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CMS Value Based Purchasing for Drugs

CMS Proposed Rule Supports Value-Based Purchasing for Drugs

Courtesy: www.CertifiedMedicalPlanner.org

On June 19, 2020 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding Medicaid Drug Rebate Program (MDRP) regulations, with the aim of lowering drug prices, increasing patient access, and encouraging innovation in the insurance and pharmaceutical industries.

This proposal is consistent with the Trump Administration’s Blueprint to Lower Drug Prices (Blueprint) released in May 2018, in which the administration highlighted its goal to “avoid excessive pricing by relying more on value-based pricing by expanding outcome-based payments in Medicare and Medicaid” and to “speed access to and lower the cost of new drugs by clarifying policies for sharing information between insurers and drug makers.”

***

***

The proposed rule seeks to accomplish the Blueprint’s goals by reducing regulatory barriers that have previously prevented commercial plans and states from entering into value-based purchasing (VBP) arrangements with drug manufacturers.

Colleagues from Health Capital Consultants, LLC; explain.

ESSAY: DRUGS

Assessment: Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

Medical Practice “Prior Authorizations”

THE “SIREN CALL” OF MEDICAL PRACTICE PRIOR AUTHORIZATONS

Courtesy: www.CertifiedMedicalPlanner.org

“The Doctor Can’t See You – She’s Too Busy Doing Prior Authorizations.”

By Dr. David Edward Marcinko MBA

Somewhere along the way, physicians took a wrong step. Colleagues said OK to the SERPENT who whispered: “this saves money,” and now we’re entangled. We should’ve asked, “Whose money?”

PRIOR AUTHORIZATIONS for medical treatment and prescription drug are killing medicine and all those who would follow into this once great profession.

LINK: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

And so, here is an excerpt [blinded and abbreviated] from an email we received from a medical physician colleague.

***

DOCTOR: For every hour that I spend with a patient, I spend another three hours documenting and begging.
TYPICAL DAY: 4 hours of seeing patients, sprinkled between 12 hours of doing what we used to call “paperwork”.

EMRs: Calling it Electronic Medical Records and data collection doesn’t make this nonsense any more appealing.
ASSESSMENT: Patients get turned away because PCPs are too busy with paperwork. People are sick and dying while I’m calling clerks and pleading for RXs. I’d rather be doctoring.
BOTTOM LINE: 1/5 of my day, over 12 hours a week as a PCP, is now spent on prior authorizations. 1/3 of my assistant’s day is on prior authorizations. That’s why he couldn’t call you back.

CONCLUSION: Next time you can’t get a doctor’s appointment, you’ll know why.

***

Assessment: Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

The Power of Pharmaceuticals

Spending Outpaces Inpatient Hospital Spending

CIRCA: 2018-2019

By Staff Reporters

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Product DetailsProduct DetailsProduct Details

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A 4/20 [Medical] Cannabis Culture Day Pictorial

Join Our Mailing List

About Four-Twenty Day

[By Anonymous DEA Agent]

Today is … 420, 4:20, or 4/20 (pronounced four-twenty).

And, it refers to consumption of cannabis and, by extension, a way to identify oneself with cannabis subculture. Observances based on the number include the time (4:20 p.m.) as well as the date (April 20).

Again … that’s today as this ME-P was published @ 4:20 p.m., EST!

THE DEA DESTROYS A POT FARM

PHOTOS: 

  1. Photo taken after the “grow” was eradicated. There is still no “pot” of gold at the end of the rainbow.
  2. DEA taking one of many seized vehicles/equipment.
  3. The marijuana farm was operating under the name “Brian’s Green Thumb Farm.”
  4. Inside the barn, Agents found rows and rows of drying marijuana.
  5. Over 2,000 pounds of drying marijuana from the barn, bagged and ready for destruction.
  6. Air view of the massive “grow” from the guard tower.
  7. One of two sleeping shelters, each guarding the middle perimeter. In the back, one of four tents, each positioned in the corners for guards.
  8. The plant being ripped out of the ground by the backhoe.

© iMBA Inc. All rights reserved.

Assessment

Link: http://en.wikipedia.org/wiki/420_(cannabis_culture)

UPDATE 2019: Carl’s Jr. will become the first major fast-food chain to debut a cannabis-infused burger:

LINK: http://www.msn.com/en-us/foodanddrink/foodnews/carls-jr-will-become-the-first-major-fast-food-chain-to-debut-a-cannabis-infused-burger/ar-BBW1Q7H?li=BBnbfcL

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details

23 Potential COVID-19 Drugs

COVID-19 Drugs

[By staff reporters]

Drugs being studied in clinical trials. 30+ drug candidates in preclinical research phase.

There is HOPE!

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***

Disclaimer – For informational purposes only; should not be considered medical advice; consult a healthcare professional. Drugs shown are not yet approved for use to treat COVID-19 but are being investigated for use in clinical trials.

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Corona Virus Economics

***

******

THANK YOU

 

Insurers, PBMs and Specialty Pharmacies Today

CIRCA: 2019 Vertical Business Relationships

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***

Conclusion: Your thoughts are appreciated.

