From drug price concerns to the evolving role of PBMs to the influence of specialty pharmaceuticals, what healthcare executives think about the future of pharmacy.
To identify some of the top managed care pharmacy challenges-and how healthcare executives are solving those problems-Managed Healthcare Executive polled over 200 executives in medical practices, hospitals, large health systems, pharmacy benefit management organizations, consulting firms, and more.
The annual poll, conducted in the first quarter of 2019, covers fears about cost and access to pharmaceuticals, the changing roles of pharmacy benefit managers, evolving payment models, and more.
Coupled with the results of the survey are insights from experts from around the field, from executives at pharmacy benefit managers to pharmacy consultants, helping to break down the data and give other healthcare executives a path forward to 2020 and beyond.
“It is well-evident from these results that our nation’s key healthcare stakeholders recognize the critical value, and unmet need, related to enhancing communication with the prescribing community at the point of patient care … Providing greater transparency for providers into comparative drug prices, utilization management programs, and patient-specific clinical intervention opportunities at point of prescribing not only offers the potential to reduce pharmacy costs, but also increases the likelihood for longer-term improvement in patient outcomes and total cost of care.
- David Calabrese, RPh, MHP, is senior vice president and chief pharmacy officer of OptumRx. He also is an editorial advisor for Managed Healthcare Executive
“There are many factors that drive specialty drugs costs:
“Each patient population (e.g., commercial, Medicare, and Medicaid) will feel the rising drug costs differently.”
-Perry Cohen, PharmD, is chief executive officer of The Pharmacy Group and the TPG family of companies and is an editorial advisor for Managed Healthcare Executive
“I am surprised that almost half of the survey’s respondents feel that the current drug manufacturer rebate contracts to payers and PBMs will be replaced by value-based contracts. Healthcare executives and plan sponsors do not tend to move that quickly, and health benefits are traditionally very slow in terms of adapting to innovation. It’s one thing to say you’re going to adopt value-based contracts, but it’s another thing to actually make that shift, as some organizations are very resistant to change … Value-based contracts are definitely the most progressive approach and seem to be where we’re headed. It’s really of a matter of how and when this will become the rule rather than the exception.
- David Henka is president and CEO of ActiveRADAR
“We’re seeing renewed scrutiny of the PBMs on a large scale, and I think that’s probably why more people predicted that a performance-based, shared savings model will take flight. The overall opacity of the current PBM system is at the root of most of the concerns that purchasers have today. The idea of a true pass-through model is becoming less and less realistic, as there are often contracting provisions buried deep within the documents, charging for things you wouldn’t normally be charged for. This makes it difficult for benefits professionals to see the subtle differences regarding where and how costs are being incurred. Even as PBMs claim to bring more transparency to their purchasing, rebates, contracting, and formularies, they will always find a way to make their margins.”
“While ICER cost-effectiveness analyses have been underappreciated in this space, the findings suggest that payers are really starting to understand the value of this organization and its tremendous work. ICER-like tools are the gold standard and what payers should be looking to in order to identify cost-effective pharmaceutical therapies. The next step is to determine how to best integrate these kinds of tools into a benefits package or a purchasing program for a plan sponsor.”
“Responses here clearly reflect the strong desire amongst our healthcare colleagues for manufacturers to focus their R&D efforts in bringing about new products that represent true innovation in patient care versus small, incremental clinical advancements and/or more ‘me-too’ type therapies.”
“The overwhelming response here in favor of crenezumab is not surprising. For decades, we have struggled as an industry in identifying and bringing forth meaningful advancements in the treatment of Alzheimer’s … Unfortunately, with crenezumab, those struggles continue as the manufacturer (Roche) in early February announced that it would discontinue its phase 3 clinical trials as an interim analysis found the drug was unlikely to reach its primary clinical end point. Not long thereafter, on March 21, manufacturer Biogen announced that it, as well, was halting two late-stage studies of a similar anti-amyloid compound, aducanumab. Meanwhile, hope continues as other nonamyloid approaches are also making their way through clinical testing.”