The top three pharmacy challenges for 2018: drug affordability, nonadherence, and pharmacist compensation, may come as no surprise to many of you.
The new year, however, brings some additional challenges to the fore and further complicates the challenges the industry already faces, as outlined by industry experts. The primary impetus is wrought by the fragility of healthcare reform and the new healthcare landscape—a marketplace filled with high-cost drugs; evidence-based care; pharmacy benefits managers (PBMs) facing more pressure to share pricing and rebate practices; expanded roles for pharmacists; and new partnerships formed among insurers, PBMs and pharmacies.
Affordability has long been a concern but has ratcheted up attention with the introduction of high-cost specialty pharmacy moving in to replace drugs off patent or to fill voids in new drug classes. The affordability problem is exacerbated by banner years of drug approvals, often due to accelerated pathways, and blockbuster drugs.
Robert DiGregorio, PharmD, associate dean, clinical affairs, Long Island University-Pharmacy, says prescription drug plans must be affordable to the public while not driving pharmacies and insurance companies out of business. “Everyone needs some margin,” he says. “The obvious challenge is to be able to provide effective care at the lowest cost.”
John Corcoran, founder/president of Trinity Partners, a global life sciences consulting firm, questions how the high price of some drugs can be justified. “You have to look at value and if drugs improve quality of life and decrease the burden of disease, not just at safety and effectiveness,” he says. “If there are superior outcomes, payers will be willing to cover expensive drugs, but Pharma needs to respond.”
Corcoran points to other factors impacting drug affordability: aging baby boomers; longer life expectancy; and increased prevalence of obesity, dementia, and Alzheimer’s—all affecting drug utilization. “The industry needs to understand and acknowledge these changes in the marketplace,” he says.
There have been some innovative solutions to combat high costs, says Mike Rogers, managing director, RX Solutions, the pharmacy benefits management consulting arm of NFP, “but there is little control over drug inflation.” He blames manufacturers and pharmacies for the high prices, however, he acknowledges the necessity of providing appropriate drugs to patients with cancer and chronic illness—regardless of their high costs.
Rogers offers up a few solutions: looking at data to determine drug utilization, who is taking what, and if there are alternatives. Placing responsibility on payers, including employers—he recommends narrow formularies and pharmacy networks to leverage better pricing.