The managed care industry is still struggling with the specialty pharmacy trend. The moderator of a session entitled New Specialty Pharmacy Distribution Channels, at The Academy of Managed Care Pharmacy's 26th Annual Meeting & Expo, started the discussion with a common complaint she hears from employers in 2014.
Published Online: April 02, 2014
Clearly, the managed care industry is still struggling with the specialty pharmacy trend. The moderator of a session entitled “New Specialty Pharmacy Distribution Channels,” at The Academy of Managed Care Pharmacy's 26th Annual Meeting & Expo, started the discussion with a common complaint she hears from employers in 2014. Jan Berger, MD, MJ, president and chief executive officer, Health Intelligence Partners, Chicago, Illinois, and editor-in-chief of The American Journal of Pharmacy Benefits
said, “All I hear is ‘I don’t care about all these conventional drugs, the small molecules. What are we going to do about specialty? It’s breaking the bank! How can I stay competitive with these rising costs?’”
The panelists did not believe that the current specialty pharmaceutical distribution model itself will solve the problem. They put forth that the establishment and implementation of partnerships with health professionals on several levels will be required to not only focus on the trend but to improve care.
Atheer Kaddis, PharmD, senior vice president, sales and business development, Diplomat Specialty Pharmacy, Flint, Michigan, mentioned that beyond the 8 national distribution centers that Diplomat runs, its the partnerships with 11,000 participating retail pharmacies and 30 hospitals in its hospital specialty network that “gets me excited.”
He pointed out that the value proposition for the patient, unlike for the payer, is "more about care management, education, and counseling.” Dr Kaddis said, “We’ve always had partnerships, but we’ve just recently expanded into the retail market and the hospital market, to provide support services." He said that includes dispensing through private-label programs in which they can offer customizable education and training based on role- and client-specific needs (and disease states).
Diplomat’s evaluation of the effectiveness of its retail specialty network demonstrated increased medication possession ratios (MPRs) in many disease states, all attributable to pharmacy intervention. He cautioned that using improved MPR as a surrogate for quality of care is not ideal—it’s more of an indirect value. “It is important for us to continue offering programs to improve compliance in the market,” he stated.
Richard Couldry, MS, RPh, director of pharmacy, University of Kansas Hospital, Kansas City, Kansas, provided a hospital’s viewpoint. His institution handles approximately 45% of the cancer care in the region, and they have realized that it is not possible to provide comprehensive, world-class cancer care without high-cost specialty medications. They partnered with UnitedHealthCare in a program that now includes nearly 320 patients, handling an average of 336 prescriptions per month. Their MPR data has shown excellent gains as a result of the program, with a low of Xeloda at 83% and a high of Nexavar at 97% (average, 94%). “The pharmacists will still say that this does not tell me whether the patients are taking their meds. What can you do to partner with your payers to ensure that they do?” he asked.
Mr Couldry pointed out that the value proposition for the patient, payer, and pharmaceutical companies may be very different when it comes to specialty pharmaceuticals. “For the patient, it is getting access to top specialty medications. For the payer, it may be to reduce PMPM costs,” he said. “For the pharmaceutical companies, it may obtaining increased access by identifying the right patients.”
Christine Strahl, PharmD, MBA, BCPS, specialty pharmacy program manager, HealthPartners, Minneapolis, Minnesota, mentioned that her integrated system "has been pretty aggressive in the specialty marketplace over past 10 years, where we used an exclusive specialty pharmacy vendor.” Only recently have they expanded their specialty distribution model, looking at creating new networks by individual disease states. “We’ll be looking at which pharmacies are best equipped to provide service for specific disease states,” she said, with a focus on hemophilia and cystic fibrosis today, HIV and transplant tomorrow.
Dr Kaddis cautioned that as the market is changing and new methods of more efficiently distributing specialty pharmaceuticals are being sought to help manage the trend, “Entry into specialty pharmacy is not that difficult, the barrier to entry is low, but the barrier to success is very high because of all these requirements and the changing market.”