AXS24 Highlights: Key Insights Reshaping Specialty Pharmacy

Pharmacy, managed care, and health care technology stakeholders descended on the Wynn Las Vegas April 28 to May 2 for AXS24, the 20th Asembia summit and the see-and-be-seen annual pharmacy industry conference. You can click over to The American Journal of Managed Care^®’s conference page for expert insights and interviews with key opinion leaders in the space on. Meanwhile, here are some of the top news items from our sister publications at MJH Life Sciences^®: Drug Topics^®,Managed Healthcare Executive^®, and Pharmacy Times^®.

Drug Topics

Drug Costs. There has been much innovation in the specialty pipeline as of late, with notable drug approvals often resulting in high care costs for patients and health systems alike. In an interview, Bill McElnea, vice president of population health at Shields Health Solutions, reiterates the importance of health system specialty pharmacies for reducing care costs and of patients adhering to their medications, which is closely connected to reduced complications, hospital trips, physician visits, “and this had a real bearing on costs,” he emphasized. You can see his interview here.

Specialty Pipeline. There has been much innovation in the specialty pharmacy space as of late, including approvals for rare and orphan drugs, oncology, and traditional specialty medications. In the session, “The Specialty Pharmacy Pipeline 2024,” Ray Tancredi, RPh, MBA, CSP, divisional vice president, Specialty Pharmacy Development & Brand/Rx Vaccine Purchasing, Walgreens, discussed the ever-evolving specialty drug pipeline, with emphasis on continuous innovation through drug mechanisms of action and first-in-class medications. Advancements that he highlighted included those for Alzheimer disease and several rare/orphan diseases, cell and gene therapy, and a steady pipeline of oncologic therapeutics.

Collaboration. Autumn Zuckerman, PharmD, BCPS, CSP, director, Health Outcomes at Vanderbilt Specialty Pharmacy, and her colleagues discussed the drawbacks of using a siloed approach to patient care in their session, “From Silos to Solutions: A Collaborative Approach to Specialty Medication Care.” Instead, collaborations between health-system specialty pharmacies and drug manufacturers can help to optimize patient monitoring and improve patient outcomes. In an interview with Drug Topics, Zuckerman also discussed the partnership between Vanderbilt Specialty Pharmacy and AstraZeneca to accomplish these goals and the importance of goal alignment and communication within outcomes research.

Managed Healthcare Executive

Health Care Policy. In this election year, potential outcomes of the Inflation Reduction Act under either a second term with President Joe Biden or President Donald Trump term remain up for debate. The legislation was noted to be “the most significant change in terms of how we pay for drugs in this country that we’ve had in a number of years,” in an interview with Sara Butler, chief commercial officer, and Lindsay Greenleaf, JD, vice president and solution leader, Federal and State Policy, both of ADVI Health, regarding their session, “2024 Election Policy Issues and the Patient Journey Ripple Effect: IRA, The War on Cancer, and More.” They also discussed pharmacy benefits managers (PBMs) and the outlook for a bipartisan effort to increase PBM cost transparency.

Teamwork. In his keynote address, Admiral William McRaven, retired 4-star Navy admiral and former Chancellor of the University of Texas System used anecdotes from his 35-plus years of service as a Navy SEAL to discuss the importance of not only teamwork, but of perseverance, character, and overcoming adversity. These lessons were learned through several dangerous missions and encounters he’s had with his own health and that of injured soldiers he has encountered. Hope is another powerful tool, he emphasized, and we should never pass up the opportunity to gift that to someone.

GLP-1s. Glucagon-like peptide 1 (GLP-1) medications, as they are used to treat diabetes and obesity, have become the significant drivers of increased drug expenditures as of late, according to John Mahrt, president and chief operating officer, Optum Rx, in the session, “Addressing Cost & Accessibility for Innovative Medicines – GLP-1s and Beyond” and this interview with Managed Healthcare Executive. In both, Mahrt discussed the recent agreements between Optum Rx and GLP-1 manufacturers Novo Nordisk and Eli Lilly to allow tiered access to their approved GLP-1s; pricing strategies following these GLP-1 potential expanded indications; and the access challenges patients encounter with high drug prices.

Pharmacy Times

Women’s Health. As a health care investment and priority, women and their health have been historically underrepresented. In the session, “Advancing Equity for Women’s Health – Are We Gaining Momentum?,” Jennifer Radin, MPH, MBA, principal, Deloitte Consulting LLP, noted that for 2023, investment in women’s health comprised a mere 2% of the overall $41.2 billion funding health care companies received that year. “Investors have long viewed women's health as a niche market,” she explained. “In fact, just 4% of biopharma research and development spending goes towards female-specific conditions.” Recent market indications, however, show positive trends, with a spotlight on providing female-centered care that is also affordable and of high quality, while ramifications of the Dobbs v Jackson Women’s Health Organization have placed a renewed focus on equitable reproductive health.

Biosimilar Lifecycles. In “Leadership and Adapting to a Changing Biosimilar Industry,” Accord Healthcare’s Chrys Kokino, president, noted that although the biosimilar space has seen its share of progress—with 50 biosimilars approved for 15 biological molecules so far—uptake among approved products varies. He proposed that reasons for this include Medicare’s reimbursement strategy (average sales price of the reference biologic product plus 6%), familiarity (or not) with products, and larger vs smaller product rebates. These are questions that need answers, he explained, because with many manufacturers looking at biosimilars as having a 3-year lifecycle, their development priorities are affected by what they believe they can achieve market penetration with through ongoing production.

Pulmonary Arterial Hypertension. Despite a 2019 update to the criteria on what is considered pulmonary hypertension at the 6th World Symposium on Pulmonary Hypertension—the indication is now a mean pulmonary arterial pressure above 20 mm Hg, down from 25 mm Hg—care for the condition can benefit from additional clinical classification, according to Zachary R. Smith, PharmD, FCCP, BCPS, BCCCP, director, Critical Care, Henry Ford Hospital. During “The Evolving Treatment Paradigm for the Management of PAH: Strategies to Optimize Care,” Smith underscored there are many underlying causes of PH (eg, idiopathic, heritable, drug induced), which call for accurate categorization of patients as being at low, intermediate, or high risk, so their treatment course can be optimized, with the ultimate goal of getting all patients into the low-risk category.