Asembia 2022: Specialty Patient Access, Centricity and Adherence
Over 6,000 attendees are gathered this week in Las Vegas for Asembia 2022, a specialty pharmacy summit. Wednesday’s Asembia sessions focused on incoming tools and trends specialty pharmacists can use to help patients get the medications they need, from more affordable and available biosimilars to equitable adherence strategies.
Over 6,000 attendees are gathered this week in Las Vegas for Asembia 2022, a specialty pharmacy summit. We attended Wednesday’s sessions, which were focused on incoming tools and trends specialty pharmacists can use to help patients get the medications they need — from more affordable and available biosimilars to equitable adherence strategies.
Monday’s recap, “Legislation and Innovation for Specialty Pharmacy,” examined legislation that will affect specialty pharmacists and the impact digital and pipeline therapies will have in the coming year. Tuesday’s recap, “The Changing Dynamics of Specialty Pharmacy,” examined specialty pharmacies and pharmaceuticals trends and how they relate to patient access to specialty medications.
Session: “Uncharted Biosimilar Categories”
Presenters: Jeffrey Casberg, VP of Clinical Pharmacy, IPD Analytics; and Leslie Fish, director of Clinical Pharmacy, IPD Analytics
Summary: What was discussed
Unbranded biologic and interchangeable biologic launches are becoming more common and provide a lower-cost alternative for patients requiring more specialized therapies. Jeffrey Casberg and Leslie Fish of IPD analytics talked about how biologics could change pharmacy industry dynamics, how providers prescribe and how payers manage their formularies.
Casberg and Fish specifically called out two types of biosimilars:
INTERCHANGEABLE BIOSIMILARS Interchangeable biosimilars are biosimilars of reference drugs — the original biologic — that a pharmacist could substitute for a patient even if a provider prescribed the brand drug. This would happen in the same way generic drugs are substituted for brand names in the non-biologic space. To be designated as an interchangeable biosimilar, these products go through additional Food & Drug Administration (FDA) evaluation and testing to make sure they replicate the reference product’s clinical results in any patient.Biosimilar and Interchangeable Products, FDA, 2017 Casberg noted the first two interchangeable biosimilars were approved by the FDA last year for diabetes and immunology, with several more expected in the coming year.
AUTHORIZED BIOLOGICS Not tehcnically biosimilars, authorized biologics are exact copies of the reference product developed by the same brand. Brands launch authorized biologics — sometimes known as unbranded biologics — with the intent of competition. In other words, brands use authorized biosimilars to gain back market share from other company’s biosimilar products launched to compete with the reference product. Late 2021 saw the first two authorized biologics launch for diabetes and immunology.
While biosimilars have been available in the United States for nearly 7 years, uptake has been slow due to biopharma reference drug competition, payer hesitancy and insufficient education for providers and patients, Fish said.
However, they’re starting to gain ground and have the potential to save patients billions collectively over the next few years. Fish said interchangeable and authorized products could help all biosimilars gain ground and trust.
Key takeaways: What’s most important
The current and impending biosimilar launches could have a significant impact on branded products as well as formulary management. In the case of one oncology biologic, biosimilars gained 65% market share in a year’s time and had a cumulative savings of $2.5 billion.Pharmacy Policy Experts Describe Changes in Biosimilar Adoption Curve, AJMC, 2021 Biopharma companies are now turning to biosimilars due to a growing market demand and a greater need for accessible therapy options for lower-income patients.
To get more affordable alternatives to brand biologics in the market earlier, some biosimilar companies may pursue “skinny labeling.” This is a method in which companies introduce a biosimilar that only lists indications for which the reference drug’s use patents have already expired.
Industry call to action
With greater acceptance of biosimilars from payers and pharmacy benefit managers (PBMs), providers and patients may have even more incentive to seek out biosimilars, especially as more take new pathways.
Educational opportunities for these groups still exist. Agencies like the FDA, Department of Health & Human Services (HHS) and even biopharma and payers could collaborate to provide more accessible information about these therapy options.Realizing the Benefits of Biosimilars, Duke Margolis Center for Health Policy, 2021 Specialty pharmacists will likely continue to play a pivotal role in helping patients access and afford new biosimilar options. Benefit transparency and full integration will continue to be important as new drugs continue to be introduced to the market and to formularies through 2023.
Session: “Pharmacist Evolution: A New, More Active Role from Patient-Reported Outcomes to Developing Insights”
Presenters: Alexandra Broadus, senior director, Specialty Health Solutions, Walgreens; Melanie Radi, manager, Clinical Programs, AllianceRx Walgreens Prime; Alex Whitehead, senior director, strategy and partnerships, Treatment Technologies & Insights (TTI); Jeff Bourret, senior director, North America Medical Affairs, Inflammation & Immunology, Pfizer
Patient-reported outcomes data is essential for individualized care — full stop.
Alex WhiteheadSenior Director, Strategy and Partnerships, Treatment Technologies & Insights (TTI)
Summary: What was discussed
Patient reported outcomes (PRO) are anything a patient directly says that’s not influenced by a clinician or other care team member. With the push to collect more real-world data, accelerated by the introduction of the 21st Century Cures Act in 2016, the industry is looking to PRO to influence public health and individualized care plans.
However, the individualization of PRO makes collecting and standardizing this data tricky. This panel of pharmacy experts examined ways specialty pharmacy can use PROs to address shifting adherence and outcomes barriers on an individual level.
