2018 Specialty Rx Forum Recap


PBMI’s Executive Director, Jane Lutz, kicked off our 2nd Annual Specialty Rx Forum on September 13th in Minneapolis, Minnesota acknowledging the importance of specialty pharmacy and how it’s adding pressures to our traditional PBM model.  She stressed the fact that this uncertainty and time of change can cause discomfort to the stakeholders in the market but encouraged us all to seize the opportunity and think outside the box to creatively help solve the challenges caused by specialty pharmacy medications. The meeting featured several perspectives from a diverse set of healthcare stakeholders and brought in more of a patient perspective than ever before.  Lutz stressed the fact that we can’t lose sight of the patient during our journey.  This set the tone for the day--here’s a recap of some of the key messages from the event. A sampling of presentations is summarized below.

Opening Speaker

Albert Thigpen of CastiaRx opened the meeting with a presentation on “How Specialty Pharmacy is Changing the Supply Chain.” Cost is not necessarily the only driver of specialty spend—utilization plays a significant role. He stressed the point that where prior authorization and utilization management has worked well in the pharmacy benefit, these trend management tools are not as effective under the medical benefit. A great example is that oncology drugs are now maintenance drugs. Most patients with a specialty disease often have 2.5 comorbidities. Therefore, payers must understand everything a specialty patient faces because these aspects play into longevity treatment. Thigpen pointed out three areas where payers can act: tighter prior authorization protocols, require/incentivize lower-cost sites of care, and coordinate across the medical and pharmacy benefit.

Key Session Takeaways

New for this year was the voice of the patient during the specialty journey.  A moderated session included a leading national Neurologist and a patient with multiple sclerosis (MS).  The patient shared her struggles with unpredictability, fear, and comorbidities of this disease and stressed the importance of having access to care, a choice, and engagement of a neurologist. The physician shared insights into the challenges he faces with cost, access, and regulatory approval. For example, obtaining prior authorization for a medication requires a considerable amount of resources and takes a lot of time thereby hindering the best treatment for the patient. There needs to be an emphasis on how to work together to eliminate wasting time.

Experts from MedImpact provided strategies to manage orphan drugs, which are now high-cost therapies. Payers are challenged with attaining enough clinical information on a given disease and the ability to adequately assess the financial impact of treatment. Patients are challenged with limited treatment, comorbidities, financial burden, and limited ability for routine daily activities. Treatment impacts the entire family, as a caregiver is frequently needed.  Adherence, tracking, and communication are important factors and can result in better care. Patient populations affected by these diseases are small, but the cost to treat them is significant, and the health consequences are high for both the patient and his or her caregiver. Providing a high-level of clinical support can help patients to say healthy which can contribute to the likelihood of a longer life.

We continued the afternoon discussion by hearing the employer’s perspective.   While both companies talked about solutions to actively manage the rising costs of specialty medications, they also spoke to the fact that the industry is moving towards vertical integration.  They stressed the fact that we cannot underestimate the power of the patient.  We as an industry need to provide more transparency because ultimately, they want to know where the dollars are going.

The day closed with a forward-looking presentation from Express Scripts on Cracking the Code of Gene Therapy. Currently, there are 1,400 genetic drugs in research and development, and each therapy is unique. Challenges for these therapies include clinical management, distribution fulfillment, high-cost therapies, and regulatory dynamics. Stakeholders need to be intentional about how care is provided to these patients – focus on building a framework, not a recipe. Patients’ needs are significant and real-time. Although a lot must happen upfront, once care is administered appropriately, patients can be set for a good amount of time.

The Specialty Rx Forum was another success!  A sampling of comments from attendees included:

“Great job on diverse format/topics.  Thank you!”

“Great job!  Thanks for all your efforts.”

“For a one-day seminar, I thought the topics were spot on.”

PBMI is dedicated to informing, advising and influencing the market on industry-relevant topics related to drug cost management.  Lutz concluded by stressing that fact that specialty pharmacy is forcing us as an industry to work more collaboratively.  We cannot underestimate the power of the patient, and each patient should be treated differently.  While specialty pharmacy can cause uncertainty and complexity, it should also create excitement and hope for the future for patients struggling with chronic diseases.