Vertical Integration and Looking Toward the Future


Experts discuss the vertical integration of specialty pharmacy and its roles as opportunities for utilizing biosimilar products are expected to enter the market in the future.


Al Heaton, BS, PharmD, RPh: You mentioned that the first biosimilars came out in, really the buy-and-bill marketplace, the physician-administered rather than typical pharmacy. And a question that’s come up is, from the specialty pharmacy perspective, what does vertical integration and more consolidation do for your market?

Kyle Skiermont, PharmD: Sure. I see specialty pharmacy becoming much more involved in the biosimilar market to where they’ve been historically. As you mentioned, a lot of what’s happened has been more in the physician’s office or in the hospital, to date. Not all of it, but a lot of it. And as we see some of the new entrants coming into the marketplace in more of the self-administered space, but I think also as we see specialty pharmacies do more in the office-administered space, the specialty pharmacy’s role in biosimilars is only going to grow, and I think it’s going to grow exponentially.

With the vertical integration, we talked about buy-and-bill, and that’s where a lot of them have been. But I think as you move into medications that are governed more by the PBM [pharmacy benefit manager], or at least the pharmacy benefit, I think it has the potential for specialty pharmacy to be more involved. But the vertical integration, I think, has the potential to drive movement to a biosimilar, for example, very quickly.

We know in today’s specialty pharmacy marketplace that a huge percentage of the market is filled by a relatively small number of specialty pharmacies. And most of those specialty pharmacies are owned and/or tightly aligned with a PBM. And so for me, I can see that change. If a new biosimilar comes into the marketplace with that integration of plan design and utilization management being able to drive to a biosimilar, and then a lot of the dispensing of that medication happening through that vertical integration, I think we could see much quicker uptake of biosimilars as they come to market than we did in the past where it was a much more fragmented marketplace. You know many payers, many providers, many dispensing points or administration points; as you’re consolidating that down, the specialty pharmacy market is very consolidated. So as you consolidate that dispensing, or where those orders are coming into now, I think it could actually speed up the uptake of any 1 given biosimilar very quickly.

Jonathan Ogurchak, PharmD, CSP: You know, specialty pharmacies are going to be much more involved, particularly with these therapies that may have traditionally been dispensed in the community setting, particularly for rheumatologic products. Now having a better understanding of product availability, formulary management, etcetera, is going to put specialty pharmacies at the forefront, not only in dispensing these products, but helping PBMs and payers to manage that formulary to ensure the patient’s out-of-pocket costs are best managed and that these patients can be initiated and maintained for the long term on these drugs.

Kyle Skiermont, PharmD: Al, we’ve been talking about biosimilars ranging everywhere from pricing, to acceptance, to how they work on a plan formulary. From my perspective, I’m very excited to see what’s going to happen with biosimilars as we move forward. The last few months have been very different—something we’ve not seen, where we are starting to see more and more uptake. And as we look at the approval pipeline, there’s a lot more coming. And I think the potential advantages that this gives us to decrease cost while still providing good care, and the opportunities to potentially treat more patients and give patients access to medications that potentially they’ve not had access to in the past, or at least to reduce some of that financial burden…. As a provider, that is something very exciting to me and a change that we’ve not seen in the biologics market, I don’t think, until here just recently. How about your thoughts?

Al Heaton, BS, PharmD, RPh: Well, I would agree with that. When I look at it from the plan perspective, we do really want to treat the people. And the employers always ask us, “How can I treat my patients? I have somebody with rheumatoid arthritis.” That’s probably the one we hear most commonly. Or, Crohn disease. These are both high-cost conditions. There are high-cost biologics associated with them, and they make a substantial burden economically on the healthcare plan. And they’re chronic therapy. And these people are going to stay with their employer. They’re going to stay with the plan. So we have to look at how we can treat them efficiently. Biosimilars give us one opportunity and give us probably the single biggest opportunity in the near future, in terms of that cost differential. Again, we cut the cost in half, we treat more patients. We save money for the employer group.

It also points out this ongoing problem that we’re having here because, as a plan perspective, we treat populations. We do population health management. Biosimilars are that tip of the iceberg that’s called “personalized medicine.” And I don’t know how we can have Al’s drug and Kyle’s drug in the future without biosimilars. It’s just that simple.

Jonathan Ogurchak, PharmD, CSP: I’m excited to see what the FDA is going to do as it relates to this biosimilar action plan, and how that affects the current market. As patent negotiations are kind of wrapping up and it’s allowing for further commercialization of these biosimilars in the next 3 to 4 years, the landscape’s going to continue to change. Previously this was all conceptual. It was something that was discussed at a conference or a CE [continuing education] program, and here we are. We now have these molecules that are available for patient use. It’s exciting to see how this is going to affect the specialty pharmacy landscape to get more patients access to these therapies that are ultimately going to help to improve their quality of life overall.

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