Health Systems’ Role in Specialty Pharmacy Moves Into Focus at Asembia

As the largest conference in the United States focused solely on specialty pharmacy, the Asembia Specialty Pharmacy Summit presents an unparalleled and unique opportunity to analyze the big picture of the industry and its key players. With representatives from major stakeholders in attendance, the summit is a rare chance to discuss shared challenges, explore best practices, and take the pulse of industry-wide sentiment.

After attending panel discussions and meeting with colleagues, it is clear the specialty pharmacy industry is in a state of transition. This can be attributed to many different factors, not the least of which is specialty medications are on pace to make up half of all prescription drug spending in the United States by 2020.¹ Although pharmacists and physicians familiarize themselves with new treatment regimens and develop novel care plans to treat the nation’s sickest patients, we’re also navigating increasingly muddy waters as health care regulations continue to shift market dynamics. Relationships between drug manufacturers, payers, pharmacists, and integrated delivery networks (IDNs) remain fluid, with siloed communications leading to increasingly fractured care. Overall, although new drugs are coming to market at a rapid pace, care delivery and operational models are slow to evolve, which forces many entities to explore new strategies.

The rapid pace of development is not a new trend for the industry, but it does feel like we are reaching an inflection point. Much of the discussion at this year’s summit focused on how to improve care delivery to account for, and make the most of, the industry’s rapid, ongoing innovation. One common thread across the various stakeholders did focus on the role that umbrella networks can play in improving care coordination for complex patients. Known as specialty pharmacy IDNs, both health systems and manufacturers are beginning to recognize the value of coordinated care that tightly integrates the specialty pharmacy.

Manufacturers and the Role of Specialty Pharmacy IDNs

Along with the rise of specialty medications, it is also anticipated that by 2020, 157 million Americans will suffer from at least 1 chronic disease.² For the specialty pharmacy market to meet this growing patient demand, all stakeholders need to work together more efficiently. A more streamlined relationship between manufacturers and health systems will prove beneficial and an overarching network, such as a specialty pharmacy IDN, can orchestrate that relationship.

Specialty pharmacy IDNs create a holistic care model that places the patient at the center. This focused approach increases drug adherence, lowers readmissions, and controls costs. It also enhances the patient experience for complex patients by uniting every element of care in a single place and creating free-flowing lines of communication between the specialty pharmacy and all providers involved.

As an example, Fairview Health in Minnesota found their patients with cystic fibrosis were 70% more likely to take their medications as prescribed than those using an outside pharmacy. Overall, Fairview saw decreases in outpatient visits, emergency department visits, and readmissions among patients who used the Fairview Pharmacy.

Manufacturers have tremendous incentive to work with these networks, not only to get their therapies in patient hands, but also as a source of comprehensive patient data. Although it has taken some time for the drug companies to see the value in a relationship with an IDN, more are exploring these partnerships.

Timothy Paine, vice president of Pharma Strategy and Relations at Fairview Pharmacy Services, described how the relationships between manufacturers and IDNs has evolved in recent years.

“Manufacturers are asking ‘how do we engage? How do we work with them?’ This was different than the previous 4 years that I’ve attended Asembia,” Paine said. “The first year, major pharmaceutical companies were asking ‘I get IDN and I get specialty pharmacy, but I don’t get the 2 together.’ This was eye-opening as it helped me understand where the market was at the time and how best to communicate Fairview’s perspective.”

Within the past 2 or 3 years, Paine has fielded much more interest from manufacturers as they develop a better understanding of IDNs as a vehicle for delivering specialty medications.

“This year, IDN-based specialty pharmacy was a hot topic and manufacturers want to get involved,” he said. “There’s been an evolution of crawling, to walking, to jogging, to running, and IDN-based specialty pharmacy is starting to take off.”

The past 2 decades have seen a major uptick in the number of drugs coming to market, with an emphasis on high-priced specialty medications—particularly oncology medications. A growing number of patients in need of specialty drugs has fueled that wave of innovation, as more than 130 million Americans currently manage at least 1 chronic disease.³

IDN-based specialty pharmacies have been a part of the landscape during this time, but some are still trying to build better relationships with manufacturers to grant access to a broader range of drugs for their patients.

Despite many informative conversations at this year’s Asembia Summit, predicting the next 20 years of specialty pharmacy poses a nearly impossible task. Unforeseen government regulations based on future political elections will shape our trajectory in the same way consumers are affected by the Department of Health and Human Services requiring pharmacy advertisements to include list prices in advertising. However, cohesion among key stakeholders, which will lead to an evolution in care, is clearly on the rise, and the growth of those relationships will only benefit patients in the end.

References

1. Theraldon A. Specialty medications nearing 50 percent of spend. Express Scripts. https://lab.express-scripts.com/lab/insights/specialty-medications/specialty-medications-nearing-50-percent-of-spend. Published November 27, 2018. Accessed May 15, 2019.

2. Wu S, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. Washington, DC: RAND Health; 2000.

3. National Center for Chronic Disease Prevention and Health Promotion. Chronic diseases in America. Centers for Disease Control and Prevention. https://www.cdc. gov/chronicdisease/resources/infographic/chronic-diseases.htm. Reviewed April 15, 2019. Accessed May 15, 2019