Asembia 2021: Specialty Pharmacy’s Post-Pandemic Outlook
As some 4,400 attendees gather this week in Las Vegas for Asembia 2021, Wednesday sessions focused on how specialty pharmacy has evolved during the COVID-19 pandemic, with presenters discussing timely topics around specialty pharmacy’s post-pandemic transformation and activating health equity.
Session: "Post-pandemic Outlook for Specialty Pharmacy”
Summary: What Was Discussed
This session, featuring Dr. Adam J. Fein, CEO of Drug Channels Institute, and Doug Long, vice president of industry relations at IQVIA, reviewed key trends reshaping specialty drug channels and highlighted the latest data on the specialty market as it emerges from the global pandemic.
Despite the impact of the pandemic on healthcare across the board, specialty pharmacy continues to grow, becoming increasingly complex as providers increase market share and consolidation rages among the largest PBMs, payers, specialty pharmacies and provider services companies.
While change and consolidation in the specialty pharmacy industry may create confusion in the short term, it also opens the door to new partnerships and innovative ideas to generate revenue and manage patients.
As we look forward into 2022, the No. 1 thing to watch is a battle for control of the specialty patient. The battle is getting more complicated because it's not just a pharmacy competing as a pharmacy for a patient, it's systems and entities ... and with this, there are opportunities for a new set of entities who may be thinking about things a little differently.
Dr Adam J. Fein, CEO of Drug Channels Institute, "Post-pandemic Outlook for Specialty Pharmacy,” Asembia 2021
Key takeaway: What you should know
During the pandemic, patients canceled or delayed many elective procedures and routine visits, often leaving acute and preventive care unaddressed. Within the last year, patients missed nearly 1 billion diagnostic visits, with 300 million more forecasted this year. US Pharmaceutical Trends, Issues and Outlook for NACDS TSE, IQVIA, 2021
While the pandemic temporarily stalled the dramatic increases in specialty pharmacy spending, specialty therapies still represent 40 percent of total pharma revenues.
As specialty medication is expected to reach half of the market’s revenue in the next few years, booming growth continues in the number of accredited specialty pharmacy locations.
Since 2015, the number of locations accredited by the Utilization Review Accreditation Commission (URAC) and the Accreditation Commission for Health Care (ACHC) has grown from 378 to more than 1,200. Drug Channels: The 2021 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers
Independent specialty pharmacies remain the largest share of the market, but the second biggest category is pharmacies run by a hospital or a physician practice, growing from 10 percent in 2015 to 40 percent today.
In fact, nine out of 10 large hospitals have their own in-house specialty pharmacies, which they are using as the driver for their own benefit plans. Drug Channels: The 2021 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers
The new battleground in specialty pharmacy is for the patient.
As pharmacy benefit managers (PBMs), payers, specialty pharmacies and provider services companies look at controlling healthcare costs, they are focused on patients who take specialty drugs.
The question is how to generate revenue and profits and best manage the patient?
According to Fein, this growth and evolution of who operates specialty pharmacies is consistent with the change across the entire healthcare system, which has tremendous implications for specialty pharmacy industry participants and how the industry evolves as the economy recovers from the pandemic.
As a result of recent consolidation, the three largest PBMs are now responsible for more than three quarters of all prescription claims. Drug Channels: The 2021 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers
It was not all bad news for specialty medications during COVID-19.
According to Long, retail and mail categories expanded their dollar growth during the pandemic, while non-retail had nominal growth. Drug Channels: The 2021 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers
In addition to reviewing specialty drug channels, Long reviewed key therapeutics areas primed for growth moving forward. This includes immunology, oncology, multiple sclerosis and anticoagulants. IQVIA, National Sales Perspectives, September 2021
As the specialty pharmacy market complexity accelerates and compounds, patient access becomes harder, narrowing the path to success. For example, patients are 20 percent more likely than not to fill a prescription today than they were in 2013. Most specialty patients with a National Drug Code (NDC) block or a step edit are not able to overcome restrictions within 30 days. IQVIA Institute
As specialty pharmacy deals with health inequality, prescriber economics, industry consolidation and potential policy reform, it’s critical to improve access to get patients through the system faster and started on the medications they need.
Next Steps: What can you do now?
While presenters at several Asembia 2021 sessions remain optimistic healthcare’s making progress coming out of the pandemic and realizing the full benefits of specialty medications, many expressed concerns with providing support to patients to help improve medication access, affordability and adherence.
