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Perspectives on Integrated Specialty Networks

Posted by Matt Breese on Nov 1, 2016

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Specialty drugs account for an increasing percentage of prescriptions, as well as for increased revenues for the pharmaceutical industry. According to a study by Pembroke Consulting, total pharma revenues were $274 billion in 2010, with $41 billion attributed to specialty drugs. By 2020, those revenues are expected to rise to $483 billion, with $212 billion linked to specialty drugs.

There is a direct correlation between prescription costs — specifically the increased use of specialty drugs in treating cancer, multiple sclerosis, diabetes and inflammatory diseases — and the rising cost of health care in the United States. A report out of the Office of the Assistant Secretary for Planning and Evaluation (ASPE), advisor to the Secretary of the U.S. Department of Health and Human Resources, estimates that more than $450 billion was spent on prescription drugs in 2015. QuantilesIMS™ estimates that by 2020 $350 billion will be spent on specialty drugs alone, quadruple the $87 billion spent in 2012.

Specialty Drugs:

  • Are relevant for a smaller market than most other drugs
  • Have significantly higher prices due to complex manufacturing and distribution processes
  • Produce a quicker return on investment because of fewer clinical trial requirements

Optimizing patient access to specialty drugs is critical to pharma’s financial success. An integrated strategic approach to improving access — through in-house resources or through one or more companies specializing in market access and patient-support programs — can positively affect ease of prescribing. Effective marketing will answer a provider’s fundamental question: Will the drug and related patient-support services help my patient reach his or her treatment goal at a lower cost and with reduced dependency on health-system resources?

Specialty pharmacies, which have enhanced capabilities to handle, deliver, store and prepare specialty drugs, play an essential role in answering that question. According to UnitedHealth Group, specialty pharmacies engage patients through:

  •       One-on-one consultations
  •       Ongoing care management
  •       Financial assistance referrals
  •       Education and counseling
  •       Pro-active intervention for non-adherence
  •       Refill reminders
  •       Follow-up calls

There are many players in the specialty pharmacy arena. Independent specialty pharmacies are among the fastest growing private companies in the United States. Pharmacy benefits managers (PBMs) have their own specialty pharmacies as a way of better managing access to specialty drugs and the associated costs. Even integrated delivery networks (IDNs), health systems and private physician practices are creating their own “closed-door” specialty pharmacies to meet their patients’ needs and to control the distribution of these highly sophisticated drugs.

Many experts predict continued growth of specialty drugs as the preferred medication therapy for an increasing number of medical conditions. To achieve market success, however, pharma must integrate specialty pharmacies in their strategic plans and enlist the appropriate expertise to help providers and patients navigate access to these drugs.

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Topics: Market Access