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At AMCP, four stakeholders representing the specialty pharmacy perspective, manufacturer perspective, payer perspective, and PBM perspective shared their thoughts on the future of specialty pharmacy.
“How Do We Shape the Future of Specialty Pharmacy” led off the education sessions at the Academy of Managed Care Pharmacy’s (AMCP’s) Special Pharmacy Connect program, Tuesday, April 19, at the AMCP Annual Meeting.
Panel participants, representing four different stakeholder perspectives, were Phil Hagerman, RPh, CEO/chairman, Diplomat Pharmacy, Inc.; Jeff Henderson, vice president, managed markets, Intarcia Therapeutics; James Lang, PharmD, MBA, vice president, pharmacy services, Blue Cross Blue Shield of Michigan; and Steve Miller, MD, senior vice president and chief medical officer, Express Scripts, Inc.
Steven Avey, RPh, vice president, specialty clinical team for MedImpact Healthcare Systems who served panel moderator, set the stage by emphasizing the burden of cost created by specialty drugs, while at the same time, noting that they improve quality of life for people with rare diseases.
Hagerman represented the specialty pharmacy perspective on the panel, saying the industry has succeeded in delivering clinical results of specialty drugs but not economic projections.
He said the trend is toward more limited distribution as a way for manufacturers to control the patent experience after clinical trials.
Looking through a crystal ball, he foresees more robust technology platforms; customer work flow apps; state-of-the art data warehousing; business intelligence tools for data visualization; transparency relationship management; expanded mobile use; and physician, patient and manufacturer portals in real time.
Henderson wore the drug manufacturer hat and outlined the specialty drug landscape-cost and complexity plus business needs. His future predictions-although some already exist-feature treatment of complex conditions, access and use of data, high costs, limited distribution, revenue recognition, special storage and handling and ongoing monitoring of safety, with an emphasis on multiple sclerosis, hepatitis C and hematology.
He see specialty pharmacy as superior to retail for these high-cost drugs because of its ability to provide 24/7, high-touch service, assistance with prior authorization, help with enrolling patients in financial support programs, patient education and counseling, adherence management and follow-up with healthcare plans.
“Specialty pharmacy can help manufacturers assist patients on their journey to measure outcomes and determine the value of our products,” Henderson said.
“Manufacturers have more pressure to deliver value, provide cost-effective outcomes and develop value-based contracting through alternative payment models with plans.”
Next: The payer perspective
The payer side of specialty health was represented by Lang, who said that 60% of Blue Cross Blue Shield of Michigan’s business is administrative services contracts-mostly self-insured organizations that design their own benefits and are likely to have medical and drug stop loss.
He sees more small companies turning to ASC arrangements, eliminating the onus of federal and state regulations and providing more flexibility in benefits, such as not covering certain specialty drugs or conditions and no need for stop loss.
He says plans are responding by studying the drug pipeline, initiating prior authorization, using more comprehensive drug review before submission to P&T committees, early involvement with actuaries, predictive analytics, rebates and preferred drugs and more efficient sites including patient incentives
“Relationships are based on value; they take the drug margin out of the prescribing situation,” Lang said.
Finally, Miller shared the pharmacy benefits manager viewpoint.
“Express Scripts takes a holistic approach to specialty care, combining innovative solutions, predictive data management bold action on costs and a new kind of formulary,” he said.
He described the PBM’s Hepatitis Cure Value Program that offers Viekira Pak as its preferred treatment for hepatitis C. He says a combination of the drug and care management, guaranteed adherence and a financial cap for extended therapy enabled the company to achieve 96% care rates, 95% adherence and the ability to treat not just the sickest patients.
Tarceva, a treatment for small cell lung disease, however offered a dilemma. While the drug proves successful in extending life for 5.2 months, when used for pancreatic cancer, the life extension was a mere 12 days but the price was the same.
Miller advocates adjudicating claims at an indication level to avoid future contradictions as represented by Tarceva.
Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.