AMCP: Industry Shifts to Benefit Complex Patients

As the number of patients being treated for one or more chronic diseases continues to grow, providers are taking new approaches to more effectively manage this complex population. Aside from the obvious obligation to help the patients most in need of care, finding paths to optimal outcomes will keep costs down for both the patient and provider in an environment in which health systems accept more responsibility for the outcome.

The well-attended AMCP Managed Care & Specialty Pharmacy Annual Meeting last month featured various discussions on strategies to manage complex patients and achieve optimal outcomes, highlighted by an exciting string of innovations and policy shifts. Here are several takeaways from some of the sessions that caught my attention.

Topic: Using Rapid Cycle Analytics of Real-World Data to Manage High Risk, High Cost Patients

Panel: Sara Eapen, vice president, Aetion; Saira A. Jan, MS, PharmD, director/professor, Horizon BCBSNJ/Rutgers; Sebastian Schneeweiss, MD, ScD, professor of Medicine and Epidemiology, Harvard Medical School and Brigham and Women's Hospital.

Real world data were a recurring subject at the conference and this panel did a great job sharing their methodology for using the data to stratify patient groups. They laid out how the data impact overall cost of care and explained the ability to positively affect treatment protocols. My biggest takeaway is that providers who use real world data effectively and spread insights across clinical and pharmacy channels will optimize their formularies.

Topic: Specialty Pharmaceuticals in Development

Panel: Aimee Tharaldson, PharmD, senior clinical consultant, Emerging Therapeutics, Express Scripts.

Dr. Tharaldson detailed the drug pipeline in 9 key disease states and highlighted recently approved or soon-to-be approved medications that will have the greatest impact this year. The topics covered included biosimilars, orphan diseases, immunology (the highest specialty drug spending category), multiple sclerosis, oncology, HIV, nonalcoholic fatty liver disease, Alzheimer, and rare diseases.

Specialty drugs have earned approvals at a faster rate than traditional therapies in recent years, a fact that made Dr. Tharaldson’s review of forthcoming drugs extremely valuable in keeping up with a fast-paced process.

Topic: Patient-Reported Outcomes and Patient Preferences: Considerations for Coverage Policy Decisions?

Panel: Kim A. Caldwell, RPh, principal, Texas Star Healthcare Consulting, LLC; James D. Chambers, PhD, MPharm, MSc, associate professor, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Jennifer S. Graff, PharmD, vice president, Comparative Effectiveness Research, National Pharmaceutical Council; Eleanor M. Perfetto, PhD, executive vice president, Strategic Initiatives, National Health Council.

In an extremely interesting session, this panel deliberated on how much input patients should have in their own care plan design or formulary. Right now, patients do not have a strong voice in the decision-making process for their care, and even if they wanted to, few entry points exist for them to become involved. Additionally, the current structure of health plan pharmacy and therapeutics committees make it impossible for patients to influence their formulary.

Despite our cohorts in Europe and Canada moving to make patients more involved in their care plans, it seems premature to expect similar momentum in the United States. We first need to push for stronger health care literacy among the patient population before introducing patients to the decision-making process in their own care.

Topic: Measuring Value of an IDN Specialty Pharmacy Therapy Management Program for Biologics

Panel: Tim Affeldt, PharmD, director of Specialty/Infusion Operations, Fairview Pharmacy Services; Charles Ruetsch, PhD, president and CEO, Health Analytics, LLC; Autumn Zuckerman, PharmD, BCPS, AAHIVP, CSP, program director, Health Outcomes and Research, Vanderbilt University Medical Center.

This panel highlighted the ability of integrated delivery networks (IDNs) with in-house specialty pharmacy services to control costs for high-touch patients in an environment of ever-rising drug prices. Dr. Affeldt cited evidence from Fairview Health that supported the notion of a more holistic care model improving drug adherence and overall health, which ultimately leads to lower costs.

Fairview found that their patients with cystic fibrosis who used the integrated specialty pharmacy were 70% more likely to take their medications as prescribed than those using an outside pharmacy. Elevated adherence led to fewer readmissions and physician visits for those patients.

With policies shifting and innovation in pharmaceuticals and health tech moving at a rapid pace, I found this year’s AMCP meeting a refreshing overview of our current landscape. I came away confident our health system has the mechanisms in place to make care more efficient and affordable for even the most complex patients.