Finding #1: Collaboration is critical
In the survey, more than half of respondents, 54%, said increased collaboration to identify the most effective and cost-effective treatments is the most effective way to reduce pharmacy costs, for both specialty and nonspecialty drugs.
Other responses included adopting more stringent, evidence-based clinical pathways (14%); more aggressive and expanded utilization management strategies (14%); and narrower and/or exclusionary formularies (7%).
“Collaboration could indeed have a positive effect on drug prices in the both the near and long term,” says Will Hinde, managing director, West Monroe Partners, a business and technology consulting firm with a focus that includes healthcare. “Collaboration in the near term between the payer, provider, and patient would seem to offer hope for near-term price relief to consumers through better payer/provider coordination. However, significant barriers exist to this collaboration as each of these constituent groups jockey to ‘own’ patient and health data from various sources. Sharing all relevant data and information to truly identify cost and efficacy is a laborious and costly effort, and will take a long time.”
Opportunities for collaboration to reduce pharmacy costs include biomarker-based diagnostics and prior authorization standards, Hinde continues. These depend on laboratory results to identify whether a patient is an appropriate candidate for a specialty treatment, prior to authorization or reimbursement.
For example, providers, payers, and drug companies could collaborate to develop and validate genomics-based assays that identify patients with specific genetic and biomarker profiles to understand the efficacy profile before applying expensive biologic or oncology treatments, says Hinde.
Rademacher also believes that when stakeholders, including providers, payers, manufacturers, and health systems, collaborate and share data—from efficacy to provider quality metrics—they can identify the greatest value with the best outcomes to reduce waste and variation. “The industry is already beginning to see these types of collaborations,” she says.