In their general session, Adam J. Fein, PhD of the Drug Channels Institute, and Doug Long of IQVIA examined the current specialty pharmacy space, ongoing trends, and future expectations.
Pharmacy Benefits Managers (PBMs) continue to dominate specialty dispensing and payer scrutiny is challenging patient access, explained Adam J. Fein, PhD, CEO, Drug Channels Institute, and Doug Long, vice president , industry relations, IQVIA, during their session at the Asembia Specialty Pharmacy Summit held May 2-5 in Las Vegas, Nevada.
The top three specialized pharmacies by turnover in 2021, Fein explained, were the PBMs: CVS Health, Express Scripts, OptumRx. And payers not only limit where patients can go, they often send patients to the specialized pharmacy owned by their PBM.
Another big driver in the specialty pharmacy was 340B. The top three specialty pharmacies are also among the five companies – CVS Health, Walgreens, Walmart, Express Scripts, and OptumRx – which hold the majority (73%) of 340B reports. However, the 340B program recently faced a huge shift as 16 manufacturers pulled out of the 340B pricing from contract pharmacy networks.
This decision by the manufacturers resulted in a decline in the growth rate of new purchases in 2021 after years of positive growth, Fein explained. For example, postal pharmacy shopping growth of 340 billion has averaged more than 50% annually for four years, but growth in new purchases in 2021 was -20%.
Another market trend that’s important to note is vertical integration, Fein said. Hospitals’ practice of purchasing medical files “has accelerated more than one might think.” The integration occurred particularly in areas with 340B prices, and hospitals and health systems have begun to use the same tactics they had seen in plans and PBMs: referring patients to their own specialized pharmacies.
Health systems with larger specialty pharmacies were more likely to refer patients to them. According to Fein, 70% of health systems with fewer than 15,000 specialty prescriptions per year preferred the specialized pharmacy in the health system plan or had a specialized pharmacy exclusive to the health system plan compared to 86% of health systems with 15,000- 45,000 prescriptions and 95% of health systems with more than 45,000 prescriptions.
He continued the presentation for a long time by reminding the public of the market share of special medicines. As of February 2022, specialties accounted for 49.9% of sales, and the only reason traditional medicines still had the majority was because of COVID-19 vaccines, which are considered traditional medicines. Long noted that he expected specialty drugs to take the majority when considering the March or April numbers.
Looking at the one- and five-year growth, Long pointed out that generics and biosimilars have helped slow the growth in spending in some therapeutic areas, such as multiple sclerosis and HIV. Furthermore, oncology has shown a slowdown in growth, largely due to biosimilars. Another reason for the stunting for oncology is that there have been fewer tests and screenings for cancer during the pandemic, and patient visits have not yet returned to normal.
Long also explained that payer control was hindering patients’ access to special medicines. Compared to 2013, specialized patients are now 20% more likely not to fill a prescription and OptumRx, Caremark and Express Scripts have placed checks on more than 75% of specialty medicines. Additionally, 79% of specialist patients have a National Drug Code block and 60% have a gradual change that they are unable to overcome within 30 days.
In 2021, 81 million prescriptions were abandoned in pharmacies by patients who started a new therapy, and costs are increasing, as is the frequency of abandonment. Six percent of prescriptions that cost $ 0 have been dropped, which has increased to 20% for costs between $ 40 and $ 49.99. When the drugs cost between $ 125 and $ 249.99, 46% were abandoned and when they cost $ 250 and above, 61% were abandoned.
Only 1 in 4 new-to-brand patients who attempted to fill a launch mark were successful due to payer checks, Long said. Additionally, up to 70% of patients taking newly launched drugs are supported by patient assistance programs, which cost the manufacturer. As a result of these and other factors, launch success is becoming more difficult and time for positive investments is delayed, Long explained.