Delivering on the Potential of the Specialty Pipeline: 3 Disruptive Trends in Specialty Pharmacy

Specialty Pharmacy Times, July/August 2015, Volume 6, Issue 4

Pharmacy stakeholders must be nimble and responsive to innovations and disruptive trends in the market.

Pharmacy stakeholders must be nimble and responsive to innovations and disruptive trends in the market.

Specialty drugs represent an increasing percentage of the pharmaceutical pipeline. Their ability to positively affect patient lives hinges not only on their medical efficacy, but also on the product’s ability to be integrated into care and payment models by pharmacists, prescribers, and payers. Tomorrow’s specialty drugs may be able to drive tremendous health outcomes. Patients and specialty pharmacies, however, may not be positioned to benefit from the promise of these exciting medicines due to cost-sharing burdens or adherence challenges when clinical support for administration is not provided.

Addressing the challenges that impact treatment success will not be easy. Stakeholders in the specialty market arena are encountering ever-changing obstacles and opportunities stemming from new collaborative-care paradigms and outcomes. These challenges and opportunities are based on reimbursement models that will play a key role in driving the success or failure of treatments. In this dynamic health care ecosystem, all stakeholders must challenge themselves to be nimble and responsive to disruptive trends so that they are best positioned to drive exceptional patient outcomes. If specialty drugs are able to deliver remarkable outcomes for patients, then every stakeholder in the chain—from manufacturers to pharmacists to payers—will be invested in driving their success.

Below are 3 of the macro trends that specialty pharmacies and industry stakeholders must consider and address to ensure that patients are well served by the promise of the specialty pipeline:

(1) Increased diversity in product types. The market is moving toward highly personalized care for narrower disease states. Each new treatment may require customized solutions to address challenges to access, administration, and cost. Each of these factors has implications for specialty pharmacies, but also presents an opportunity to provide expertise and value in the patient journey.

Consider unfamiliar or difficult treatment administrations and their potential impact on continuity of care and clinical outcomes. The specialty pharmacy has a unique role in supporting these administrations through their own business model and through their ability to educate patients and providers. Without a commitment from specialty pharmacy to focus on adherence, difficult-to-administer products may not have the opportunity to live up to their outcome potential due to the fact that patients simply will not stay on their treatments. The robust specialty pipeline clearly necessitates increased education for physicians and patients who need to know how, when, and where they can receive their treatment.

This issue is compounded by the fact that more rare disease and orphan products are in the pipeline and that more specialty products are being developed to treat traditionally nonspecialty disease states like hypercholesterolemia. Oncology, in particular, is one of the leading therapeutic areas for specialty development, and the increasing prominence of treatment personalization adds to the complexity of these treatments.1 Multigene panel testing is becoming the standard of care in oncology, but the practice is still far from common.

It is possible that the enormous diversity in product types and the resulting challenges in distribution, administration, and adherence may lead specialty pharmacies to increasingly focus on specific disease states. By customizing a pharmacy and its entire supporting infrastructure to meet the needs of a handful of specific patient populations, the role of specialty pharmacy in driving the outcomes that have been promised by the specialty pipeline may be better positioned to grow.

(2) Changing economic drivers. The number of insured Americans is rising, and so are the variety of economic situations patients will face. In general, specialty care has the potential to become more expensive due to the simple fact that specialty drugs will be available to treat a wider variety of disease states and therefore patients. On the other side of the equation, payers will be working to manage their spending on specialty care and will be looking to increasingly hold manufacturers and providers accountable for driving efficiency in care delivery. Regardless of the perspective it is viewed from, however, no player in the health care system should lose sight of the fact that ensuring patients can afford and access new medications is absolutely necessary as the pipeline of specialty drugs continues to reach the marketplace.

Saying this is easy, but living it will require creativity. For example, oral oncolytic claims with a cost sharing of more than $500 were 4 times more likely to be abandoned compared with claims with $100 or less in cost sharing.1 As new patients are insured via provisions in the Affordable Care Act, however, many are enrolling in plans that call for a 30% cost share for specialty drugs, which can play a clear role in driving abandoned scripts. Biosimilars have the potential to reduce costs, but price differences are not expected to be as significant as they are in the small-molecule space. If an oncology patient has a 30% cost share, the difference between a $10,000-a-month therapy program and an $8,000-a-month treatment may not be enough to enable adherence to a care program.