Product DetailsProduct DetailsProduct Details

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The Drug Pricing “Theory of Relativity”

ONE SIGN SAYS IT ALL

[By staff reporters]

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Product DetailsProduct Details

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National Prescription Drug Take Back Day

October 26, 2019 – 10:AM to 2:PM

The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications.

Prescription Pill Bottles

MORE: https://www.bing.com/videos/search?q=dea+take+back+day&&view=detail&mid=0D5B986D9C5FD79B077B0D5B986D9C5FD79B077B&&FORM=VRDGAR

MORE: https://takebackday.dea.gov/

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Ambulance DEM

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The Opioid Epidemic Cost Distribution?

FY: 2015 – 2018

By http://www.MCOL.com

***

***

***

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

***

Product DetailsProduct Details

A BLACK MARKET PODCAST VIEW OF THE OPIOID CRISIS

A BLACK MARKET PODCAST VIEW OF THE OPIOID CRISIS

Courtesy: www.CertifiedMedicalPlanner,org

Opioid Overdose Crisis

Every day, more than 130 people in the United States die after overdosing on opioids.1 The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl used to help relieve severe ongoing pain —is a serious national crisis that affects public health as well as social and economic welfare.

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The Podcast

And so, I was fascinated with this podcast because I often encountered narcotic seeking patients while in city center and urban practice. It was recorded by my neighbor and Austrian economist Peter Raymond over at “The Free Man Beyond the Wall” website.

Colleague Dr. Mark Thornton recently gave this talk at the Mises Institute Supporters Summit on the opioid crisis that is plaguing the US. Dr. Thornton lays out a short history of this tragic epidemic that is taking lives every day. He addresses how doctors prescribe these drugs, how government regulates them and explains what happens when people are forced into the “black market” to sustain their addiction.

PODCAST: http://freemanbeyondthewall.libsyn.com/episode-169-the-opioid-crisis

MORE: https://medicalexecutivepost.com/2019/08/22/the-opioid-crisis-rising-2000-2017/

MORE: https://medicalexecutivepost.com/2019/02/06/about-the-opioid-crisis/

Your thoughts are appreciated.

BUSINESS, FINANCE AND ECONOMICS TEXTBOOKS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

Product DetailsProduct Details

***

Meth Mouth

More About Meth Mouth and Teeth [MMT]

By Anonymous DEA Agent

Meth Mouth Teeth is severe tooth decay and tooth loss, as well as tooth fracture, acid erosion, and other oral problems, potentially symptomatic of extended use of the drug methamphetamine. The condition is thought to be caused by a combination of side effects of the drug and lifestyle factors, which may be present in long-term users.

However, the legitimacy of meth mouth as a unique condition has been questioned because of the similar effects of some other drugs on teeth. Images of diseased mouths are often used in anti-drug campaigns.

 ******

EDITOR’S NOTE: I do not know if this is a legitimate picture or not. But, I do suggest that we all “Just Say No to Drugs”. And; as a dental school drop out, I have an affinity for all pro-dentite colleagues.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

***

Product DetailsProduct DetailsProduct Details

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The Opioid Crisis Rising [2000 – 2017]

More Age Groups Affected

[By NIHCM]

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Invite Dr. Marcinko

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Here’s Why Drug-Distribution and Pharmacy Stocks are Bargains Now

On Drug-Distribution and Pharmacy Stocks

Vitaliy Katsenelson, CFA
  Student of Life

These pharnacy stocks are good businesses. In general they have solid balance sheets, above-average returns on capital, and they generate a lot of cash, which is used to pay dividends and buy back stock.

But, these defensive features have not mattered much lately, as we are entering the 10th year of uninterrupted economic expansion.

Accordingly, these companies are significantly undervalued. How under valued? Let’s answer that question by examining two stocks in our portfolio in closer detail.

***

Prescription Pill Bottles

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Here’s Why Drug-Distribution and Pharmacy Stocks are Bargains Now

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

 

The True Cost of Medication Non-Adherence

In the Modern Value-Based-Care Environment

By http://www.MCOL.com

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Product DetailsProduct Details

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What is the “Baltimore Nod”?

Dope Fiends

By Anonymous DEA Agent

DOPE FIEND: A habitual user of a narcotic; slang term.

NOD: To lower and/or raise one’s head slightly and briefly, especially in greeting, assent, or understanding, or to give someone a signal.

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Single Nod

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Group Nod

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Street Nod

***

MORE: https://medicalexecutivepost.com/2012/06/01/video-of-the-new-drug-krokodil-aka-crocodile/

Assessment:

An anonymous DEA agent sent us these pictures. The videas are all over YouTube. So, just say “NO” and don’t do drugs.

NOTE: The nod is not to be confused with TD. Tardive dyskinesia is a disorder that results in involuntary, repetitive body movements. This may include grimacing, sticking out the tongue, or smacking the lips. Additionally there may be rapid jerking movements or slow writhing movements. In about 20% of people, decreased functioning results. Tardive dyskinesia occurs in some people as a result of long-term use of neuroleptic medications. These medications are usually used for mental illness, etc.

