It will be just as much a year of change for the pharmacy market as it will be for physicians and provider networks. Many of the same market pressures on providers are bearing down on pharmacies as well, including the challenges of more collaborative care, squeezed margins and the transformation toward value-based care.
We asked four pharmacy industry leaders for their perspectives on the year ahead, and here’s what they shared:
Lawrence Irene, CEO, Asembia:
“With the tremendous advances in treatments and rapid growth of Specialty Pharmacy, we truly feel that the need for managing patient care throughout the course of therapy will never be greater. Asembia is dedicated to working with our industry partners to enable the best patient outcomes. Moving forward, technology solutions, including data management and collection, represent the biggest challenge and opportunity for the Specialty Pharmacy industry. We are investing vast resources in the technology space to ensure that Asembia’s total channel management solutions address the evolving needs of Specialty Pharmacy patients.”
Jayson Slotnik, Health Policy Advisor, National Association of Specialty Pharmacy, and Partner, Health Policy Strategies:
“Specialty pharmacies anticipate many changes in the market for 2017. For example, the industry is quickly transitioning from a drug revenue model to a quality of care model. This transition is good for patients as competition based on quality of care provided must be the focus. On the flip side, the industry is also facing a dramatic increase in network participation fees, which in a consolidating market is rapidly forcing some specialty pharmacies to forgo certain lines of business creating narrow networks for patients. While narrower networks may help reduce financial costs in the short term for the system, it comes at the expense of choice and reduced opportunity for specialty pharmacies that could lead them out of business. The market will eventually circle around to actually increased costs due to lack of competition.
“For 2017, the biggest challenge for specialty pharmacies is also their opportunity. The industry’s opportunity is to further educate and promote the value that specialty pharmacies bring to all aspects of the healthcare system—physicians, payers and most importantly patients. In a year of change, many ideas and approaches will be proposed and discussed on how to improve access to healthcare while improving the value of the care provided. For specialty pharmacies, this is an ideal opportunity to be at the center of the discussion because of they are part of the solution due to services they provide and their role in patient care while reducing costs.”
Rashmi Grover, Pharm D., Director, Specialty Manufacturer Services, CVS Specialty™:
“There are several trends and market forces that have emerged in recent months that will continue to impact Specialty pharmacy over the course of 2017. One market force which has traditionally been present in pharmacy but is relatively new to the Specialty space is availability of less expensive medication substitutes. While typically seen as FDA-approved interchangeable generic products in the non-Specialty space, the substitution becomes more complex for traditional pharmacy medications such as biologics. Here we are seeing an increased pipeline for biosimilars, which would allow the product to be highly similar to an FDA-approved biological product. However, it is yet to be seen how many of these would apply for approval to be an interchangeable biologic. Approval with or without interchangeability could have significant impact to how well prescribers embrace the new products and the amount of utilization we see.
“A second impact for 2017 is potential review and refinement of the definition of a Specialty product. In the past couple years and in the upcoming pipeline, we see products for conventional disease states moving into the Specialty pharmacy space. Recently released products have treated disease states with larger patient populations, including hypercholesterolemia and migraines. In the near future, there will be higher volume specialty products emerging for the treatment of type 2 diabetes, atopic dermatitis and NASH (nonalcoholic steatohepatitis). The Specialty pharmacy high touch model combined with larger patient volumes can result in significant margin compression and, at times, negative margin.
“One of the biggest challenges Specialty pharmacy will face in 2017 is the ongoing increased cost burden on payors and patients. Introduction of novel agents to treat orphan disease states, advances in drug development for existing Specialty conditions, and introduction of Specialty treatments for conventional therapies have led to overall increased payor and patient cost responsibility. In order to contend with the increasing cost trends, we anticipate seeing innovative approaches to manage drug spend including value-based insurance designs for coverage and reimbursement percentages.
“The biggest opportunity Specialty pharmacy providers have in 2017 is offering solutions that deliver improved medication adherence. Countless studies have demonstrated that adherence is a critical driver to not only improve patient treatment outcomes, but also avoid unnecessary medical costs. Driving medication adherence has been a constant challenge, whether the medication is Specialty or traditional and different programs have been continuously developed to assist patients with improved adherence. In fact, the pipeline diabetes Specialty product takes a traditional oral medication and places it into a subdermal insert with the intent of improving adherence and thus minimizing diabetic complications. The recent Medicare Advantage Value-Based Insurance Design Model that is being piloted in several states offers reduced cost sharing for enrollees who participate in disease management programs. This is another testament to the commitment and value of improving patient medication adherence.”
Beth Measley, Specialty Pharmacy Coordinator, Lifespan Pharmacy:
“Because we are a large academic medical center, the recent surge in specialty medication prescribing has impacted us in many ways and has significantly enhanced our opportunity to provide personal, coordinated, high-quality care for our patients.
“Unlike most traditional prescriptions, specialty medications require a well-coordinated effort between pharmacists, physicians, nurses, allied health professionals such as nutritionists, and of course, the patient and caregiver. We all need to work together to ensure the patient has timely access to treatment and that the treatment is safe and effective. Patients also need comprehensive teaching prior to starting their medication, followed by continuous monitoring and clinical outreach throughout the treatment.
“To meet the clinical needs and increased collaboration, we have expanded our clinical pharmacy services to most of our ambulatory specialty clinics, including oncology, transplant, hepatitis, rheumatology, and dermatology. Since our specialty pharmacy is based within our health system, we are able to integrate the clinical pharmacist directly into the clinic setting, where they can meet with the patient in person and work side-by-side with other providers, who have full access to the patient’s electronic health record, including lab results and physician notes. These improvements to our practice model, and the growth in specialty pharmacy, have significantly enhanced the level of pharmacy services and overall care we provide for our patients.
“Insurance networks have been and continue to be a challenge. Many insurance providers still require a designated specialty pharmacy for their patients. These pharmacies are usually out of state, and the pharmacists do not have access to the patient’s electronic health record. Without ready access to the providers or relevant clinical information, such as the patient’s lab results, their ability to perform clinical monitoring for toxicity and effectiveness is limited. Our clinic-based pharmacists will still work closely with the patient, even if we are not dispensing the specialty medication, but they are also limited in monitoring without access to prescription fill and refill history. On a positive note, providers and patients and caregivers have embraced the benefits of clinic-based specialty pharmacists and, through the continued growth of our ambulatory care services, we will continue to enhance the level of care for our patients receiving these high-cost, high-risk medications. “
These experts agree that the pharmacy market has a significant role to play in creating a more collaborative model of care, particularly in the types of high-touch therapies provided by specialty pharmacies. The coming year will bring expanding opportunities for pharmacy to highlight the critical role they play in improving patient care while reducing costs.