Takeaways from NASP: The State of Pricing Reform Efforts and AI Decision Support in Specialty Pharmacy

The National Association of Specialty Pharmacy (NASP) held its 7th Annual Meeting and Expo in September as experts throughout the industry discussed the rapid developments in specialty pharmacy, including national legislative and regulatory policy, and shared the latest on innovations that will improve care for complex patients.

NASP’s annual meeting is one of the industry’s only conferences where all stakeholders can fully participate. This year, the meeting welcomed more than 1100 attendees to Washington DC. Despite the growth in attendance, the conference has retained a boutique-like atmosphere that easily lends to meeting with colleagues and partners.

As a member of the Excelera Network, for example, we were able to spend time with our health system specialty pharmacy colleagues to discuss a variety of topics at the top of mind for this sector of pharmacy.

At the event, NASP presented two highly anticipated industry awards, the Distinguished Service to Specialty Pharmacy award and the Specialty Pharmacy of the Year award. Tim Safley, clinical manager at the Accreditation Commission for Health Care, Inc, received the Distinguished Service to Specialty Pharmacy award. The honor recognized his exceptional and sustained leadership within the Specialty Pharmacy industry and NASP.

Fairview Specialty Pharmacy, another member of the Excelera Network, was honored with the Pharmacy of the Year award for the organization’s commitment to patient satisfaction, cost management, community involvement, and patient engagement.

NASP continues to offer learning opportunities to improve patient-centered care and adapt to rapidly changing science and industry. Here are a few of the sessions that caught my attention, along with my takeaways:

Science and Innovation in Specialty Pharmacy

Of interest in the domain of science was the following session, which explored the current state of artificial intelligence (AI) in pharmacy:

Title: Innovation in Specialty: Pharmacogenetics, Artificial Intelligence, and Beyond

Speakers: Rebecca L. Bigler, Phd, chief scientific officer, Therapeutic Genetics Consulting Associates; Cory Kidd, PhD, founder and CEO, Catalia Health; and Luis Rodriquez, president, KeyCentrix, LLC.

During the session, the speakers explored the emergence of AI decision support and the enormous potential the application holds in pharmacogenomics to improve patient outcomes and reduce waste. Patient response to treatment is complex, involving genetic, medical, and environmental factors.

The influence of genetic variation on a patient’s response to a drug is relevant when considering mechanism of action, genotype, metabolism and risk for adverse events, including fatal anaphylaxis. With access to a wealth of deidentified patient data, AI algorithms may eventually help prescribe medication and treatment plans based on data from the successful outcomes of patients with similar conditions and genetic makeup.

In pharma, AI also has applications to drug discovery, clinical trials, insurance benefit design and management, prescribing, and patient care. AI continues to evolve as a valuable tool to augment decision-making and patient care.

As AI’s role in specialty pharmacy continues to grow, the role of specialty pharmacists will evolve to include genomic and AI-driven information, while maintaining clinical oversight and the critical human interaction provided by direct patient care and support.

Health Care Reform and Controlling Costs

Within the pharmacy industry, payment reform efforts have been garnering support. In an environment of competing interests, the eventual outcome will have major implications, especially for patient out-of-pocket costs. Two sessions at NASP offered insight into the status of reform within the administrative and legislative branches of our government:

Title: NASP in Action

Speakers: Julie Scott Allen, senior director of Governments Affairs, Powers Pyles Sutter & Verville PC; Nick Calla, RPH, Esq, vice president, Pharma Relations, BioMatrix Specialty Pharmacy; and Erik Halstrom, managing director, Turning Point

Title: DIR Fees—Administrative and Legislative Efforts to Get There

Speaker: Julie Scott Allen, Senior Director of Governments Affairs, Powers Pyles Sutter & Verville PC

As part of a broader coalition that includes NACDS, MCPA, APhA, FMI, NGA, NASPA and ASCP, NASP has played an important role in advocating for specialty pharmacy reform on the national stage, including taking political, congressional and regulatory action, publishing position statements, and organizing other grassroots efforts.

A major focus of the coalition’s reform efforts has been direct and indirect remuneration (DIR) fees, for which NASP has been actively pursuing change as part of Medicare Part D reform, as well as promoting drug pricing reform through congressional channels.

These sessions explored the current state of DIR reform from a policy perspective. Previously, the Centers for Medicare and Medicaid Services had proposed DIR reform as part of changes to Medicare Part D, but none of the policies were finalized. While many of the proposed reforms supported the goals of the coalition, others, such as a projected increase in premiums for patients, drew objections.

NASP voiced strong support for pharmacy price concessions at the point of sale and redefinition of “negotiated price,” the prohibition of any claw-back arrangements, and other coalition goals.

Regarding congressional efforts, bills pending in both the House (HR 1034) and Senate (s640) with 25% of congress urging the Trump Administration for DIR relief. In parallel, The Senate Finance Committee has asked committee members to request that the administration act on DIR reform this year. NASP continues to lobby for Medicare Part D pharmacy DIR reform in drug pricing legislation and urges its members to engage in this effort.

The coalition’s priorities are to move DIR to the point of sale, revise the quality metric process, clearly define specialty pharmacy to ensure fair treatment, ensure rates are not below cost, move toward a value-based pharmacy payment system, improve transparency in rates, and require plans to provide data to pharmacies.

Specialty Pharmacy Continues to Rapidly Evolve

Overall, this year’s annual meeting provided valuable insights on a variety of topics and disciplines from keynote speakers, session presenters, and attendees. Our industry is quickly evolving, and business conditions and patient expectations continue to rapidly change.

Pharmacists and specialty pharmacy networks, such as the Excelera Network, must lead the way to ensure the integration of specialty pharmacy within the broader health care industry, while also innovating care models that will be achievable through advances in technology and science.