Fresh data confirms that spending on traditional pharmaceutical drugs continues to decline while specialty therapies are on the rise, accounting for 44 percent of the dollar share. The same data reveals that specialty spend is growing at 9.5 percent while traditional is declining at 2.5 percent. [IQVIA, National Sales Perspectives, March 2018] This shift will continue to impact the entire healthcare system from drug manufacturers to distributors, payers, regulators, service providers, prescribers and patients.
Maneuvering Against Headwinds
Drug manufacturers are facing many challenges, including tighter, more consolidated payer management, higher out of pocket payments, public pressure for price transparency, stringent medical benefit management and an evolving payer landscape. While health systems are growing, currently they represent a small fraction of pharmaceutical sales, and the high prices attached to specialty medications are altering the reimbursement mix.
From the manufacturer point of view, channels of drug distribution have become a strategic component of their commercial strategy. Manufacturers, under increasing financial pressure like every other entity in healthcare, need to see a balance in their net revenue goals, product demand and reimbursement to stay competitive. Open distribution is moving toward limited networks where certain drugs are sold through a controlled number of specialty distributors or specialty pharmacy providers. Some drugs are only made available through exclusive specialty distributors or specialty pharmacy providers.
With the emphasis on value-based care, health systems also are adapting to changing times and thinner margins. As many continue to consolidate, these larger health systems will drive scale that manufacturers will need to pay attention to. Health systems also are developing Integrated Delivery Networks (IDNs), which are evolving to be the center of the healthcare marketplace as the industry moves to accept risk and understand the need to control spend on covered lives. Moving forward, IDNs will begin to employ the same controls that health plans have used for years. These IDNs will look more like mini health plans, leaning on the tools of the traditional payer world.
Solutions for Health Systems
With all of these moving parts, what is the path forward for health systems? Though most health systems have traditionally lived in the medical benefit world, and most never considered the pharmacy benefit as a new source of revenue, it is now the key go-forward strategy with specialty pharmacy center stage. Health systems, hospitals and physicians are shifting their view to include the complete patient journey and registering a growing interest in owning specialty pharmacy operations in order to capture prescriptions associated with newly discharged patients.
Specialty pharmacy with an ambulatory component is a logical step for health systems because they possess internal expertise regarding handling, storing and dispensing specialty drugs and present an effective, streamlined delivery of patient services that result in better care and outcomes. Many systems have retail experience and the opportunity to expand capacity. But providers are frustrated by the complexity of aligning physicians, payers and the requirements of the federal 340B program. Without specialized knowledge, the specialty market may seem unattainable for most health systems. Health Systems will need to seek an external partner to assist with the burden of entering into specialty pharmacy services in order to drive revenue, manage costs and improve patient care.
Aggregators, such as Comprehensive Pharmacy Services with the proprietary AssistRx/Caret software solution, are stepping into the breach to serve as specialty pharmacy partners as well as single points of contact for pharmaceutical manufacturers and the health systems that need their medications. With an expert third-party team on their side, easing the burden on health systems, providers are able to deliver needed services to their patient population with greater impact on clinical quality. They benefit from new sources of revenue driven by specialty drugs in the 340B program and they achieve tighter controls on expensive specialty medications necessary in today’s market. For more information, visit CPS Specialty Pharmacy Solutions.
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