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The Healthcare World According to Fein | 2023 Asembia Specialty Pharmacy Summit


Adam Fein, Ph.D., talked about some surprising trends in specialty pharmacy and healthcare at the 2023 Asembia Specialty Pharmacy Summit. The number of specialty pharmacy locations may be peaking. And that "gross-to-net bubble" in drug prices that Fein has written about so much — well, it may be shrinking.

Some long-term trends may be leveling out or even reversing, and the vertically integrated titans of U.S. healthcare are battling each other—and are turning their sights on pharmaceutical manufactures,according to Adam Fein. Ph.D.

Adam Fein, Ph.D.

Adam Fein, Ph.D.

Fein, whose Drug Channels website is closely read by people in the drug and pharmacy industries, was host of the general session Tuesday morning at the 2023 Asembia Specialty Pharmacy Summit and one of its featured speakers.

Mixing jokes with data and PowerPoint slides — Fein said he created 1,387,422 PowerPoint slides in his career — Fein told the large, attentive audience that by his tally, there are 1,651 accredited specialty pharmacy locations. That number may be peaking, he said, because the growth in the number of locations was the slowest he had seen during the eight years he has been tracking specialty pharmacy locations. He also mentioned that he was starting to see a “little bit of de-consolidation as the industry gets broader, and some of the vertically integrated providers and physician practices are pushing back.”

Fein also said the difference between gross and net drug prices — he calls it the “gross-to-net bubble” — was narrowing for “first time in a long time” because of policy changes such as the uncapping of Medicaid rebates. “We’re starting to see more and more products start to address this gap between the list price and the net price, he said.

Fein drew a picture of U.S. healthcare divided into two “vertically aligned channels, the insurer-PBM (pharmacy benefit manager)-pharmacy provider channel and the health system-physician practice-pharmacy and, maybe, insurer channel.” He said the two channels are “essentially battling each other — and they are coming after pharma.”

“If you are at pharmaceutical manufacturer — as some of you are — you, in some sense, are going to have to match the way the market is evolving around you,” Fein warned.

Here are some of the other developments that Fein urged to keep an eye on this year:

  • Price competition among the specialty drugs. “We are entering a new era in which specialty drug prices are going to start to grow much more slowly. And the level of price competition is going to become greater,” Fein said.
  • Fights over financial support of patients. Fein said 4 out of 10 people covered by commercial insurance are in plans with maximizer programs, which adjust cost sharing so it is equal to a manufacturer’s copay assistance. He also mentioned the growing number of alternative funding programs, which remove drugs from formularies, so patients become eligible for assistance programs. Fein predicted a running battle over financial assistance and questions about who should get it and where exactly does the money go.
  • Effects of the Inflation Reduction Act (IRA). “This (the IRA) is not just going to affect Medicare.This is going to flowthrough and have contagion effects throughout the system," said Fein.

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