Utilization, Management Trends in Specialty Pharmacy Discussed at Asembia

Fourteen years after it began, the EMD Serono Specialty Digest continues to take an in-depth look at specialty pharmacy from a health plan perspective.

Kevin Host, PharmD, president and chief operating officer of PSG; Michael Lonergan, RPh, president of Artemetrx; and Sharon Glave Frazee, PhD, MPH, digest editor, discussed highlights from the 14th edition of the EMD Serono Specialty Digest in a session held yesterday at Asembia’s Specialty Pharmacy Summit 2018.

The digest compiles survey results from 59 commercial health plan providers. The providers were questioned during the survey period of October to November 2017 about key challenges, management strategies, and top initiatives in the future regarding specialty drugs.

Discussing key challenges, survey respondents echoed the findings from previous years, but in the 2017 survey, determining the value of specialty drugs took the No. 1 spot as a challenge. Host attributed this, in part, to the continued entrance of new technologies, which challenge health care managers in determining the value of these services. Managing oncology, which survey participants noted as a top challenge, remained in a similar spot as last year, and ensuring clinically appropriate use continued to be listed among top challenges.

“When only the topmost challenge by respondents was analyzed, determining the value of specialty drugs and managing oncology drugs and services tied as the top challenge (both selected by 22% of plans as their #1 challenge),” according to findings from the digest.

Lonergan noted that the gap between most cancer management goals and the achievement of those goals had been reduced since the 2016 sur- vey, with the No. 1 greatest gap noted as reducing oncology drug costs, which dropped to 49% in 2017 compared with 64% in 2016.

Use of clinical pathways has remained relatively stable, but with much higher rates of collaboration noted between oncologists, jumping from 38% to 84% in 2017. Lonergan attributed this difference in large part to recommendations from the American Society of Clinical Oncology, which recently advocated for more collaboration in the development of clinical pathways.

Regarding genetic testing and companion diagnostic strategies, Lonergan noted that the majority of plans continue to cover companion diagnostic testing (64%, which was an increase from 56% in 2016).

Discussing overall specialty drug management, Host said there is slightly more utilization in the home infusion space compared with the 2016 survey findings. He said outpatient infusion clinic use remained fairly consistent in the 2016 and 2017 surveys.

A key takeaway was that medical benefit cost- sharing strategies seemed to be very common across all sites of care.

Lonergan broke down the survey’s findings on ancillary and distribution services by specialty pharmacies.

“In a nutshell, the plans think specialty pharmacies do a good job of getting drugs to their patients and servicing their patients,” he explained. He added that there remains a great opportunity for specialty pharmacies to distinguish themselves by improving in this area.

As noted by the editorial advisory board in this year’s digest, several emerging topics were added to this year’s edition, including multiple sclerosis (MS) management.

Lonergan noted that MS was added as a category because its management presents “unique challenges” for plan sponsors, specifically related to biological drugs.

Similar to the digest survey on oncology, the survey participants included a gap analysis in managing MS, and Lonergan noted that the overall consensus from the survey seemed to indicate that from a health plan perspective, the gaps in managing MS are much smaller than the gaps in the oncology space. He noted the No. 1 gap is reducing drug costs, at 37%, followed closely by reporting on treatment cost and outcomes.

Fewer than one-third of respondents currently use or plan to use clinical pathways for MS, he said.

Discussing key initiatives for the future, the panel stressed coordination among benefits, which they concluded is important for patients and providers so that the care will be seamless. The panel also noted the importance of coordinating across departments within health plans, enhancing reporting requirements, and continuing to enhance prior authorizations to ensure clinical effectiveness.