To identify the top managed care pharmacy challenges and what your peers are doing about them, our sister publication, Managed Healthcare Executive, conducted its annual pharmacy survey during the first quarter of 2018.
The survey received more than 100 responses from executives at medical practices, hospitals, large healthcare systems, benefit management organizations, health plans, long-term care organizations, group purchasing organizations, consulting firms, and more.
According to healthcare professionals, the number one challenge in medicine these days is curbing costs. Survey respondents expressed some clear thoughts on how to curb rising healthcare costs beginning with collaboration — we need more of it in medicine, said 51% of survey respondents. By working together as a single unit, healthcare professionals may be able identify the most eff ective and costeff ective treatments for patients to reduce pharmaceutical costs. 17% percent said that the industry needs more aggressive and expanded utilization of management strategies to reduce costs and 15% suggest the adoption of clinical pathways could curb costs.
“When it comes to working toward a more collaborative system, it’s all about the alignment of incentives. We need to demonstrate efficacy and then give the physicians reason to care about prescribing the most cost effective treatments,” said Doug Chaet, chief managed care officer of Sentara Healthcare, chair of the American Association of Integrated Healthcare Delivery Systems.
Reducing costs could be achieved by adopting performance-based pricing, said 39% of respondents.
Perry Cohen, PharmD, CEO of The Pharmacy Group and the TPG family of companies, agrees. “In the long-term, pharmaceutical companies need to tie their drug pricing to outcomes. Since health plans have medical and pharmacy claims data, they can calculate total cost of care for patients with certain diseases that are treated by specialty pharmaceuticals and can therefore measure the benefit of value of these medications on the total healthcare spend. This means they have the ability to do outcomes based on contracting and make pharmaceutical companies price their drugs accordingly,” he said.
But only 41% said that performance-based pricing will be used over reference-based pricing in the next three to five years.
“Performance-based pricing has a great appeal, however, to succeed in helping bend the cost curve and improve quality, behavior and cultural change from all players — patients, providers, payers, pharma and other suppliers must occur. Healthcare is notoriously slow to adopt new approaches and performance-based pricing requires all parties to accept risk and uncertainty,” said David Schmidt, president of TPG International Health Academy and a healthcare consultant.
Despite financial forecasts that said biosimilars will reduce the cost of specialty drugs, healthcare professionals who took this survey don’t really believe those reduced costs will come to fruition this year or in years to come. Only 13% said that biosimilars will reduce specialty drug costs in 2018 and 23% said that we will begin to see those cost reductions, but after 2020.
Any cost savings we see from biosimilars this year or next will be far outpaced by so many other factors — the introduction of new specialty drugs, the growing healthcare demands of baby boomers, the increased prevalence of chronic disease, manufacturer pricing, off label use of drugs, expanding indications of existing drugs and more.
“Early signals indicate that the most signif-icant factor likely to drive specialty trends in 2018 will remain the same as it has for the last several years,” said David Calabrese, RPh, MHP, senior vice president and chief pharmacy officer at OptumRx.
Of new drugs approved in the last 12 months, one approved for moderate-to-severe atopic dermatitis, dupixent ranked as among those healthcare professionals are most excited about. The others include CAR T-cell therapies (immunotherapies for cancer), Ocrevus for primary progressive multiple sclerosis, and the gene therapy drug Luxturna (voretigene neparvovec-rzyl) for patients with Inherited Retinal Disease.
And, finally, survey respondents were asked, “Who should play the biggest role in combating the opioid epidemic?” Physicians should take the lead, they said. Specifically: 66% are in favor of providers taking the lead, 17% for government, 10% for payers/PBMs and 7% of pharmacists.