuring patients have timely access to medications. I think independent pharmacies are in a position to fix this problem because of the deep roots they tend to have in their communities. This connection can bridge this gap by providing more personalized services and ensuring medication availability, especially for rare or specialty drugs. I would say the other major challenge I see in this industry is affordability. Anyone who needs medication probably sees consistent increases in medication prices... luckily, independent pharmacies can help. Many people might believe that smaller, independent pharmacies are more expensive, but that isn't usually the case. Independent pharmacies can work directly with manufacturers and leverage their flexibility to negotiate better prices and offer cost-saving alternatives. #PharmaIndustry #PharmaChallenges #IndependentPharmacies

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What you won’t find: Wheel powering any of the sketchy DTC GLP-1 compounding companies. What you will find: This market exists because companies like Wheel, who prioritize clinical quality and regulatory compliance in every process and product, refuse to take shortcuts. We're committed to ensuring that patients receive high-quality care—not just drive quick profits. Sometimes, choosing ethics over revenue means we don't see a short-term windfall during a "Gold Rush." But as CEO, I can assure you that it also means that patients, customers, and clinicians can trust that Wheel is always on the right side of history. I believe GLP-1s will transform healthcare as profoundly as AI, and Wheel is dedicated to being at the forefront—delivering compliant, accessible, and responsible care.

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This vertically integrated and concentrated market structure has allowed PBMs to profit at the expense of patients and independent pharmacists The interim report highlights several key insights gathered from documents and data obtained from the FTC’s orders, as well as from publicly available information: Concentration and vertical integration: The market for pharmacy benefit management services has become highly concentrated, and the largest PBMs are now also vertically integrated with the nation’s largest health insurers and specialty and retail pharmacies. The top three PBMs processed nearly 80 percent of the approximately 6.6 billion prescriptions dispensed by U.S. pharmacies in 2023, while the top six PBMs processed more than 90 percent. Pharmacies affiliated with the three largest PBMs now account for nearly 70 percent of all specialty drug revenue. Significant power and influence: As a result of this high degree of consolidation and vertical integration, the leading PBMs now exercise significant power over Americans’ ability to access and afford their prescription drugs. The largest PBMs often exercise significant control over what drugs are available and at what price, and which pharmacies patients can use to access their prescribed medications. PBMs oversee these critical decisions about access to and affordability of life-saving medications, without transparency or accountability to the public. Self-preferencing: Vertically integrated PBMs appear to have the ability and incentive to prefer their own affiliated businesses, creating conflicts of interest that can disadvantage unaffiliated pharmacies and increase prescription drug costs. PBMs may be steering patients to their affiliated pharmacies and away from smaller, independent pharmacies. These practices have allowed pharmacies affiliated with the three largest PBMs to retain high levels of dispensing revenue in excess of their estimated drug acquisition costs, including nearly $1.6 billion in excess revenue on just two cancer drugs in under three years. Unfair contract terms: Evidence suggests that increased concentration gives the leading PBMs leverage to enter contractual relationships that disadvantage smaller, unaffiliated pharmacies. The rates in PBM contracts with independent pharmacies often do not clearly reflect the ultimate total payment amounts, making it difficult or impossible for pharmacists to ascertain how much they will be compensated. Efforts to limit access to low-cost competitors: PBMs and brand drug manufacturers negotiate prescription drug rebates some of which are expressly conditioned on limiting access to potentially lower-cost generic and biosimilar competitors. So it goes n8 #PMB #valuebasedcare #hospitals #healthsystems https://lnkd.in/g2qEaWPk

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📅 Another week, time for some more reasons to team up with us, community and retail #pharmacy! 🙌 We're counting down the top 12 reasons why all retail open-door, walk-in #pharmacies in the US should join our pharmacy network and the #TeamCubanCard at www.teamcubancard.com with Mark Cuban Cost Plus Drug Company, PBC: Last week: Reason #12: https://lnkd.in/gy-cftKe Reason #11: https://lnkd.in/gJDdfCVa Reason #10: https://lnkd.in/geck9PHy Reason #9 today - below. 💊 If you're a patient, head on over to www.teamcubancard.com and grab your own Team Cuban Card and join, just in time for 1/1/25 plan changes - it's free! 💊 If you're a #pharmacy and you haven't joined our network but want to learn more - just complete this form and we will be in touch: https://lnkd.in/gnruGTkH

