The tangled web we weave… Enactment of the Inflation Reduction Act (“IRA”) was a long winding road. IRA opens the proverbial door to a new frontier of complex prescription drug provisions with far-reaching implications. For the first time in history, the federal government will negotiate prices for high-cost drugs covered under Medicare. Medicare price increases [...]
The implications of the cumulative effect of multiple GTN adjustments resulting in negative net sales and unprofitable prescriptions are far-reaching. Pharmaceutical companies may need to refine physician targeting and salesforce incentive programs to avoid a disproportionate number of underwater unprofitable prescriptions. Examples of Unprofitable Prescriptions Commercial Rebates Coupled With Copay Buydown A $600 copay buydown [...]
We are getting older. Approximately 46 million of the more than 62 million Medicare beneficiaries are enrolled in the Part D federal-government program to help pay for self-administered prescription drugs. The number of enrollees more than doubled since the inception of the program in 2006. Branded pharma companies are required to pay a government rebate [...]
Pharma companies prefer stable predictable sales and earnings growth. Unexpected material GTN true-up adjustments results in earnings volatility and may significantly impact the stock price. A disappointing surprise occurred in the fourth quarter in the example depicted below due to true-up adjustments for higher commercial rebates, more Medicaid & 340B business and unanticipated levels of [...]
Pharmaceutical manufacturers have a funnel, depicted below, clogged by escalating gross-to-net (GTN) reductions. GTN Sales Funnel Components of the GTN Sales Funnel are as follows: Gross Sales at a drug’s Wholesaler Acquisition Cost (WAC). Note that gross sales are for prescriptions filled representing prescriptions written less reductions attributable to payer restrictions, patient abandonment due to [...]
