Asembia Conference Recap Image - Future of specialty pharmacy and patient access previewed at Asembia Summit 2022

Future of specialty pharmacy and patient access previewed at Asembia Summit 2022

What happens in Vegas stays in Vegas? Not on this trip! I’m excited to share how specialty pharmacies, manufacturers, payers, and other stakeholders gathered in Sin City to address the business and clinical components of specialty pharmacy.

This year’s Asembia Specialty Pharmacy Summit, held in May in Las Vegas, saw more than 6,000 attendees, and almost 170 exhibitors spanning the specialty pharmacy industry, for three and a half days of networking and information sharing. If you were wondering how that compares to pre-pandemic, that’s over 1,000 more attendees!

Lidia Rodriguez-Hupp, The Craneware Group’s Chief Customer Officer, and I met with our industry peers in the hospital, specialty pharmacy, distribution, legal and consulting spaces to discuss the intersection of 340B and access to specialty medications. We left this conference with a lot of steps taken (it was half a mile from my hotel room to the networking breakfast) and with a new sense of optimism for hospital specialty pharmacies leading the way to better outcomes and patient experience. However, we also felt daunted being at the table in an industry increasingly defined by vertical integration and hardships for hospitals to overcome.

The old saying still applies: If you’re not at the table, you’re probably on the menu! Well, let’s just say, we pulled up to the table and we had crucial conversations.

How is the specialty pharmacy industry evolving?

In 2019, we talked about rising drug prices. Not much has changed in 2022, except that drug prices in specialty pharmacy are still rising and are now outpacing traditional pharmacy spending growth, with specialty pharmacy now estimated at 49% of total market share, said Doug Long from IQVIA. He and Adam Fein, of Drug Channels Institute, share the stage each year. Here are their slides if you’d like to review the numbers for yourself.

Vertical integration has been a hot topic in healthcare, and specialty pharmacy continues to see movement. Fein updates his verticalization chart each year with some new trends that show more shell games, with businesses moving from one vertical to a new one. Specialty pharmacy verticals start with the insurer and move to the PBM or a GPO, which flows to the specialty pharmacy and subsequently the provider. Blue Cross Blue Shield, Centene, Cigna and Humana all had recent action, with the big moves being Prime Therapeutics hopping from BCBS to Cigna, and both Humana and BCBS shifting to Ascent (for rebate processing) all under Cigna’s vertical. After Asembia wrapped up, Centene announced plans to sell PANTHERRx and Magellan Rx.

Unless you’re a magician, you probably won’t be able to follow the shell games and know who went where. Just know that the verticals are designed to provide more data, control, and ultimately revenue to the insurers at the top.

The growth in specialty drugs comes with growth in specialty pharmacy operations. Today, there are 1,570 accredited pharmacies in the U.S., compared with 911 less than five years ago, with over 75% of dispensing accounted for by PBM-owned specialty pharmacies.

Trending topics

Value-based purchasing, patient access and 340B (of course) were hot topics.

This year, I saw more hospital specialty pharmacy attendees than past years, a sign that hospitals are building specialty pharmacy operations. Asembia gave them an opportunity to connect with manufacturers and share their patient care models and, more importantly, their results. These types of discussions can lead to value-based purchasing (VBP) models that incorporate hospital-owned specialty pharmacies because of their ability to reduce readmissions and improve time to therapy and coordination of care—all leading to reductions in total cost of care.

The challenge previously with VBP has been how drug prices are set using CMS’s definition of “best price.” Typically, CMS would incorporate discounts, such as VBP, and recalculate best price for the market. Naturally, manufacturers haven’t been fond of participating in VBP, if it meant lowering best price. A new federal policy will go into effect July 1 that will eliminate that concern. This would lead to states having the ability to receive rebates on a per-patient episode.

Outside of creative new payment models, patient access took the stage. Patient abandonment of drugs prescribed to them has become the new problem created from high-cost drugs and the hurdles patients and providers must jump to gain access.

Here, hospitals have risen to the challenge, with net promoter scores (NPS) averaging near 80 (world-class service is a 70 or higher!). Hospital pharmacies have done an outstanding job of working with their provider groups to make prior authorizations successful and help patients with discounts and assistance programs. Coupled with improved outcomes, this approach gives manufacturers confidence in making limited distribution drugs more accessible.

Of course, it wouldn’t be a conference without a 340B discussion. This conference views 340B through a very different lens, given the audience of payers, payer-owned specialty pharmacies, and manufacturers.

The dialogue started off with a clever title that perhaps brought happiness to many attendees—340B and “the impending cliff.” It was more of a debate about why manufacturers are making unilateral changes to 340B and the bigger question of whether it will continue through the next decade.

The answer? No. Why? Hospitals and other covered entities provide care to marginalized communities. The current approach will be short lived, what with the forthcoming new administrative dispute resolution process and lobbying efforts by all parties to solve the problem, which ultimately will lead only to negative public relations for manufacturers. The conversation carried on the next day with Drug Channels providing insight into specialty pharmacy growth by Express Scripts and Optum on the leader board with major retailers, who also have specialty pharmacies including CVS, Walgreens and Walmart in order of volume. Total 340B growth over time has slowed because of the 16 manufacturers excluding contract pharmacies.

Focus on the future

Discussions around technology solutions, from patient monitoring programs to robotics, and about supporting compliance in high-cost drug markets, drew great interest from attendees. Investors are likely to continue to watch the specialty shuffle.

Conference presenters also discussed:

  • Moving from copay accumulators to copay maximizers to help with affordability
  • Anti-steering legislation to allow for more patient choice
  • Access to care by addressing social determinants of health

States are taking action, intervening to ensure patients have options and access to low-cost drugs. With all the contract pharmacy exclusions, it’s even more important for hospital specialty pharmacies to fight for access to support their patients. By having a specialty pharmacy, hospitals can still provide access, and the care and patient experience are world-class. The challenge will be met with negotiations to demonstrate improved patient outcomes, despite resistance from payers. Hospital leaders continue to forge a path forward. Data is your friend.

What lies ahead?

Specialty pharmacy will continue to grow. We will see more formulations and the use of biosimilars. Hospitals and hospital pharmacies need a plan to ensure patients can access highly specialized drugs, either through their own specialty pharmacy operation or via a combination of contract pharmacies that cater to the patients’ needs and can access payers and limited distribution. Politics, economics, social issues and technology will continue to advance the future of specialty pharmacy.

Watch the shells, and perhaps you’ll be able to follow the next move.