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Product DetailsProduct DetailsProduct Details

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Invite Dr. Marcinko

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Medicare Part D – Drug Plan Enrollment

Distribution 2019

By http://www.MCOL.com

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Product DetailsProduct Details

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Prescription Drug Uses and Costs

Seclected Facts: 2015-2016

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Product DetailsProduct Details

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On PBM Business Practices

Unfair -OR- Not?

[By staff reporters]

PBMs, like Prime Theraputics, Optum, CVS/Caremark, Walgreens/prime Mail and Express Scripts, Bring no value but huge expense to pharmaceutical medication prices.

The Trump administration and Congress must repeal the GPO and PBM safe harbor that allows them to extort pharmaceutical manufacturers to the tune of $200 billion a year.

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Assessment:

Your thoughts are appreciated.

Product DetailsProduct Details

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Level 5 Drug Setting and Price Trends

FY:  2009 – 2017

By www. MCOL.com

******

Invite Dr. Marcinko

***

Product DetailsProduct Details

***

 

Geographic Variations in Opioid Prescription Rates

For 2017

By http://www.MCOL.com

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Invite Dr. Marcinko

BUSINESS, ORGANIZATIONAL BEHAVIOR & FINANCE FOR DOCTORS:

THANK YOU

***

On Hospital Prescription Drug Spending

FY 2015 – 2017

By MCOL.com

***

***

Assessment

Your thoughts are appreciated.

RESOURCES:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

***

Product Details

About the Opioid Crisis

And, Drug Distributors

[By Vitaliy Katsenelson CFA]

I don’t know anyone personally who has been affected by the opioid epidemic in the US. And I truly hope I never will. I don’t know if I would be able to maintain objectivity in my analysis of drug distributors and their involvement in this epidemic if I had experienced getting a call at night informing me that my loved one had died from a drug overdose. Drug overdoses killed 70,237 Americans in 2017. Of these deaths, 47,600 (67.8%) involved opioids and 17,000 involved prescription opioids (24% of total overdose deaths). Legally prescribed opioids are killing 47 of us every day.

How did we get here?

According to the National Institute on Drug Abuse: “In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.”

Today pharma distributors are used as scapegoats for the opioid epidemic – not because they are guilty but because they have money and they are “drug distributors.” They are dragged through the same mud as the tobacco companies and British Petroleum (after it spilled millions of gallons of oil in the Gulf of Mexico). Despite negative headlines, we own drug distributors.

Here is why:

They distribute legally prescribed medicine to pharmacies that are approved by several government agencies, including the DEA. Doctors write scripts; pharma distributors order medicine from pharma manufacturers and deliver them to pharmacies. The sad truth about the opioid epidemic is that 21-29% of patients who were prescribed them for chronic pain misused them, and 8-12% of those who received an opioid prescription developed an opioid use disorder.
However, just as truck drivers cannot be held liable for delivering cigarettes to convenience stores, pharma distributors are not manufacturers of drugs and cannot be held liable for the addictive properties of the drugs they distribute or the fact that doctors overprescribe them and patients misuse them.
Also, the DEA should be responsible for limiting the illegal use of opioids. That is its job – DEA stands for Drug Enforcement Agency. It has legal and enforcement resources that distributors lack. And it has a lot more data and tools. Drug distributors do their part and provide data to the ARCOS database that DEA manages.
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drugs
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However, each individual distributor has data only for the drugs it distributes, while DEA has data (which it doesn’t share with distributors) for all opioid sales to pharmacies. The DEA is in a much better position to spot suspicious activity in orders than distributors. The DEA controls how much legal opioid is manufactured in the US every year and has been increasing quotas of opioids produced.
Opioids constitute only a very small percentage of the $450 billion in drugs distributed in the US, and thus incentives for distributors to overdistribute opioids are very limited. Though lawyers and the media keep saying that distributors are some of the largest companies in the S&P 500 by sales, they forget to mention that distributors operate on razor thin margins of less than 2%. Comparing the distributors (not even the makers) of legal medicine, that helps millions of people cope with excruciating pain, to cigarette companies that have a 40% pretax profit margin on a product that doesn’t have a societal benefit, and is almost guaranteed to cause cancer if you use it long enough, creates awesome headlines but has little substance.
  • What if DEA was the one distributing all the opioid drugs to pharmacies instead of McKesson, Cardinal Health, and Amerisource Bergen?
  • Would fewer people get addicted to opioids?
  • Would opioids be less accessible? Remember, DEA sets the production targets every year.
Maybe DEA would catch a few bad actors sooner – it has more data than distributors and a specific skillset and mindset aimed at catching criminals.
But in the big scheme of things, even if DEA distributed opioids nothing would really change. Doctors would still prescribe them; some patients would still get addicted to them … and so on. Distributors will likely settle lawsuits for two reasons:
First, McKesson already settled with the FDA for $150 million for “failure to report suspicious orders of pharmaceutical drugs.”
***
Second, McKesson and other drug distributors don’t want to be involved in costly and protracted litigation. We don’t know how much the settlement will be, but it is very unlikely to be in the hundreds of billions of dollars and likely (see reasons above) to be hundreds of millions or a few billion dollars.
***
Assessment
Today McKessonʻs market capitalization is $25 billion. We think the company is worth at least $50 billion (at 15 times earnings), thus there is a $25 billion of margin of safety. If the lawsuit costs the company less than $25 billion, McKesson will be a profitable investment; if not, then the market is right and we are wrong.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Is AENA – Still Up to Old Tricks?

