During the Academy of Managed Care Pharmacy Managed Care & Specialty Pharmcy Annual Meeting, held March 25-28, in San Diego, California, managed care professionals from across the globe gathered to discuss opportunities and challenges facing stakeholders in pharmaceutical management, ranging from drug pricing reform to strategies to address the opioid epidemic. Here are 5 things that came from the meeting:
1. What’s Coming Down the Pipeline
Giving her annual update of what’s coming down the development pipeline, Aimee Tharaldson, PharmD, senior clinical consultant for Express Scripts, offered the crowd
updates regarding increased competition, cancer drug development, and orphan drug development. Looking at drug competition, Tharaldson explained that with many specialty drugs going generic in the next few years, there’s potential for about $24 billion in savings through 2023. She also cited increased presence of biosimilars in the market, with 8 pending approval this year. In contrast, despite 17 new cancer drugs approved in 2018, there haven’t been cost reductions as a result.
Tharaldson outlined 7 classes of specialty drugs to watch for: inflammatory disease, multiple sclerosis, oncology, HIV, nonalcoholic steatohepatitis, Alzheimer disease, and hemophilia.
2. Drug Pricing Reform
As the Trump administration's blueprint to lower drug prices heads toward its 1-year mark, a session at the meeting took a look at different efforts
underway to tackle drug costs. Melissa Andel, MPP, vice president of health policy at Applied Policy, explained that when implementing these efforts, policy makers need to carefully consider which mechanisms will actually address these costs. For example, she said, pushes to get manufacturers to lower list prices could lead to them eliminating rebates, which would lead to no net reduction in spending.
While a large focus is typically placed on rebates, Andel warned that rebate change agreements will come with their fair share of tradeoffs, with a potential of higher premiums and fewer plan choices as a result of no rebate revenue. She added that lower list prices would slow Medicare beneficiaries’ progression through their benefits and could result in longer time spent in the coverage gap.
3. Value-Based Contracts in Medicaid
A session during the meeting included perspectives
from both manufacturers and payers on the value-based contract process in Medicaid, with stakeholders from both sides agreeing that trust is crucial for getting an agreement in place. On the payer side, Terry Cothran, DPh, director of Pharmacy Management Consultants, explained that the state Medicaid program is an ideal setting for experimenting with new ideas, such as these contracts. However, he noted that there are challenges, with payers having to work with a finite budget set by legislature.
Meanwhile, Russell L. Knoth, PhD, director of health economics & outcomes research at Eisai, outlined factors that can help facilitate these agreements, including having a robust infrastructure for collecting and analyzing data. Knoth also cited a study published
in the February issue of The American Journal of Managed Care®
, which found that the majority of value-based agreements are not publicly disclosed, potentially leading to underestimation of their true prevalence and impact.
4. Fighting the Opioid Epidemic
As efforts around the country continue to try and address the opioid crisis, Bonnie C. Greenwood, PharmD, BCPS, clinical director at the University of Massachusetts Medical School, outlined a 4-part framework
for managed care pharmacy strategies, including establishing goals for safe prescribing and appropriate pain management; expanding patient access to coordinated pain management and substance use disorder treatment; developing systems approaches to changing prescribing behavior; and enhancing provider tools for screening, monitoring, and mitigating the risks of opioid therapy.
During the session, Kimberly Lenz, PharmD, clinical pharmacy manager of MassHealth/Office of Clinical Affairs and University of Massachusetts Medical School, joined Greenwood in emphasizing the role of naloxone in addressing the epidemic. As the only intervention that has demonstrated a direct link with opioid mortality, the surgeon general and the FDA commissioner have called for greater access to naloxone, and advocacy efforts have sprouted throughout the country. Lenz noted that strategies should be tweaked and tailored as needed.
5. Improving Costs of Living With HIV
Three different posters presented at the meeting demonstrated that rapid initiation of antiretroviral therapy (ART) can help mitigate the high costs
associated with HIV due to high healthcare utilization. One poster analyzed more than 21,000 Medicaid claims, finding that mean costs in the United States ranged from $1849 to $3451 per inpatient day, $704 to $828 per emergency department visit, and $130 to $417 per outpatient visit for these patients. A second poster looked at the economic impact based on initiation of ART, finding that medical costs were consistently greater among patients who had delayed initiation of ART.
The third poster had a similar conclusion, finding that rapid initiation of ART was associated with lower healthcare costs after examining characteristics of and healthcare costs among commercially insured people living with HIV in the United States treated within 60 days of diagnosis. Costs among patients who had rapid initiation were $109,456, whereas costs were $116,870 among patients who had moderately rapid initiation over the 36 months following diagnosis.