Looking Forward

Specialty Pharmacy Times, December 2012, Volume 3, Issue 6

I’ve been privileged these last several months to be a speaker at a number events, discussing opportunities in specialty pharmacy to several diversified groups throughout the United States. The groups all had a different focus—manufacturers, distributors, regulators, hospital pharmacists, and retailers. Regardless of the setting or the audience, however, the feedback is the same. Where do I get started and what are the new trends?

Looking back at 2012, we had some very interesting dynamics such as the acquisition of Medco by Express Scripts and Axium by Kroger to a whole new set of emerging players coming out of existing brick and mortar retailers. The November elections should bring new dynamics as the Obama administration’s agenda around accountable care organizations is highly likely to gain more momentum than it has already.

Pharma organizations must learn to adapt to the new environment, and so do specialty pharmacies and distributors. Clearly, we are entering into an area of growing complexity compounded by fiscal restraints while at the same time expanding access. This paradox will challenge all of us in health care.

Expect to see more competition in the marketplace as dominant players will start to ratchet up their organizations, and those organizations that are in the managed care arena will be focused even more on managed cost. Expect that a greater focus will be on reimbursement and payers, and government will look toward the proverbial “deep pockets” of pharma. Specialty pharmacy is in the channel and we should expect even greater margin pressure. Key stakeholders will be looking for all to put some “skin in the game” through risk sharing and outcomes measures as elements in agreements. If you are a pharma organization and want access, access likely will come with some form of risk share embedded in the rules.

In our last edition of Specialty Pharmacy Times, we focused on data and we believe those organizations that can control data can have more control over their future as they can demonstrate better outcomes and overall value in the stream of health care delivery.

We should also expect to see an even greater blurring of the pharmacy benefit with the medical benefit and vice versa. The sophistication of the pharmacy benefit processing systems is driving more and more into the medical benefit space. It will be access to data that will be a key driver in the measure of what is “accountable” or not. Without data we cannot have accountability.

Expect to see more hospital GPOs and IDNs to emerge with hybrid offerings where the transition of the patient from inpatient to discharge into the community will be better directed and tracked. We have seen a couple of GPOs making strategic decisions to either build, buy, or partner with organizations strictly focused on the specialty pharmacy side. Retailers are no longer standing on the sidelines and are realizing they can no longer take a “wait and see” attitude—and they have built great community-based solutions for patients utilizing specialty products.

In this issue, Mark Barnes does an excellent job pointing out that the perceived and actual challenges of buy-and-bill methodologies are causing some payers to migrate from medical to pharmacy benefit coverage, and he discusses key issues and opportunities. The bar will be raised in our new, more “accountable” future.

Traditionally, payers have closely tracked the prescribing habits of practioners, but now in our “accountable” future expect specialty pharmacies to play a larger role in predictive modeling, comparative prescribing data on plan MDs, and measurement of outcomes and savings, not only for the direct activities of prescribers, but also the role that specialty pharmacies play in influencing patient outcomes through compliance and adherence programs.

We are likely to see greater changes in benefit designs also where patients will also be held accountable through share of cost initiatives, and these will only grow as the cost of specialty products increases.

We are excited about the new entrants in the marketplace as competition breeds excellence. We’ll keep you abreast of the emerging trends. Stay tuned in 2013 with our expanded editions of Specialty Pharmacy Times. We’ll be coming at you through print, web, and our industry-leading iPad editions.

Mr. Steiber is a principal of D2 Pharma Consulting LLC (d2rx.com) and is responsible for commercial operations, trade-supply chain strategy development including 3PL selection, regulatory oversight, and “operationalizing”organizations. Mr. Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 35-year career. Mr. Steiber is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and a frequent speaker on behalf of many professional organizations. Mr. Steiber graduated from Washington State University College of Pharmacy. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University. Mr. Steiber currently resides in Highland Village, Texas.