Dr. Anonymous 

[via staff reporters]

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Determination of Medicare Drug Benefits

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MORE:

CALIFORNIA LAUNCHES INVESTIGATION FOLLOWING STUNNING ADMISSION BY AETNA MEDICAL DIRECTOR

Is Aetna Sucking Up after their Last Big Fiasco?

 

Assessment: Any thoughts?

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Product DetailsProduct Details

 

 

On PBMs [Pharmacy Benefits Management]

Pharmacy Benefits Management [PBM]

[By staff reporters]

DEFINITION:

In the United States, a pharmacy benefit manager (PBM) is a third-party administrator (TPA) of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), and state government employee plans. As of 2018 they have become industrial behemoths in the US health sector.

According to the American Pharmacists Association, “PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.

For the most part, they work with self-insured companies and government programs striving to maintain or reduce the pharmacy expenditures of the plan while concurrently trying to improve health care outcomes”.

DICTIONARY

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Now, read this: https://lnkd.in/eV2q2nB

Assessment

Your thoughts are appreciated.

***

meds

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HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

Product DetailsProduct Details

 

On Thomas Bayes’ Theorem

Courtesy: www.CertifiedMedicalPlanner.org

The Theory of Conditional Probability

In probability theory and statistics, Bayes’ theorem (alternatively Thomas Bayes’ law or Bayes’ rule, also written as Bayes’s theorem) describes the probability of an event, based on prior knowledge of conditions that might be related to the event.

Examples:

For example, if cancer is related to age, then, using Bayes’ theorem, a person’s age can be used to more accurately assess the probability that they have cancer, compared to the assessment of the probability of cancer made without knowledge of the person’s age.

As another example, imagine there is a drug test that is 98% accurate, meaning 98% of the time it shows a true positive result for someone using the drug and 98% of the time it shows a true negative result for nonusers of the drug. Next, assume 0.5% of people use the drug. If a person selected at random tests positive for the drug, the following calculation can be made to see whether the probability the person is actually a user of the drug.

(0.98 x 0.005) / [(0.98 x 0.005) + ((1 – 0.98) x (1 – 0.005))] = 0.0049 / (0.0049 + 0.0199) = 19.76%

Bayes’ theorem shows that even if a person tested positive in this scenario, it is actually much more likely the person is not a user of the drug.

 Assessment

In finance, Bayes’ theorem can be used to rate the risk of lending money to potential borrowers.

MORE: https://www.coursera.org/lecture/combinatorics/bayes-theorem-sqAyt

Conclusion

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Investors Have Misdiagnosed Amazon’s Push Into The Pharmacy Business

Investors Have Misdiagnosed Amazon’s Push Into The Pharmacy Business

By Vitaliy Katsenelson CFA

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Companies everywhere, in every business, are paranoid about Amazon.com. This sort of paranoia is healthy for the long-term well-being of our investment portfolio, as it is creating interesting buying opportunities.

A case in point: My firm spent a lot of time thinking about pharmacies when we were analyzing investments in McKesson and other drug distributors. We struggled with a question: How will the retail pharmaceutical industry look in the future? Or more precisely, how will Amazon’s entrance into the retail pharmacy business change this industry?

Our inability to answer this question kept us away from retail pharmacies. Then we had a small but important insight that shifted our thinking on Walgreens Boots Alliance. The preponderance of drugs in the U.S. is consumed by an older population, whose habits change slowly or not at all. Accordingly, it’s likely that Amazon’s online pharmacy will not significantly impact the existing drug industry.

Here’s why: Americans currently spend $450 billion a year on drugs. Walmart is the fourth-largest pharmacy in the U.S., with sales of $21 billion, or 4.6% of the company’s total sales. Let’s say that over the next five years Amazon gets to Walmart’s sales level of $21 billion. If the U.S. pharmaceutical industry grows 2% a year over that time, total drug sales will have increased by $45 billion, or the equivalent of two Walmarts (we are ignoring compounding here), to $495 billion. Walgreens, with its pharmacy selling about $70 billion a year, would barely notice Amazon’s presence.

I’ve made this point before, but it is important to repeat: 10 years ago Amazon was not taken too seriously. Giants like Google, now Alphabet, and Microsoft ignored Amazon’s entry into cloud hosting, thinking “What does a bookseller know about the cloud?” They have regretted it ever since.

