Payers and Manufacturers Gather to Discuss Issues in Specialty Pharmacy

Acro Pharmaceutical Services annual symposium brings together key players from through the specialty pharmacy landscape.

On December 4, 2014, Acro Pharmaceutical Services hosted their 8th Annual Symposium for Payer/Managed Care Strategies for Specialty Medications.

Key stakeholders in specialty pharmacy and health care from across the country convened at the Hyatt at the Bellevue in Philadelphia to discuss several topics around Accountable Care Organizations (ACO), the Affordable Care Act (ACA), drug research and development, data collection and analysis, payer-manufacturer partnerships, and the impact of the 340 B program.

The Acro Symposium included a number of presentations and panel discussions relating directly or indirectly to the payer coverage of specialty medications, as well as other factors that can impact specialty medications in the US health care market space. The keynote speaker David Shulkin, MD, president of the second largest Medicare approved ACO in the country, Atlantic Accountable Care Organization, provided a real world perspective on how ACO’s are performing.

Dr. Shulkin noted that most are not succeeding in profiting through shared savings arrangements and provided some important insights as to why this maybe the case. He also suggested that ACO business models and incentive arrangements should be changed in order for ACO’s to thrive and be successful at fulfilling their envisioned purpose.

Other speakers included Mesfin Tegenu, MS, RPh, president of PerformRx, who provided an update on the future impact of the continued roll out of the ACA and how it is perceived by the general public; Marc Duey, president and CEO of Prometrics, provided insights on how prescription data from specialty pharmacies on the experiences of patients prescribed a specialty medication can be used to provide valuable insights to many health care stake holders; and the president of Glendalough productions, Robert Henry, who provided a joint presentation with associates Dr. Michael F. Murphy and Charles E. Collins on the need to improve medication research to address the growing aging population that is fraught with multiple comorbid medical conditions.

There were also 2 payer panel discussions that included participants from Emblem Health, Independence Blue Cross, Capital Blue Cross, AscellaHealth, Health Partners, Johns Hopkins Healthcare, and BlueCross BlueShield of Tennessee.

The panel discussions, moderated by Dr. Philip Gerbino, President Emeritus of the University of the Sciences, discussed key topics on how payers perceive the impact of the 340 B Disproportionate Share program, tactics and strategies on how payers plan to manage the growing specialty drug trend, impact of the continued roll out of the ACA, payer relationships with manufacturers of specialty medications, payer viewpoint of the pending marketing of biosimilars, the role of ACOs, genomic guided cancer therapy, and the impact of the growth of Integrated Delivery Networks.

Payers expressed concern over of the 340 B Disproportionate Share program as a catalyst for hospital systems to buy oncology physician practices. They further indicated that this practice drives patients to receive their oncology therapy as an outpatient hospital patient, which is the most expensive site of care.

The panel participants also acknowledged their interest in partnering with pharmaceutical manufacturers in risk or outcome-based drug contracts if convinced of the potential value. Regarding coverage of oncology therapy prescribed outside the standard of care guidelines based on genomic testing, these situations are being handled on a case by case basis and it is an area in which payers are still developing the coverage policies.

Payers expressed tepid expectations as to the impact biosimilars will have on bending the specialty drug cost curve. They are taking a “wait and see” attitude and will evaluate newly marketed biosimilars on an individual basis.

###

About Acro Pharmaceutical Services

Acro Pharmaceutical Services, located outside of Philadelphia, delivers specialty prescriptions by mail throughout the United States and has an extensive network of pharmacies through its parent company, Lincare. It offers personalized services and cost management solutions for payers, providers and pharmaceutical manufacturers (i.e. formulary and prior authorization management). Acro Pharmaceutical Services is owned by Lincare, Inc. a subsidiary of The Linde Group.

SOURCE: Acro Pharmaceutical Services