The three-day 2021 Annual National Conference of the Pharmacy Benefit Management Institute® this week featured more than dozen speakers discussing everything from interoperability to digital therapeutics to preparations for switching PBMs to the COVID-19 pandemic.
Here are six takeaways from the meeting:
- Specialty is where the action is. Speaker after speaker mentioned that specialty drugs — often, but not always, biologics for rare diseases — now account for half, or nearly half, of drug costs even though they amount to 2% to 3% of all prescriptions. So how to tame the specialty drug trend? There were lots of suggestions. Paula Bickley and Ashleigh Burdette of Biologics by McKesson, a specialty pharmacy that focuses on cancer patients, discussed how their company’s care plans for patients reduce hospitalizations and avoid wasteful prescribing. Joshua Fredell, Pharm.D., and Tierra Ford, Pharm.D., of CVS Health discussed the three principles that the company uses to guided specialty drug management: start therapy with certainty (i.e., use quality evidence), aim to eliminate waste throughout treatment, and intervene when needed. Ford discussed the example of program to reduce the number of high-dose Stelara (ustekinumab) prescriptions.
- There may be better ways to crunch the numbers. Managing drug costs means dealing with the numbers that reflect those drug costs. Confidio’s Thatcher Sloan made a case for his company’s net economic value assessment that factors in formulary and utilization management effectiveness, not just costs after rebates. Matthew Gibbs, Pharm.D., of president of Capital Rx, gave a spirited argument against the industry’s reliance on the average wholesale price and lack of specific drug prices and for the National Average Drug Acquisition Cost (NADAC), a data set of prices reported by retail pharmacies.
- How freely will data flow? Data is king in managing drug costs and healthcare overall. But it tends to be walled off into small, tightly controlled fiefs, so getting a full picture, going by the numbers, is nigh impossible. On the first day of the conference, Kim Diehl-Boyd, vice president of industry relations and government affairs at CoverMyMeds, thumbnailed federal rules that are supposed to promote interoperability and “data fluidity” and efforts by various groups to create standards that are supposed to enable that to happen. Fredell, at CVS, spoke about the importance of “connectivity” and the information coming from the electronic health records and from patients.
- Whither the pandemic — and the flu? The keynote speaker, former FDA commissioner Scott Gottlieb, M.D., had an upbeat appraisal for the next few months of the COVID-19. While not explicitly backing a booster shot — Gottlieb is on the Pfizer’s board of directors — the country’s former top drug regulator said a booster would bring up antibody levels seen after the second shot of the two-shot RNA vaccines (Pfizer’s and Moderna’s) and make vaccination live up to the promise of protecting people against infection, not just serious illness from COVID-19. But Gottlieb also predicted a future of endemic COVID-19 and said the country will need to adjust to infectious respiratory illnesses as health threats. In his rapid-fire, chart-filled presentation, Doug Long, MBA, vice president of industry relations at IQVIA, noted how the near-absence of flu cases last year was one of the factors that drove down medical utilization. Long showed data from Australia that suggested that the number of flu cases during the 2021-22 season may again be much lower than normal.
- Jenga vs. unbundled. Size matters apparently matters a lot in pharmacy benefit as the industry has become increasingly consolidated. Kerri Tanner, RPh, Pharm.D., senior vice president, specialty product, at Optum, made a case for a centralized, coordinated approach to drug benefit management as she described a program called Optum Specialty Fusion that has been shown to save Optum clients $15 per member, per month in specialty drug spend. Tanner compared specializing in an aspect of pharmacy benefit to removing a piece in game of Jenga. But Javier Gonzalez, Pharm.D., chief growth officer at Abarca, kicked off the second day of the conference taking a different tack as he discussed the advantages of bringing some aspects drug management in house, unbundled and perhaps in an à la carte fashion.
- Happy to be unZoomed and resume being back in person. The meeting was conducted in hybrid fashion with some attendees in person and others online. Almost every in-person speaker said this was one of the first, if not the first, meeting they had traveled to in person since the beginning of the pandemic. Some joked about being rusty and awkward in social situations, but virtually every speaker began their presentation by saying how happy they were to be addressing people in person again.