Nowadays everyone is taking Amazon too seriously, bestowing CEO Jeff Bezos with walk-on-water-like superpowers. Boardrooms today are filled to overflowing with chatter about Amazon. There‘s admittedly a lot Corporate America can learn from Bezos (for instance, about ignoring short-term results), but Bezos is not superhuman and Amazon cannot bend the laws of economic gravity.

Walgreens’ U.S. business, which is about 75% of its total sales, is impressive. A single stand-alone store produces revenues of about $10 million a year — $7 million in the pharmacy and $3 million in front-end sales (milk, candy bars, T-shirts, etc.) A single store fills about 121,000 scripts a year (up from 97,000 four years ago). Walgreens has one of the highest sales-per-square-foot numbers in the retail industry, at around $1,000 per-square-foot (compared to Walmart’s $450, Kroger’s $550, and Target’s $300). (Note that Tesco’s U.K. stores have sales per square foot of $1,100 — this is why we like the U.K. grocery business more than ones in the US).

Walgreens also has an underutilized asset: the front end of the store. Think about it: The pharmacy takes up 20% of the floor space but generates 70% of revenue. In other words 80% of the store (the front end) brings in only 30% of revenue. Walgreens is experimenting with different ways to optimize this underutilized asset — it’s opening medical clinics and bringing LabCorp into its stores, for instance.

In 2018 Walgreens bought 1,900 stores from Rite Aid, bringing its total U.S. store count up to around 10,000. Store-count growth days are behind Walgreens, but the scripts-per-store-growth will continue, since baby boomers are not getting any younger. Accordingly, total sales growth will continue at a level of at least 2%-3% a year. When retailers mature and cannot open new stores, their free cash flows explode. Which begs the question, what will Walgreens do with its cash?

Already Walgreens is taking a quite different approach than its largest counterpart, CVS Health Corp. CVS owns one of the largest pharmacy benefit management (PBM) companies (a business that has a lot of political risk, as it’s ridden with conflicts of interest), and CVS is doubling down on complexity and buying Aetna , a health insurance company. CVS is trying to become an integrated healthcare provider. We don’t know if CVS will be successful in this endeavor, but the historical odds of success with acquisitions of this complexity clearly do not favor CVS.

Walgreens is run by Stefano Pessina, who owns 13% of the company; and thus 13 cents of every dollar spent is his. Walgreens has therefore been deleveraging its business, buying back stock, and paying a dividend. Walgreens is expected to earn $6 a share in 2018. My estimate is that earnings, helped by the Rite Aid acquisition, same-store sales growth, and share buybacks (WBA repurchased 8% of its shares in 2018 and has an authorization to buy another 13%), will exceed $8 per share in 2021.

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drugs

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Assessment

If Walgreens shares trade at 13 times its $8 earnings per share in three years, then the upside from here is about 70%; if it trades at 15 times then it’s a double (Walmart trades currently at 18 times estimated 2018 earnings, while Target is at 15 times). We bought Walgreens at a little over 10 times estimated 2018 earnings in July 2018. Walgreens is a better business than Target and at least as good a business as Walmart. At this valuation, heads we win, tails we win — the only question is by how much.

Conclusion

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MORE FOR DOCTORS AND NURES:

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“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Top 15 pharmaceutical products by sales worldwide in 2017

Top 15 pharmaceutical products by sales worldwide in 2017

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Conclusion

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MORE FOR DOCTORS AND NURES:

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“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

Product DetailsProduct Details

Medicare Part D Prescriptions

And … Rebates in 2016

By http://www.MCOL.com

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Conclusion

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DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

Product DetailsProduct Details

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On Un-Necessary Antibiotic Prescribing

The Sixty [60] – Forty [40] – Percent Ratio

By http://www.MCOL.com

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Conclusion

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DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

Product DetailsProduct Details

On Medication Non-Adherence

Data and Analytics Can Make an Impact

http://www.MCOL.com

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Conclusion

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Product DetailsProduct DetailsProduct Details

April 28th., 2018 is National Prescription “Drug Take-Back” Day

Rx Drug Take-Back Day

By Dr. David Edward Marcinko MBA

Today, Saturday April 28th, is National Prescription Drug Take-Back Day. Sponsored by the DEA semi-annually, this is an opportunity to eradicate “rainy day” (when only 2 of the 30 pills were actually taken for a medical condition) dangerous Rx drugs that have been the source of many people’s introduction or continuation of addiction to opioids (Rx and illicit). 

Beyond the need to take these unused drugs out of circulation, they might not even still be appropriate weeks/months/years later for the person for whom they were originally prescribed. Nothing good comes from leaving dangerous Rx drugs unlocked and available for abuse.

While the DEA is advertising it, local communities are the ones that are actually making it happen. It is scheduled from 10-2pm local time on Saturday. I’ve already received an e-mail from my community leaders about their location. Go to www.DEATakeBack.com to identify a collection site closest to you (or your friends or family members).