Alex Whitehead, senior director of strategy and partnerships for Treatment Technologies & Insights, discussed a specialty pharmacy app that allowed patients to self-report daily symptoms, side effects and generally how they were feeling as they initiated a new medication. The app then reflected trends to the patient that could indicate triggers for symptoms. It also deep linked to educational information about symptom management. While patients are usually very active in the first week or two, they often fall off using it due to the strain of keeping up with multiple comorbidities or simply the business of life, said Melanie Radi, manager of clinical programs at AllianceRx Walgreens Prime. Such is the case for many self-reporting adherence applications.
That’s where integration with pharmacy workflows can help. Care team members could then step in when they see a patient having difficulties adhering to medications or experiencing unpleasant side effects. This can also provide an opportunity to connect with patients who may need an alternative communication method, such as a phone call where they can talk through challenges related to their condition or medication. Further benefit comes from specialty pharmacists having easy pathways to connect with care teams when they feel a drug may not be working or further clinical intervention is needed.
Key takeaways: What’s most important
Whitehead said it best. “Patient-reported outcomes data is essential for individualized care — full stop,” he said. While social determinants of health and symptom data gathering are important, taking individualized action for the patient at hand is most important to driving positive outcomes and keeping costs down for all stakeholders.
“Information gathered based on patients' everyday behaviors might lead to different actions for different care plans,” Whitehead said. “They may be able to ask how many minutes a day someone’s doing yoga, are they praying if they’re religious or keeping in touch with their mother, for example.” Panelists emphasized the continued need for information and interventions to be offered in mediums beyond digital. Paper educational materials in multiple languages, phone calls and even locating care team members in pharmacy deserts could help access greater sets of patients who may often be forgotten or left behind, said Jeff Bourret, senior director of North America Medical Affairs, inflammation and immunology at Pfizer.
Industry call to action
Many patients want to be an active participant in their care. The industry can and should look for opportunities to partner with the patient throughout their care for an improved experience, outcomes and better adherence. Biopharma companies are often specialty pharmacy’s closest partners in developing PRO solutions, helping to define the patient journey to co-create an experience for the patient.
Specialty pharmacies who are willing to partner in creating solutions to gather and act on patient data can further let providers know what they’re learning about the patient to improve their care.
ICYMI: Monday’s recap, “Legislation and Innovation for Specialty Pharmacy,” examined legislation that will affect specialty pharmacists and the impact digital and pipeline therapies will have in the coming year. Tuesday’s recap, “The Changing Dynamics of Specialty Pharmacy,” examined specialty pharmacies and pharmaceuticals trends and how they relate to patient access to specialty medications.
Session: “Medication Adherence: Why Patients Need More Than Reminders and Coupons”
Presenter: Greg Gallo, chief revenue officer, AdhereTech; Rob Hauser, Pharm.D., Vidence, LLC
Summary: What was discussed
When it comes to medication adherence, many apps and electronic tools in the healthcare market can help patients find coupons and even remind them to take their pills. While these tools are often medication- and condition-specific, where they fail to help most is not being patient-specific. Adherence challenges span the gamut of health determinants, from transportation to literacy to side effect management. Additionally, each of these determinants can vary based on the patient, down to differing side effects for patients on the same medication. Because of this, it takes more than technology to help improve adherence rates — human connection and clinical expertise can’t be replaced, but they can be made more accessible.
In this session, Greg Gallo, chief revenue officer at AdhereTech, and Rob Hauser, Pharm.D. at Vidence, LLC, discussed how disparate stakeholders can address the “epidemic” of nonadherence.
It's a team sport. I think everybody owns a piece of adherence as we work to improve the care of the patient.
Rob HauserPharm.D., Vidence, LLC
The consequences of multiple stakeholders holding responsibility for adherence are friction and confusion. This confusion trickles down to the patient, causing a further lack of adherence. It’s unfortunate because patients, for the most part, want to take their medications as prescribed, said Gallo. However, as many as half of patients don’t take their medication as prescribed and a third don’t even fill their prescription.Why You Need to Take Your Medications as Prescribed or Instructed, FDA, 2016
Key takeaways: What’s most important
Gallo asked audience members to remember that patients are complex and most of their lives don’t revolve around their healthcare, though they can be greatly impacted by it. Factors such as a lost mail-order prescription, a language barrier or even a broken-down car can affect whether a patient can take their medication that day.
Hauser mentioned provider and pharmacist care and empathy from the start and proper “onboarding” of a new prescription, can pay off in adherence later. "It's a team sport,” Hauser said. “I think everybody owns a piece of adherence as we work to improve the care of the patient."
Taking the time to address how bad a patient feels, what their home life is like or talking through the importance of a dosing schedule could bring care plans to true patient centricity.
“The more we say 'patient-centric' and don't put action behind it, the more we're going to see [adherence] problems and perhaps make them worse,” Gallo said.
Industry call to action
Adherence approaches should be holistic and help connect patients to people who can best help address their challenges on a case-by-case basis. At the same time, Hauser emphasized that simplistic approaches are best. “There’s only so much data a patient or their family can process at any given time,” he said.
Interoperability can help care teams and patients avoid data overload and duplicative questions and processes to simplify healthcare for everyone. With technology in a support role, clinically trained experts can be true changemakers for patients. Effort in the healthcare technology space should shift away from one-off, single-point solutions and aim to address adherence challenges across the patient continuum, with expertise connected along the way.
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