Specialty therapies are often the hardest to access for patients due to process complexity and affordability challenges. To learn more about specialty medication access and specialty pharmacies, download the 2021 Medication Access Report: Complex Care & Specialty Edition.
Session: "Activating Health Equity in Specialty Pharmacy”
Summary: What was discussed
While prescription out-of-pocket costs can be a major hindrance for patients on their journey to therapy access, other variables can also affect their ability to access and maintain adherence to medications.
Take, for instance, social determinants of health.
Social determinants of health are the conditions in which people are born, live, learn, work, play, worship and age — and how those conditions affect a wide range of health, quality-of-life outcomes and risks. CDC Research on SDOH, Centers for Disease Control and Prevention, 2020
During the “Activating Health Equity in Specialty Pharmacy” session, panelists focused on programs addressing health equity and long-term strategies for the industry to work together to truly advance quality and care, and work with patients to help them become their best selves.
In response to why this was so important, panelists said, “It’s what patients need and what they expect.”
We need to do a better job with health literacy and help people understand that, because it comes back to patients not knowing what's available to them and to be treated, to take ownership of their disease ... that's what we really need to empower and simplify it.
"Activating Health Equity in Specialty Pharmacy,” Asembia 2021
Key takeaway: What you should know
The panel went beyond simply offering the state of health equity.
Panelists focused on how things should change to address care plans, clinical algorithms, clinical trials and patient engagement to acknowledge individual and disease complexity with a focus on health equity and drivers of health, such as social, economic and environmental factors.
Where a person is born can impact available opportunities throughout their life, including income level and socioeconomic status and even medication affordability.
Socioeconomic status, education, transportation options, physical living environment, race and ethnicity have come to the forefront of healthcare equity.
For example, 47 percent of racial minorities skipped treatments and/or medications to pay for other essential items or bills. CoverMyMeds Patient Survey, 2020
In addition, 58 percent of providers indicate that access to transportation impacted their patients’ ability to access healthcare. CoverMyMeds Provider Survey, 2020
One panelist recalled speaking to a patient who described an all-day process to pick up her medication as she had to take three buses to get to the pharmacy.
Health literacy, which can often relate to general literacy and other social determinants, Agency for Healthcare Research and Quality (AHRQ), “Health Literacy Universal Precautions Toolkit,” 2010 is a critical area that needs to be addressed to improve patient outcomes.
Health literacy is the measure of a person’s ability to gather, process and understand basic health information to make decisions.
Currently, 36 percent of adults have limited health literacy, and only 12 percent have proficient health literacy. Health Literacy, Barry D. Weiss, MD, College of Medicine
Estimates indicate low health literacy costs the U.S. economy up to $238 billion a year due to a greater risk of patient hospitalization and higher use of expensive services to treat advanced conditions and readmissions. “Low Health Literacy: Implications for National Health Policy,” Vernon, Trujillo, Rosenbaum, DeBuono, 2007
Health equity issues also extend to clinical trials and identifying barriers to enrollment for underrepresented populations and improving data collection.
For example, Mike Valenta, of Merck’s oncology group, said the company has been committed for years to help ensure a diverse population in clinical trials; however, there is still work to do.
“We know it’s hard to recruit those patients, but we have to do a better job of identifying them,” Valenta said.
“Right now, we recruit actively from 50 different countries around the world, which is great, but how about 60 or 80? How do we get more and more patients?”
Next Steps: What can you do now?
Holistically, the industry needs to collect and share data better to help predict those at risk for clinical, behavioral and socioeconomic challenges that can affect patient access and adherence.
This data can be used to not only better identify population groups most affected by diseases but also better test safety and efficacy in sub-groups to improve drug selection and dosing.
With better patient education comes better health literacy.
Education as a key to future success was also a theme echoed during the “Pharmacy and Pharma Leadership on the Frontlines” session.
Panelists identified one of the biggest opportunities for specialty pharmacy was to develop education and awareness tools in simple, easy to understand language for patients and their caregivers and families.
Biopharma companies can help fill gaps here with educational materials to go with prescriptions so patients can better understand their condition and treatment plan.
Increased clarity in these areas can support improved adherence and outcomes.
Specialty therapies are often the hardest to access for patients due to process complexity and affordability challenges. To learn more about specialty medication access and specialty pharmacies, download the 2021 Medication Access Report: Complex Care & Specialty Edition.
Editor: Information from Asembia 2021 was obtained from a third-party source.
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