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/ 

Contact: MarcinkoAdvisors@msn.com

CMP logo

http://www.CertifiedMedicalPlanner.org

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On the Nobel Dr. Jonas Salk

Pioneer and Humanitarian

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/ 

Contact: MarcinkoAdvisors@msn.com

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Product DetailsProduct Details

The Most Prescribed Drugs Today

In the USA

By http://www.MCOL.com

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Conclusion

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Contact: MarcinkoAdvisors@msn.com

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Product Details

The Opioid Crisis: Treating Addiction and Saving Lives

An Audio Webinar

By NIHCM

Transforming Health Care Through Evidence and Collaboration

An estimated 2.1 million Americans have an opioid use disorder, according to the latest national data. Opioid overdose takes the lives of 4.6 Americans every hour. With a crisis of this magnitude, it is easy to lose sight of the fact that effective, life-saving treatments are out there. Medication-assisted therapy and the opioid-reversing drug naloxone, for example, are two highly effective interventions for addiction and overdose, but access barriers persist.

In this part of our opioid webinar series, we explored ways to expand the use of evidence-based treatment, including:

  • Strategies to smooth access to key drug therapies through standing orders to dispense and removal of prior authorization requirements
  • Federal and private-sector initiatives to protect the patients from sub-standard or fraudulent addiction treatment
  • A multi-sector collaboration to adopt principles of care for substance abuse treatment and to help practitioners stay abreast of the evidence
  • Ideas for using pharmacy data to identify potential abuse and for deploying telehealth technology to improve access to treatment

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Who Pays for your Medication?

Understanding the Supply-Chain Management [SCM]

By Business Inside

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Conclusion

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Contact: MarcinkoAdvisors@msn.com

https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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Survival Trends for GI Cancers

Five Years Trends

By http://www.MCOL.com

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Conclusion

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Contact: MarcinkoAdvisors@msn.com

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Prescription Drug Spending for Commercial Plans

FY 2017

By http://www.MCOL.com

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Conclusion

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On Drug Overdose Deaths

2016 – 2017

By http://www.MCOL.com

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Conclusion

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***

On Medication Therapy Management (MTM)

What it is – How it works

By wikipedia

DEM 2

David Edward Marcinko

http://www.HealthDictionarySeries.org

Medication therapy management (MTM) is medical care provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients.

Eleven national pharmacy organizations adopted this definition in 2004. Medication therapy management includes a broad range of professional activities, including but not limited to performing patient assessment and/or a comprehensive medication review, formulating a medication treatment plan, monitoring efficacy and safety of medication therapy, enhancing medication adherence through patient empowerment and education, and documenting and communicating MTM services to prescribers in order to maintain comprehensive patient care.

Core Elements

Medication therapy management includes five core components: a medication therapy review (MTR), personal medication record (PMR), medication-related action plan (MAP), intervention and/or referral, and documentation and follow-up. A MTR is a systematic process of collecting patient and medication-related information which occurs during the pharmacist-patient encounter.

In addition, the MTR assists in the identification and prioritization of medication-related problems. During the MTM encounter, the pharmacist develops a PMR for use by the patient. The PMR includes all prescription and nonprescription products and requires updating as necessary. After assessing and identifying medication-related problems, the pharmacist develops a patient-specific MAP. The MAP is a list of self-management actions necessary to achieve the patient’s specific health goals.

Moreover, the patient and pharmacist utilize the MAP to record actions and track progress towards health goals. During the MTM session, the pharmacist identifies medication-related problem(s) and determines appropriate intervention(s) for resolution. Often, the pharmacist collaborates with other health care professionals to resolve the identified problem(s). Following the patient encounter and/or intervention, the pharmacist must document his/her encounter and determine appropriate patient follow-up.

Pharmaceutical care  defined 

Hepler and Strand define pharmaceutical care as the provision of drug therapy in order to achieve definite outcomes that improve a patient’s quality of life. Outcomes include cure of a disease, elimination or reduction of a patient’s symptoms, arresting or slowing of a disease process, and preventing a disease or symptom. The process includes pharmacist collaboration with other health care professionals in designing, implementing, and monitoring a therapeutic plan for a patient. Pharmaceutical care focuses on the pharmacist’s role in achieving therapeutic goals to improve the patient’s quality of life.

MMA of 2003 – Part D

The Medicare Modernization Act of 2003, requires Medicare Part D prescription drug plans to include medication therapy management services delivered by a qualified healthcare professional, including pharmacists, beginning in 2006. MTM services target beneficiaries who have multiple chronic conditions (such as diabetes, asthma, hypertension, hyperlipidemia, and congestive heart failure), take multiple medications, or are likely to incur annual costs above a predetermined level.

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Assessment

Medication therapy management is a unique niche for the pharmacy profession, allowing pharmacists to apply their extensive medication knowledge as medication experts with the intent of improving patient outcomes.

Conclusion

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***

On consumer DNA testing

Two states still resist consumer DNA testing

[By MIT Technology Review]

Earlier this month, 55,000 football fans were to receive a giveaway at a Baltimore Ravens game: not a T-shirt or a beer koozie, but a free DNA test. Ultimately, though, Maryland laws nixed the stunt.

Ronni Sandroff explains why.

