Armada Speaker: Increased Communication Crucial to Next Generation Specialty Model

CVS Caremark specialty pharmacy executive discusses the evolution of a patient-centered health care ecosystem.

CVS Caremark specialty pharmacy executive discusses the evolution of a patient-centered health care ecosystem.

The next generation of specialty drug management needs to improve communication between patients and providers in order to enhance patient care, according to a top executive at CVS Caremark.

During a speech at the annual Armada Health Care Specialty Pharmacy Summit and Expo on May 6 in Las Vegas, CVS Caremark senior vice president of specialty pharmacy services Randy Falkenrath, MBA, discussed the evolution of health care within the growing specialty drug market and the changes that must occur to ensure optimal outcomes for patients. Patient engagement, he noted, is not about a series of transactions, but about managing the challenges patients confront on a daily basis as a result of their illness.

“Everything we do in specialty has a patient at the end of the activity,” Falkenrath told the audience. “It’s really all about the services we provide in improving their care, improving their quality of life, and finding the opportunity, ideally, to improve a length of their life span.”

As a result of the Affordable Care Act, the next generation of specialty management will need to focus less on medication management and more on the total patient, according to Falkenrath. In this new era, he said, the health care model must improve connectivity around the patient through increased interaction between the physician, pharmacy benefit management, health care plan, care management nurse, and specialty pharmacy to create a total care ecosystem that fits each patient’s needs.

“I would argue as you go forward, there is part of this that provides an infrastructure and investment as it relates to information sharing, but there is also part of this that is really and honestly about people on phones,” Falkenrath said. “It’s about someone being able to wake up, look at the patients and connect with them, engage other providers in the care model, and lead the patient to ensure these connectivity points are being addressed and the outcomes are being improved.”

Falkenrath pointed to the huge increase in spending on specialty drugs forecast through the next decade as the key trend impacting specialty pharmacy. In its annual Insights report, CVS Caremark found that spending on specialty medications grew by 15.6% in 2013 to represent approximately 22.5% of total drug spending among CVS customers. Spending on specialty drugs is projected to increase from $92 billion in 2012 to $235 billion by 2018.

Biosimilars are a possible avenue of relief from rising drug costs, but one that carries its own set of problems, according to Falkenrath. Unlike generics, biosimilars would require that a pharmacist communicate with a physician every time a brand name biologic drug is replaced by a biosimilar, which Falkenrath said will create challenges for the adoption of these therapies.

He added that there are not many biosimilars currently in the pipeline, as manufacturers prepare for a slow acceptance of the drugs.

“This is a really long term play. We’ve got $20 billion of specialty branded products going off of patent in the next 4 years,” Falkenrath said. “So there is a huge opportunity and this is a meaningful conversation.”

An independent analysis by Milliman Inc cited in the Insights report finds that 53% of specialty medication costs were paid under the medical benefit in 2012 in a near even split with the pharmacy benefit. Falkenrath noted that differing medical benefits lead to huge variability in provider reimbursement policies and rates on specialty drugs.

Falkenrath said as an industry specialty pharmacy must find ways to improve services and management across the medical and pharmacy benefit.

“We need to find ways for care providers to create a connected solution to better serve the needs of the patient, while also improving cost and quality,” Falkenrath said.