While pharmacy assumes different challenges every year, affordability has stayed at the top of the list. Last year, non-adherence and pharmacist compensation capped off the top three, but in 2019, industry experts are identifying new barriers that have even more impact.
The FDA approved 55 drugs as of early December 2018, in therapeutic areas as diverse as influenza, breast cancer, immunodeficiency, pneumonia, and migraines. That is nine more than record-breaking 2017, which had the highest number of approvals in more than two decades, according to an April 12, 2018 Health Policy Report in the New England Journal of Medicine.
Here are the six top pharmacy challenges health executives can expect in 2019:
Similar to last year, specialty drugs are hiking up the cost of pharmacy. “Innovation with gene therapies and precision medicine increases the fight to afford specialty drugs,” says Susan A. Cantrell, RPh, CEO, Academy of Managed Care Pharmacy (AMCP).
In 2016, the United States spent 18% of gross domestic product on healthcare—nearly twice the rate of 10 other high-income countries, according to a study in the Journal of the American Medical Association. This country also claims the highest pharmaceutical spending among its peers.
Although Steve Lucio, associate vice president, Vizient, a performance improvement company located in Irving, Texas, recognizes the effectiveness of specialty drugs, such as those for immunotherapy, he says they can saddle patients with high costs. He also believes that patients have to weigh a drug’s relative value against its price tag.
“The challenge of high costs is lessened if you have control of your healthcare budget and access to drugs,” Lucio says.
“Drugs are eating up more and more of the healthcare pie,” says Jane Lutz, executive director, Pharmacy Benefit Management Institute (PBMI). “Pharmacy is the most frequently-used benefit, and it’s a real-time benefit—you know what you are going to pay when you pick up a prescription.”
She is concerned that the price of drugs is outweighing income when the average annual cost of a specialty drug is $52,000 and the median wage in 2016 in this country was $48,665.
Lucio is looking forward to potential biosimilars—especially in oncology—entering the marketplace in 2019 to help mitigate costs through competition.
On the other hand, Lutz believes that no model exists that can support the development and distribution of orphan and genomic drugs and biosimilars.
Jonathan Gavras, MD, senior vice president and chief medical officer of Prime Therapeutics, a PBM headquartered in Eagan, Minnesota, believes it is important to anticipate what’s coming down the pipeline, especially high-cost specialty drugs; develop appropriate policies around cost to be affordable for payers and patients; and keep ahead of drug approvals, many of which are fast tracked.