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https://www.consumerreports.org/cro/news/2010/09/who-owns-your-dna/index.htm

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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When a Drug Coupon Helps You but Hurts Others

When a Drug Coupon Helps You but Hurts Others

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https://theincidentaleconomist.com/wordpress/when-a-drug-coupon-helps-you-but-hurts-others/

Conclusion

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Contact: MarcinkoAdvisors@msn.com

On Unfilled RXs in the USA

Respondents Poll

By http://www.MCOL.com

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Conclusion

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Contact: MarcinkoAdvisors@msn.com

***

On Serious Medication Errors at Home

Circa 2000-2012

By http://www.MCOL.com

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Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Chance of leading Pharma companies producing a successful app has decreased from 2.0% (2014) to 0.5% (2016)

Pharma Report Findings

By David Ireland Berlin

[Research2Guidance ]

Leading Pharma companies continue to struggle to gain significant reach (downloads) within their target groups. While companies have cumulatively over doubled their number of active apps available on Apple App and Google Play stores (2014 – Q1 2017), most have added to the growing tail of under performers.

Why is it that Pharma companies continue to struggle in mhealth?

Have they showed other signs of improvement within their app portfolios, or through 3rd party digital eco-systems?

Only 0.5% of all apps published by the leading 12 Pharma companies have managed to achieve annual downloads of over 100K; one of the major findings from the recently published, 2nd edition Pharma App Benchmarking 2017 report by Research2Guidance.

The report builds on figures identified from the previous edition, released in 2014. It also explores the leading 3rd party digital innovation strategies, their components, and their successfulness in terms of benefits (ROI, reach etc.). While companies have on average increased their app portfolio sizes from 65 to 153, average per app annual downloads remain low at just 3.3K.

Here are three of the main reasons why:

1. Companies are competing against a growing number of mhealth competitors. According to the 2016 mhealth Developer Economics Report, there were 290K mhealth apps listed on major app stores, an increase of +174K since 2014. Annual mhealth app download growth rates are also decreasing, adding to the growing pressure.

2. Pharma app portfolios have a narrower target audience than their mhealth competitors. App portfolios of Pharma companies differ from the average mhealth app portfolio in the greater degree to which they supply apps for HCP use cases. When comparing the app categorization differences between Pharma and mhealth, Pharma tends to target a greater share of patients over healthy individuals. This in turn decreases their potential target audience, making it harder to generate downloads.

3. Apps, on average, still fall behind their mhealth competitors in terms of product quality. Pharma app portfolios are not achieving the reach and retention experienced by the average mhealth provider. Inconsistencies of design elements and cross-referencing between apps are still far too common, and continue to let Pharma app quality down.

With the hype of, for example, Artificial Intelligence (AI), Augmented Reality (AR), Virtual Reality (VR), connected devices and sensors mounting throughout the digital health industry, consumers are simply demanding more usability from their mhealth products and services.

Life-Cycles

Traditional Pharma product production life-cycles are simply incompatible when dealing with their digital offerings, given the rate of technological change. However, there are a few instances whereby Pharma companies have achieved some success with their internal app publishing.

Johnson&Johnson for example have published three of the five most downloaded Pharma apps for 2016; J&J Official 7 Minute Workout and onetouch Reveal. All three achieved over 200K downloads for 2016. The success of their leading apps has improved their portfolios overall performance in comparison to 2014.

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All leading Pharma companies have grown their internal app portfolio size since 2014, and all but two (Abbott and Sanofi) have increased their reach.

However, thanks to the growing app portfolio size of Bayer and Novartis, and the high downloads of J&J, half of the leading Pharma companies have portfolios that fall below the average-lines. Previously, this was the case for five companies.

Taking J&J as an example, the success of a mere two or three apps can result in Pharma app market leadership.

Take Sanofi as another example. With the hype of Sanofi’s previous most downloaded app coming to an end (GoMeals), their internal app portfolio has experienced a significant decrease in annual downloads in comparison to 2014. Their portfolio has now fallen to 4th place in terms of reach behind J&J, Bayer and GSK. Novartis, Sanofi and Bayer have made the most significant strides in their app publishing activities, but are not seeing the ROI in the way of market penetration.

The newly released Pharma report goes into more company level detail on supply and demand from a platform, category, use-case and user-retention perspective. The report also analyses the 3rd party digital eco-system activities and strategies of these companies. Some appear to be relying more heavily on their 3rd party channels to source digital innovation than others, and their achievements to date give insight into which channels create the most potential for overall benefit to the Pharma company. These benefits can range from, for example, brand image improvement, digital innovation adoption, and new product distribution channels.

Assessment

Find out more about the app portfolios and digital strategies of leading Pharma companies by downloading your copy of the report today. Click here to find out more about what’s inside.                                                                                                          

Conclusion

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The Future of Pharma?

The Top 10 Trends Shaping the Future of Pharma

 

 

 

By Bert Mesko MD PhD

The drug sends a message to a caregiver after the patient swallowed it. The doctor prescribes virtual reality treatments for migraines.