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💹 Tuesday morning, CVS reported its Q1 earnings, and the stock has dropped 18% as Wall Street did not like them leaning into Medicare Advantage at a time when it is riddled with challenges. Check out my substack but below are some of the takeaways. 👬 Similar to the Humana call, they documented many of the headwinds as they look to try to build their integrated network with CVS, Aetna, Caremark, Oak Street and Signify. Despite a revenue growth of $3 billion, reaching over $88 billion, net income took a significant hit, halving from $2.14 billion to $1.11 billion. Click on my substack for the full takeaways from the call with the highlights below: 📈 Key Highlights: ➡ Membership growth to 26.8 million, driven by 800k new MAPD enrollees (lost 300K Medicaid Members YOY) ➡ Revenue from premiums increased by 25%, despite the financial setbacks driven mainly by the 800K new Medicare members they fished out of the open enrollment period. ➡ They had a 580 basis point increase in the Medical Benefit Ratio (90.4%) from the elevated utilization in the Medicare population. The strategic acquisitions like Signify and Oak Street to bolster Medicare offerings are so early days and were not able to offset the headwind ➡ Similar to Humana and UNH, they are going to exit some geographies that are not as profitable along with price for a smaller range of services for 2025 Medicare bids. 🚀 Looking Ahead: - CVS plans operational adjustments aiming for a 4%-5% margin in the MAPD sector, despite expecting to operate at a loss in 2024 of 3%-4%. The longer term goal here will not be achieved in 2025 but is set for 2026 and beyond similar to other MAPD providers. - They are enhancing their pricing strategy for higher utilization in 2025 (probably not a great open enrollment coming for Aetna) and they have their fingers crossed for improving STAR ratings to potentially add $700 million in revenue next year. This was not a great call for CVS, as many expected some of their 2023 acquisitions to begin to bear fruit but in hindsight they bought a meme coin or stock (Medicare Advantage) at the peak as many of the MAPD challenges are major headwinds. I look for them to survive and advance in 2024 with the longer term goal of executing on their strategy. As always, feel free to reach out with your comments and input along with subscribing to my substack. #healthcare #marketaccess #earnings https://lnkd.in/gsf26HaJ

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📍 How to work with us at Mark Cuban Cost Plus Drug Company, PBC - a classic: 💊 1. If you're a pharmacist, clinic, or hospital looking for other B2B options to buy low cost prescription drugs for your patients, consider shopping the Marketplace - and there's no quotas to buy: https://lnkd.in/gypvkXde 👩‍🦰 2. If you're a patient in need of a lower cost or another option for a mail order pharmacy and pay cash - check out: www.costplusdrugs.com. 👩🏿‍⚕️ 3. If you're a prescriber and your patient wants their meds sent to cpd.com, check out this page: https://lnkd.in/gsyQU7hJ. 🏡 4. If you're a patient but love your local pharmacy and want to keep your prescriptions closer to home with your local #pharmacist - great! Check out www.teamcubancard.com to see if we stock your drugs and/or have your pharmacy included in our pharmacy network today. Cost of a #TeamCubanCard? $0. 🛜 5. If you're a retail pharmacist PIC or pharmacy owner and want to join our retail pharmacy network - welcome. Our baseline dispensing fee is going up soon as well - hop in the cue before the rush! Fill out the form to learn more at: https://lnkd.in/gnruGTkH. 🏥 6. If you're a hospital and want to know more about our 503B facility and buying a product we manufacture on the FDA shortages list, LMK and I can connect you. 💵 7. If you're a payer and want to connect with us, complete the form at this page: https://lnkd.in/gcnq33kF. ❓ 8. If you have a general query that does not fit any of these categories, you can email us at: [email protected]. 🧑🏼‍🔧 9. If you're looking for a #job with MCCPDC, check out our jobs page right here at LinkedIn! https://lnkd.in/gegjQBq3 (Please note that we do not currently work with recruiters at this time.)

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More than 300 independent pharmacies closed in 2023, creating pharmacy deserts in rural communities. PBMs have become key pieces of mega-health care companies that control the market from top to bottom. The three largest PBMs are each connected to a major health insurer. CVS Caremark owns Aetna and is number 6 on the Fortune 500 list. In 2023, CVS Health expanded into yet another health care space, creating a subsidiary that manufactures drugs. The 2nd largest PBM, Express Scripts, is owned by Cigna Group (number 16 on the Fortune 500). The 3rd, OptumRx, is owned by UnitedHealth Group, which is number four on the Fortune 500 list, and is the nation’s largest private health insurer and the largest employer of physicians. Per Becker's.....On Aug. 28, Rep. James Comer, chair of the House Committee on Oversight and Accountability, called on three PBM executives "to correct the record" regarding testimonies they made during a hearing about how the PBM industry influences prescription drug markets. "At our hearing, the witnesses claimed they do not steer patients to PBM-owned pharmacies," the committee wrote on X. "The executives also made claims contradicting the committee's and FTC's findings regarding contract negotiations, contract opt outs, and payments to pharmacies." Mr. Comer is asking David Joyner, president of CVS Caremark; Adam Kautzner, PharmD, president of Cigna's Express Scripts; and Patrick Conway, MD, CEO of UnitedHealth's OptumRx, to provide any necessary corrections to the record by Sept. 11. In his letter to the three executives, Mr. Comer highlighted the potential consequences of making false statements to Congress, including fines and imprisonment of up to five years. #pbms #fraud #spreadpricing #drugs #prescriptiondrugs #prescriptions #employers #middlemen #brokers #advisors #consultants #erisa #patients #employees #selffunding #carriers #medications #pharmacies #pharmacist

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