Are you getting the best price for your prescriptions? Some strategies to pay less


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News that DepoMed, Inc . (NASDAQ: DEPO) might entertain offers from potential acquirers sent shares in the company soaring last Friday. Could shares continue to go higher? Or is the company’s current $1.5 billion market cap fair? Read on to get a better idea of what an acquirer would get in a DepoMed acquisition and what they might be willing to pay.
Jousting with management
After being out-bid by DepoMed in its attempt to buy Johnson & Johnson ‘s opioid pain medicine Nucynta last spring, competitor  Horizon Pharma  crunched the numbers and tried to buy DepoMed last summer.
Horizon Pharma made DepoMed three offers, including a final $33 per share bid, before DepoMed’s board finally rejected them. However, growing concern over opioid abuse has caused DepoMed’s shares to decline since then, and that’s got activist investors lobbying for the company to change its mind and embrace a deal.
Jeffrey Smith, who is at the helm of Starboard Value L.P., an investment management partnership, has been especially critical of DepoMed’s board. In April, Starboard Value L.P. disclosed a nearly 10% stake in DepoMed, and since then, Smith has sent no fewer than three letters to shareholders calling for changes to DepoMed’s board of directors.
What’s in play?
DepoMed’s crown jewel is Nucynta, a nine-figure pain medication that’s DepoMed’s best-selling drug. After acquiring Nucynta from J&J last year, the company relaunched it with a new price and a tripling of its sales force, and those efforts have paid off with spiking sales and prescription volume. In Q2, Nucynta’s sales totaled $72 million, and prescription volume for Nucynta ER, the extended-release version, were at a record high in June.
DepoMed recorded $274 million in Nucynta sales in the past year, up 59% from the amount J&J hauled in from the drug during the comparable period the year before. Second-quarter prescriptions of Nucynta ER finished June up 26% year over year, and prescriptions for Nucynta’s immediate release version have started growing again for the first time since 2011.
Clearly, DepoMed’s promotion strategy is resonating with prescribers and patients, but management still thinks there’s more runway ahead. The company hasn’t increased Nucynta’s price yet this year, and if it does, that could add some momentum into year end. More importantly, Nucynta’s market share of the pain market remains tiny, suggesting it could make big inroads still against market share leader Oxycontin.
In addition to Nucynta, an acquirer would also get shingles pain medicine Gralise, with annualized sales of $96 million, migraine drug Cambia, with $30 million in annualized sales, fentanyl spray Lazenda, with $25 million in annualized sales, and pain medicine Zipsor, which is selling at a $25 million annualized clip.
What’s it worth?
It’s anyone’s guess what price DepoMed could fetch in an outright bidding war, but it wouldn’t be unreasonable to think that any deal that gets done would happen at a price that’s north of where shares are trading today.
The company has stepped back from prior projections for $500 million in Nucynta sales by 2018, but it hasn’t abandoned projections that Nucynta has a billion-dollar per year blockbuster sales potential. In July, DepoMed measured Nucynta’s market share at a paltry 1.95%.
Since Nucynta’s prescription volume and sales are growing while competitors are struggling, it’s not hard to see why management’s so bullish — and an acquirer might be willing to pay up, especially if the company can demonstrate that Nucynta is a better and safer alternative to oxycontin.
DepoMed reports that only 5% of Nucynta patients experience withdrawal following abrupt discontinuation, and evidence suggests Nucynta isn’t subject to the same level of dose-creep as other opioids, a sign of opioid misuse. Nucynta also maintains preferred tier 2 status on both Express Scripts and CVS Health ‘s drug formularies, suggesting that pharmacy benefit managers believe it offers good value.
Assuming an acquirer is willing to pay three to five times sales, Nucynta’s current sales pace suggests Nucynta is worth at least $1.2 billion all by itself. Applying a similar multiple to the company’s other drugs, which are selling at an annualized $176 million clip, suggests an acquirer could be willing to pay an additional $500 million for them, too. Combine those figures together, and we get a starting point of $1.7 billion, which is about 12% higher than shares are currently trading.
Clarity coming
An acquirer, however, could be willing to pay much more than that if a patent decision expected later this month goes DepoMed’s way. If management nets a favorable patent ruling, Nucynta will be protected until 2029, if not, Nucynta could lose patent protection in 2023.
Since a patent win could provide clarity deep into the next decade, an acquirer might be willing to boost the multiple to sales to reflect a much higher peak sales forecast for the drug. If that’s the case, an offer north of $2 billion wouldn’t seem crazy to me.
Nevertheless, there’s always a risk that drugmakers will stay on the sidelines because of concerns over the opioid abuse problem, and if patents don’t go DepoMed’s way, no suitors may emerge. For that reason, investors shouldn’t buy DepoMed shares simply because they think it may get bought. Instead, they should focus on DepoMed’s potential as a stand-alone company. Since the company is well-capitalized and already profitable (industry watchers expect EPS to grow from $1.21 this year to $1.49 next year), I think a good argument can be made for buying this company regardless of the M&A potential — especially if patents are upheld. Todd Campbell has no position in any stocks mentioned.  Todd owns E.B. Capital Markets, LLC. E.B. Capital’s clients may have positions in the companies mentioned. Like this article? Follow him on Twitter, where he goes by the handle @ebcapital   to see more articles like this.
The Motley Fool recommends Johnson and Johnson. Try any of our Foolish newsletter services free for 30 days . We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy . The Motley Fool is a USA TODAY content partner offering financial news, analysis and commentary designed to help people take control of their financial lives. Its content is produced independently of USA TODAY. Offer from the Motley Fool: A secret billion-dollar stock opportunity

