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AMCP 2016

The Future of Specialty Pharmacy: Where Do We Need to Go?

Laura Joszt
The specialty pharmacy industry is unique in many ways, but the price growth for these drugs is no longer sustainable, Steve Miller, MD, senior vice president and chief medical officer of Express Scripts, said during a pre-meeting session of AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016.
Jeff Henderson, BA, vice president of managed markets at Intarcia Therapeutics, also discussed limited distribution as a positive force. These limited distribution networks are leading to manufacturers working with specialty partners and payers on risk-based contracts.
 
“Working through specialty pharmacy as a manufacturer probably brings us closer to the patient than we as a manufacturer have been since we conducted our clinical trials to get our drug approved,” he said.
 
As he looked to the future, Henderson highlighted integrated delivery networks (IDNs), which have been around for a while, but they are evolving in their level of sophistication, use of technology, and as a result of factors like accountable care and quality measures.
 
“We as manufacturers, as the healthcare marketplace evolves, are being asked to demonstrate value, demonstrate cost effectiveness, demonstrate outcomes, and demonstrate whether we can help with some of these dynamics that are taking place in the marketplace,” he said. “For example, alternative payment models.”
 
Dr Miller rounded out the session by discussing cost and the need for innovation.
 
While the rising cost of specialty pharmacy drugs has been held at bay through the ability to shift other patients onto generic drugs, the industry is reaching the end of that generic drug wave. To combat this, there needs to be a more holistic approach to specialty pharmacy patients.
 
In addition to taking the time to talk about how Express Scripts pitted pharmaceutical manufacturers against one another to negotiate lower prices for hepatitis C drugs and save $1 billion in just 1 year, Dr Miller outlined a new way to reimburse drugs.
 
He used the example of Tarceva, which can extend life for a patient with lung cancer by 4.2 months, but can only extend life by 12 days for someone with pancreatic cancer.
 
“Would you have paid the same price for a product that worked one-tenth as well?” he asked.
 
With help from Steven D. Pearson, MD, MSc, president of the Institute for Clinical and Economic Review, and Peter Bach, MD, MAPP, from Memorial Sloan Kettering Cancer Center, a new reimbursement model is being developed that looks at innovative ways to reimburse not just at the drug level but at the indication level.
 
“The future for specialty pharmacy is not just ‘are we going to use data better’? Not just taking better care of patients…” he said. “But rather we all have to innovate together to bring the field where it needs to go and create a sustainable situation for our patients.”

 
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