Do you think it is science fiction? You are mistaken. Just let me familiarize you with the top 10 trends shaping the future of pharma. Read more.

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Conclusion

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Doctors and Drug Addiction

Doctors and Drug Addiction

via Michael Langan MD

This article originally appeared on http://www.DrugRehab.com, a web resource provided and funded by Advanced Recovery Systems (ARS).

Their mission is to equip patients and families with the best information, resources, and tools to overcome addiction and lead a lifelong recovery.

This article has been reproduced with permission. For more information, please visit their site.

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 Doctors and Addiction

Conclusion

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Prescription Drug Utilization Market Share

Brand V. Generic Drugs

By http://www.MCOL.com

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Conclusion

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Prescription Drug Pricing, Spending and Utilization Trends

US Statistics

By http://www.MCOL.com

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Conclusion

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Pharmaceutical Stocks in the Post-Trump Era?

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By Vitaliy Katsenelson CFA

vitaly

Trumps Hates Them – We Love Them

 Originally written for Institutional Investor Magazine
 A few weeks after Donald Trump was elected president of the United States, he was asked about pharmaceuticals prices. With typical rhetorical gusto, he declared, “Pharmaceutical companies are getting away with murder.” Well, my firm has been increasing our allocation to those “murderers,” and despite Mr. Trump’s comments, we are very comfortable with our positions in the long run (which lies beyond what may end up being a very volatile short run).

Big Pharma

Pharmaceuticals companies check off a lot of boxes in our quality and growth dimensions. They are usually monopolies or oligopolies when it comes to their specific drugs; they have high recurrence of revenue; their business is not cyclic and thus marches to its own drummer; they have strong balance sheets and a high return on capital, and generate a lot of cash flow; they benefit from a significant growth tailwind as the global population ages (I aged just while writing this); and they enjoy pricing power (more on that later). Yet the pharmaceuticals sector as a whole has been decimated over the past eight months due to perceived political risk — first by pharma pricing critic Hillary Clinton’s “It’s in the bag” expectation of victory and then by Trump’s “They get away with murder” comments. We view the carnage created by the political risk as an opportunity to increase our exposure to this sector. Here is why.

President Trump mentioned that he wants the U.S. government — mainly, its Medicare program — to negotiate directly with drug-makers on price. His remark may create the impression that pharmaceuticals companies today charge the government whatever prices they want. That is not the case. Medicare covers prescription drug costs through a program known as Medicare Part D. Medicare basically outsources the negotiation of drug prices to pharmacy benefit management (PBM) companies such as CVS, Express Scripts, and UnitedHealth Group (a health insurance company that owns its own PBM). In fact, less than a handful of PBMs control this market and so exercise tremendous pricing power; thus the government is already negotiating with pharmaceuticals companies.

The Stats

Here are some useful stats about this market: As of the end of 2015, 290 million Americans had health insurance. Among them, 214 million had private insurance and 52 million were insured by Medicare. Medicare insures a lot of people; however, UnitedHealth — a company whose business model relies on paying as little as possible for prescriptions — insures 70 million Americans and thus already has greater bargaining power than Medicare.

But let’s say President Trump gets his wish, the law is changed, and the government bypasses PBMs and starts bargaining with Gilead Sciences, Amgen, and Allergan directly — the Trump take-no-prisoners approach. Let’s even assume that President Trump’s ingenious negotiating techniques result in a 20 percent concession on price. Since Medicare represents only 18 percent of the total insured population, the net impact on pharmaceuticals companies’ revenue would be 3.6 percent. That’s a small pimple that they’d be able to cover up by raising prices 4 percent on the remaining 82 percent of payers.

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drugs

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Europeans and Canadians

The reality is that the reason Europeans and Canadians are paying much lower prices for their prescriptions is that they have a single-payer system, and thus pharmaceuticals companies are bargaining not with four or five entities but with one: the government. At this stage, however, it is very unlikely that a Republican president and Republican-controlled Congress will move this country to a single-payer system.

If the U.S. starts allowing re-importation of pharmaceuticals from Canada and Europe — another threat made by our president — then American companies will simply start raising prices outside of the United States.

Finally, let’s remember an important but often forgotten fact: Donald Trump is the president of the U.S.; he is not its king and doesn’t have the powers of one. Although we expect his tweets and other remarks to create additional volatility, they will not necessarily have a symmetrical impact on pharmaceuticals companies or whatever other businesses he tweets about.

Assessment

We have taken advantage of price weakness and added to our positions in Amgen (analysis here), Allergan (analysis here), and Gilead (analysis here). We also bought some new positions. Stay tuned for next week, when I’ll reveal those names.

Conclusion

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Birth of “Addiction Medicine” as a New Discipline

The Need for an in Utero Diagnostic Assessment Prior to Delivery

By Michael Lawrence Langan MD

One thing is for certain.

When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.

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Carl Sagan’s Baloney Detection Kit and the Birth of “Addiction Medicine” as a New Discipline: The Need for an in Utero Diagnostic Assessment Prior to Delivery — Disrupted Physician

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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