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Filling a prescription is pretty simple. In some states, including Maine, Minnesota and New York, your doctor electronically files the order. Elsewhere you bring the doctor’s scribbled instructions to a pharmacist.

Except that maybe it’s not so simple. Maybe there is a cheaper medication available that would do the same job. In that case, why doesn’t your pharmacist tell you?

Because in many states, your pharmacist operates under a contract that forbids telling you about less expensive alternatives.

“Every time a pharmacist dispenses a medication, they know a lot about other medications for sale that aren’t necessarily related to that person’s health plan,” said Shawn Bishop, vice president of programs that control health care costs and advance Medicare at the Commonwealth Fund. (The Commonwealth Fund is a health care policy research organization.)

Bishop compares buying a prescription drug to shopping for a sweetener.

“You can use a brand name like Domino sugar, or the supermarket’s house brand, which is a bit cheaper,” she said. “You could use stevia or another sugar substitute.”

Just imagine, though, that your supermarket steers you only to the name brand without mentioning any of the options.

“Pharmacists are the experts on these medications,” Bishop said. “They’re trained in the chemical properties of drugs and their interactions.”

More: Opioid epidemic: New laws restricting prescriptions go into effect in three states

More: One-third of adults in U.S. taking drugs that may cause depression, study finds

More: Drug makers called out for delaying generics have cost Medicare and Medicaid billions

Generics help cut costs

The explosion in generic drugs — now at about a 90 percent dispensing rate — came in the wake of the 1984 Hatch-Waxman Act, Bishop explains, which was intended to encourage the manufacture of generic drugs.

“It literally went from 20 percent or so in the 1980s,” Bishop said.

But the language in some contracts prevents pharmacists from mentioning these alternatives. “Except for generics, pharmacists are not allowed to consult on other available products,” Bishop said.

Sometimes called “gag rules,” contracts between pharmacists and pharmacy benefit managers — who work on behalf of your company’s health plan — use boilerplate language to prevent a pharmacist discussing lower-cost alternatives.

The benefit manager creates the formulary of drugs on the health plan, usually in three cost tiers. The conflict arises when the benefit manager gets a rebate on brand-name drugs, said Bishop.

Tiered copayment can help rein in drug costs, but sometimes a copay is higher than the cash cost of the drug, according to Bishop. The rebates are cause for concern.

“Every time you have a rebate, there should be some raised eyebrows,” Bishop said. “There is a conflict when you get a rebate from the manufacturer.”

This conflict caught the attention of the Trump administration, which issued in May a blueprint to lower drug prices. The memo targets drug companies for keeping lower-cost drugs out of the market and cites the lack of transparency in drug-pricing benefits, among other issues.

More: Drug makers called out for delaying generics have cost Medicare and Medicaid billions

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Female pharmacist hands female customer prescribed drugs

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Ask your pharmacist

Consumers need to learn to ask questions when they have their prescriptions refilled, Bishop says. Ask for lower-cost alternatives, even if they aren’t related to the consumer’s plan.

Mark Merritt, president of the Pharmaceutical Care Management Association, which represents America’s pharmacy benefit managers, says the association is opposed to these contractual clauses.

The PCMA says in a statement it supports the patient always paying the lowest cost at the pharmacy counter, whether the cash price or the copay. “This is standard industry practice in both Medicare and the commercial sector,” the organization said.

Merritt recommends three strategies to get the lowest prescription prices. “First, make sure you understand your pharmacy benefit and your insurance plan,” Merritt said.

People aren’t always aware that different drugstores may charge different prices, and that goes for copays, too. “Always shop around,” Merritt said.

Next, talk with your physician about your prescriptions to make sure you are taking the most affordable drug, and that your prescriptions don’t duplicate each other.

If you’ve been on a drug for many years, generics or other suitable drugs may have come onto the market, Merritt says.

You can also consider home delivery.

“Often that is much less expensive and (people) can save three trips to the drugstore,” Merritt said. Home delivery orders generally offer a 90-day supply.

Seniors who use Medicare’s most popular plans use preferred pharmacy networks, Merritt says, another way to save money. These are discount pharmacy networks that yield bigger savings when you go to specific stores that have discount drugs for a plan.

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