Treb schreef op 12 november 2015 16:30:
In juli was Fagron volgens industrie kenners nog geen onderdeel van het onderzoek en nu nadat het onderzoek maanden gaande is ondertussen dus wel. Onwaarschijnlijk dus dat het pas een eerste inventarisatieronde in het fraude onderzoek is.
www.valueinvestorsclub.com/idea/Fagro..."
There are two reasons:
The first is that the PBMs manage drug spending for insurers based on specific terms, so when they implement new cost management plans like they're doing for compound drugs they need to sign up the individual insurers. ESI only started implementing their plan in 4Q14 and by the end of the year they had signed up only 60% of clients. While this did affect compound drug spending it only slowed the increase in spend from 276.9% y-o-y for the first 3 Qs to 128.4% y-o-y for the 4th Q. This year ESI expects spend to decline 45% as those who have signed up enjoy a full year of savings, and other plan sponsors also sign up. ESI is about 1/3rd of the market, and has been a leader in compound drug spending management. So the rest of the PBMs are behind this schedule, but the majority are also making strong efforts here.
The second reason is that the compound pharmacies are shrewd and they're engaging in some pretty sleazy sales practices to avoid the compound management programs.
Read the following document, which describes the Department of Defense's compound spending, and you'll see that their spend on compound drugs increased 100x from '04-'14, and is on pace to quadruple in 2015 but this is something that they are currently furiously addressing. The government is obviously much slower to cut inefficient spending and change benefits so hopefully the majority of payers have already gotten onto the right programs:
c.ymcdn.com/sites/www.iacprx.org/reso...Speaking with industry insiders, I've heard that prices on the retail side, especially in pain, are definitely coming down now. Furthermore, a number of compound pharmacies are shutting down because they can no longer get reimbursed for most of what they do and this obviously affects Freedom, Fagron's main wholesale business in the US, (which was ~10% of total group sales in 2014 and a big growth driver).
Another thing that I've been hearing is that a number of compound pharmacies have begun receiving letters from the DOJ notifying them that they're being investigated for fraud for knowingly billing for drugs that weren't medically necessary. I haven't heard anything about this affecting Fagron on the retail side, but on the wholesale side it'll certainly reduce their customer pool. The government is also doing similar investigations as it relates to Tricare (the DoD healthcare plan) and I've heard this could directly affect Fagron."