To address this, payers will be looking to partner with pharmacies that can work collaboratively and provide access to data that inform their ability to make decisions with patient outcomes and cost savings in mind. For example, MyPathpoint, a portal created by US Bioservices, a part of AmerisourceBergen, is designed to ensure all appropriate stakeholders have access to patient pharmacy records in real time. In part due to the evolving economic landscape, in an effort to reduce expenses and improve outcomes, MyPathpoint recently began offering case managers at payers a customized version of this system to facilitate the sharing of information that can assist with active care coordination.

Specialty pharmacies will find success in partnering with physicians, payers, and manufacturers to help drive better care outcomes. Stakeholders should be encouraged to consider the total cost of care plus patient outcomes, not just individual treatment costs. There is an opportunity to collaborate on aspects of care such as reimbursement support and prior authorizations. Particularly in growing areas like oncology, these steps can help specialty pharmacies engage with oncologists to mitigate financially-driven noncompliance.

(3) New patient populations and service models. Rising life expectancies have created large patient populations with significant medication needs. For example, people older than 60 years consume 2.7 times the amount of prescription and OTC pharmaceuticals than people younger than 60 years. Patient populations are also growing in size and complexity. There is a smaller ratio of people aged 20 to 64 years per person over 65 years, resulting in fewer people under 65 years to fund health care for older patient populations.2

It is imperative for all stakeholders to take a patient-centric approach and align services with patient expectations. Although pharmacists have traditionally been viewed as a highly accessible point of care for patients, one of the ways to enhance patient access is through telehealth care. Providers in all areas and specialties employ technology, be it via phone, Internet, or video, to provide care to patients. Telehealth care can enhance the quality of care in many patient segments by extending the diversity of care patient populations receive while simultaneously extending the reach of care and reducing costs.

Regarding therapy adherence services, instead of focusing on disease product information, therapeutic risks, and product attributes, the focus is turning to understanding the patient journey, maximizing engagement, and empowering patients to help resolve barriers to quality care. Having a better understanding of the needs of the patients and their unique journey will help customize treatments early and often, and streamline the process among stakeholders to ensure patients are getting the best care possible.

Conclusion

There is a common theme throughout these ideas: patient-centricity is key to success. How patients will access care, who will have access to care, and how access to care will be organized are imperative considerations for specialty pharmacists. The organizations that encourage and promote access will be the ones that ultimately advance the health care market the furthest and who will see the most success.

As personalized medicine gradually becomes the priority, the generation of high-quality economic outcomes will result in higher reimbursement confidence. Pharmacists will be on the front lines of care, evaluating patients and monitoring for their response to therapy, reporting back outcomes and driving payer confidence in the market cycle.

As the cost and site of care changes, stakeholder engagement of is crucial to positive clinical outcomes and cost-saving programs. The positive clinical outcomes will result in successes for all stakeholders, again resulting in a more patient-centric market. It is a cycle that will continue to create success and quality care, thus driving down costs.

There is a tremendous promise in the specialty drug pipeline. Improving patient lives and generating outcomes is possible in ways that never were before. Success for the patient journey will only come with pharmacists continuing to be central to driving quality care outcomes, adding critical value, and serving as a key part of the journey for all stakeholders. SPT

References

  • Streeter SB, Schwartzberg L, Husain N, Johnsrud M. Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions. J Oncol Pract. 2011;7(3s):46s-51s. doi: 10.1200/JOP.2011.000316.
  • Perrigo. Presentation at: JP Morgan Healthcare Conference; January 12, 2015; San Francisco, CA. http://perrigo.investorroom.com/download/Perrigo_healthcare15_v2.pdf.

About the Author

Keith McGee is Vice President, Business Development, at US Bioservices, part of AmerisourceBergen. In this role, he provides account management of specialty pharmaceutical manufacturers, as well as business development and strategic planning for US Bioservices’ Specialty Pharmacy Program initiatives.