For Douglas Long, MBA, vice president, industry relations, IMS Health, Inc, keeping up-to-date on the trends and forecasts of the evolving managed care arena is crucial to remaining competitive.
Published Online: October 18, 2013
For Douglas Long, MBA, vice president, industry relations, IMS Health, Inc, keeping up-to-date on the trends and forecasts of the evolving managed care arena is crucial to remaining competitive. In discussing the growth and decline of certain industry segments—in addition to the important considerations regarding brand name drugs, generic drugs, and pharmacy providers—Mr Long suggests that market predictions can shape the approach made toward managing the pharmacy benefit.
IMS Health Inc data show that the Moving Annual Total (MAT) August 2013 sales of branded drugs fell 4.4%, while branded generics rose 2.6% and generic drugs rose 8.1%. The specialty market share rose 6% between 2007 and 2013. The data also indicated that nearly one-third of spending is concentrated in the top 5 therapy classes.
Mr Long predicts that by 2020, changes to the United States healthcare system will be “substantial.” Reasons for this forecast include expansion of Medicaid programs, a 65% shift of spending from fee-for-service, restructuring of healthcare delivery (ACOs, IDNs, IHNs, etc), and >
90% of EMR adoption. Of course, one must consider that risk, rate, pace, and policy will also play a part in this transformation. In particular, Mr Long suggests that healthcare policy reform will have a significant impact, as it brings elements that will provide support for positive positioning and increased usage of medications. This change is necessary since a small minority of patients account for the vast majority of healthcare costs.
Cost containment opportunities lie in readmissions, coordination of care, and pharmacy. Over $200 billion in healthcare costs are incurred annually due to medicines not being used responsibly, including in patient medication adherence. Mr Long says that pharmacies have a “critical role to play in addressing the key opportunities for improvement,” as they provide a “unique role and understanding of medicines, direct engagement with patients, and link to other stakeholders.” Pharmacists also provide value in controlling costs, but barriers to their participation must be addressed.
Focusing on the responsible use of medicine is an essential part of healthcare, but management of drug use remains siloed from other parts of care, and this can be costly. Medication nonadherence, delayed evidence-based treatment, antibiotic misuse, medication errors, suboptimal generics use, and mismanaged polypharmacy all account for $213.2 billion in avoidable costs. To mitigate costs, pharmacies and pharmacists can engage directly and meaningfully with patients, in addition to tailoring programs in support of patient cohorts who are likely to be nonadherent.
The most effective way to control costs and drive quality? Mr Long says the most innovative approaches will only be possible through collaboration among multiple healthcare stakeholders including patients, pharmacists, providers, policy makers, payers, and pharmaceutical manufacturers.