How 2018 Pharmacy Trends Are Affecting 2019

MHE Publication, Managed Healthcare Executive March 2019 Issue, Volume 29, Issue 3

Last year brought a variety of new treatments-and complications-for patients and payers. These five areas that defined 2018 will continue to define the future.

In reviewing the healthcare industry’s most impactful innovations, advancements and shortcomings over the past year, several focus areas emerged that were, and will continue to be, important in the years ahead.

1. New options for cancer

While it was a busy year for specialty pharmacy overall, perhaps no area was more active than oncology. In addition to a new class of drugs for breast cancer, the FDA approved several new drugs based on a concept called immunotherapy. The idea is simple enough: train the body’s own immune system to identify and kill cancer cells.

However, the enthusiasm surrounding immunotherapy must be balanced against the considerable safety and cost issues that the therapy entails. While immunotherapy is currently targeted for a narrow range of cancers, the hope is it will soon be approved for broader indications.

2. More migraine relief

Much as immunotherapy offers new options for treating certain types of cancer, a new class of migraine medications entered the market in 2018. Known as CGRP antagonists, these long-lasting drugs are antibodies that target the physiologic processes underlying migraine.

While CGRP antagonists appear promising, they do come at a substantial cost. Moreover, it has not yet been established that they are any better in terms of efficacy or safety than other currently available therapeutic options from other drug classes. Accordingly, OptumRx has a comprehensive management strategy for the CGRP antagonist class.

3. Making sense of drug pricing complexities

The issue of prescription drug pricing has long been a matter of debate. Yet, in 2018, the issue became even more high profile as the White House, regulatory bodies, and Congress all issued public proclamations on the issue of drug costs.

The current model isn’t going away completely any time soon, but change is coming, and one of those primary shifts will be the evolution of value-based contracting. Pharmacy care services companies must proactively engage in value-based agreements with pharmaceutical companies and work to develop broader-based applications of the value-based concept to bring to clients and lead the market, as opposed to follow it. 

Related: Provider Engagement in the New Digital Era

4. Million-dollar drugs

Speaking of expensive medications, 2018 gave us a glimpse into a future where the price of certain drugs eclipses $1 million.

Many of the drugs are gene therapies. Working at the genetic level, they offer us entirely new avenues to treat disease. Recent introductions have included two CAR T gene therapies for the treatment of select forms of cancer and a third agent to treat patients with an inherited form of vision loss that may result in blindness.

With over 400 gene-based therapies in either phase 2 or phase 3 clinical development, significant attention will continue to be drawn to this area as changes in policy, pricing, education, treatment, and accessibility evolve.

5. A comprehensive approach to opioids

In 2018, there was real progress in collective efforts to turn back the tide of the opioid epidemic as new preventative and treatment programs were introduced to the market.

OptumRx notably achieved compelling results from its Opioid Risk Management program, a comprehensive framework created to reduce opioid misuse and abuse. Centered around the deployment of five interrelated strategies-prevention and education, minimizing early exposure, reducing inappropriate supply, treating at-risk and high-risk populations, and supporting those in recovery-the program has achieved a 31% reduction in opioid prescriptions, as well as a 42% decrease in the total opioid morphine milligram equivalent (MMEs) dispensed, since its inception.

Nationwide, increased access to care and clinical support has resulted in a decrease of fatal drug overdoses. As solutions become more readily available, pharmacy care services companies will have a unique opportunity to directly deploy these programs and help those suffering from opioid addiction and dependence. 

David Calabrese, RPh, MHP, is senior vice president and chief pharmacy officer of OptumRx. He also is an editorial advisor for Managed Healthcare Executive.