What Makes a Specialty Pharmacy Attractive to Payers?

Specialty pharmacies rely on payers to gain access to drugs and reimbursement for services. In a session at the National Association of Specialty Pharmacy Annual Meeting and Educational Conference, stakeholders discussed how specialty pharmacies can ensure that their portfolio is attractive to payers and manufacturers.

On a daily basis, payers are asking specialty pharmacies, “do you have access to this drug” and “what does the market look like?” On the other side, pharmaceutical manufacturers are interested in learning about the different capabilities specialty pharmacies have for managing drugs, according to Shannon Ferrer, vice president, Pharma Relations, BioPlus Specialty Pharmacy.

As pharmacy spend on specialty drugs increase, payers are becoming more invested in the industry and are looking for ways to control costs. It is crucial for specialty pharmacies to keep up with these trends, according to the panel.

“Specialty pharmacy is trending upwards,” said Luis Torres, MBA, vice president of managed care, Bioplus Specialty Pharmacy. “Payers are looking for ways to help manage those complex therapeutic classes and setting new criteria for formulary decisions, management of medications, and who is included in the network.”

Inflammatory, oncology, multiple sclerosis, and hepatitis C virus (HCV) medications continue to drive specialty drug costs, despite a downturn of HCV spending over the past 2 years. The HCV market is likely to remain high on the list, despite the emergence of lower cost drugs, including AbbVie’s recently approved Mavyret (glecaprevir and pibrentasvir), according to the session.

For the other categories, Ferrer said that it is likely that the trends will continue through 2018, especially for inflammatory biologics.

However, biosimilars may change the top drugs that are contributing to specialty spending. With the approval of several drugs, the market may shift towards biosimilar utilization, but the degree of the shift depends on interchangeability designation, according to the panelists.

Notably, the top 5 drugs that dominated spending in 2017 have been specialty, with non-specialty drugs for diabetes coming in at numbers 9 and 10. Payers understand these drugs are driving pharmacy spend and they have to develop novel strategies to control costs on an ongoing basis, according to the session.

Ferrer suggests that specialty pharmacies must also be aware of the top products that drive spending to ensure that they stay competitive, which will open opportunities for manufacturer partnerships.

Payers are always searching for novel ways to manage specialty drug spending, including formulary lists, benefit design, and co-payment assistance programs. These initiatives are necessary to ensure that all patients are able to access treatment.

At Bioplus, they remain competitive by ensuring that patients start therapy quickly and remain adherent throughout treatment, which is what pharma is looking for in a specialty pharmacy partner, according to the session. Ferrer also indicated that pharma is looking for partners who are able to provide them with data.

According to the session, payers select specialty partners based on these parameters:

· How are service, pricing, and programs balanced?

· How price sensitive is the client?

· How is responsiveness gauged?

· What drug classes require significant management?

· How frequent is reporting?

· What are the client’s needs?

· Innovation

For pharma, these considerations are quite different. The experts said that this group looks for:

· Data collection and trends

· Customized reporting

· Clinical programs

· Payer portfolio

· Technology

· Access

· Time to therapy

· Special programs for patients, prescribers, and pharma

“We have to continue to innovate, as the specialty pharmacy industry. [We have to] ask different types of questions and think outside of the box,” Torres concluded. “Nothing is off the table when it comes to payers because they are always looking to better manage their drug spend.”