In 2018, two new drugs were approved to treat polyneuropathy due to Hereditary ATTR (hATTR) amyloidosis, a rare disease estimated to impact 10,000 people worldwide.6, The drugs, Onpattro® and Tegsedi™, employ variants of RNA therapy to transfer bits of genetic code to prevent production of the mutated TTR protein, which halts the disease. In addition to hATTR, RNA-based therapies are in clinical trials for a broad range of diseases, including cystic fibrosis, HIV and hemophilia.7, Unlike RNA- based therapies, DNA-based therapies offer the prospect of a lasting cure for disease. The State of Specialty Pharmacy 2020: Market Data and Trends (video) In May, I recorded a brief video webinar for an on-demand business education session at Asembia's 2020 Specialty Pharmacy Summit Virtual Experience. Canadian Agency for Drugs and Technologies in Health. In contrast, biologic drugs are much larger molecules developed via much more complex modifications of live microorganisms in the human body, and thus exact chemical synthesis and replication is not possible. Healthcare executives should continue to monitor specialty medical pharmacy claim information and trends, according to Eric McKinley, PharmD, director, specialty clinical solutions at Magellan Rx Management. Specialty trend was... More. HIV is a retrovirus that leads to AIDS, a disease that causes severe damage to the immune system. Currently, 65% of total drug spend is handled via the pharmacy benefit and 35% is handled via the medical benefit. In addition to orphan drugs, which are aimed at diseases or conditions affecting fewer than 200,000 people in U.S., there are now “ultra-orphan” drugs, which are intended for an even smaller numbers of people. Health plans, Tag: and the author shall not be responsible for any liability arising from or related to the use or accuracy of the information in any way. The first approved DNA-altering gene therapy, Luxturna™, treats an inherited form of vision loss known as retinal dystrophy. Specialty Pharmacy; Roadblocks and Remedies: Succeeding in Health System Special... Over the past decade, health systems have invested in specialty pharmacies at a growing rate. While not appropriate for all specialty drugs, shifting certain medicines from the medical benefit to the pharmacy benefit unlocks an array of cost management strategies and can result in significant PMPM savings. So far, only 16 biosimilars have received FDA approval, of those, only six have reached the … Pharmacy & Therapeutics. This means that, not only are there rarely biosimilars to compete with the branded biologics, there are almost never enough biosimilars to compete with each other in the same category. The healthcare system is shifting in its pharmaceutical delivery model, with more targeted, high dollar therapies procured through specialty pharmacy. Brand-Name Drug Prices Fell (Again) in 2020, The Big Three PBMs Ramp Up Specialty Drug Exclusions for 2021, How GoodRx Profits from Our Broken Pharmacy Pricing System, Specialty Pharmacy Keeps Disrupting Buy-and-Bill—and COVID-19 Will Accelerate It (rerun), Preferred Pharmacy Networks Dominate in 2021 Medicare Part D Plans: The Scoop on Cigna, CVS Health, Humana, WellCare, and More. Over time, the result will be an expanding footprint for specialty pharmacies and a much greater relevance in the … This new version of a biologic formula is classified as a biosimilar. 2020. Content includes information relative to market trends, commercialization, distribution, order to cash, HUB Services, managed care strategies and DIR fees. FDA. Specialty and high-cost medications continue to dominate the news. Keytruda had an impactful increase in utilization, with PMPM trend … 5. Both therapies cost several hundred thousand dollars per patient per year and must be administered for life. ¹ IQVIA, “The Global Use of Medicine in 2019 and Outlook to 2023.” ² Express Scripts, “2019 Drug Trend Report.” ³ The Academy Proprietary Database. “AbbVie, Amgen settlement sets Humira U.S. biosimilar launch for 2023.” Accessed at: https://www.reuters.com/article/us-abbvie-amgen-humira/abbvie-amgen-settlement-sets-humira-u-s-biosimilar-launch-for-2023-idUSKCN1C32G5 As specialty medications consume a greater share of overall drug spending, it’s important to note the larger trends underlying this dynamic and how OptumRx is meeting this challenge. An overview of the drivers of change in specialty pharmacy. Thus, while there are more than 200 biologic drugs approved by the FDA, only 23 biosimilars have been FDA approved.1. Die Erhebung wird in der Kategorie Rx seit dem Jahr 2000 in Deutschland jährlich bei niedergelassenen Ärzten und seit 2018 in den Kategorien OTC (Apotheker und Patienten), Orphan Drugs (Klinikärzte) und Startups sowie seit 2019 in der Kategorie Specialty Care (Klinikärzte) zusätzlich durchgeführt. According to Express Scripts 2007 Drug Trend Report in 2007 there was a 14% increase in specialty drugs. Members used Express Scripts for retail and home-delivery pharmacy services; they used Accredo, the Express Scripts specialty pharmacy, for specialty drug prescriptions. 1. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article. The drug, Hemlibra,® can be used to prevent bleeds before they happen. Switching the site of care to infusion centers, clinics or the home can save thousands per impacted member annually. Specialty Pharmacy Providers: Manufacturer Engagement and Contracting Trends June 2020. STATEMENT REGARDING FINANCIAL INFLUENCE: Trends in Specialty Pharmacy Management | Population Health Learning Network By 2008 there were more than 200 specialty pharmaceuticals on the market. Top specialty drug pharmacies in the U.S. by revenue 2019; Top revenue growth rates of private specialty pharmacies U.S. 2015-2018; Revenue of top growing private specialty pharmacies in U.S. 2018 Trends in Specialty Pharmacy. The 2019 Summit attracted an incredible range of job functions and organizations. The State of Specialty Pharmacy 2020: Market Data ... Why Do CVS And Express Scripts Rely on Secretive P... Copay Maximizers Are Displacing Accumulators—But C... Walgreens and CVS Top the 28,000 Pharmacies Profit... PBMs and Drug Spending in 2019: CVS Health and Exp... ‘Smart pill’ company etectRx and Pear Therapeutics form CNS partnership, NCPA files lawsuit against HHS to eliminate spiraling pharmacy DIR fees, STAT+: Maryland Senate overrides governor’s veto of prescription drug affordability board, PCMA Welcomes Additions to Regulatory Affairs, Research Teams, Gilead partner Arcus earns analysts' plaudits for early pancreatic cancer data that 'exceeded expectations', Research shows gene therapies can offer cost savings potential of up to $1.8M over five years for patients with certain blood diseases, Glaukos' glaucoma implant matches eye drops in 24-month analysis, NACDS debuts ad touting pharmacies’ role in providing COVID-19 vaccinations, What They Said – Overview of FDA Press Releases for 2020, An Oncologist’s Concern About the Biosimilar Use in Real-World Patients With Cancer, Central Focus: Targeting Unmet Need in CNS, The role of specialty drugs in the pharmacy industry, Our latest data on specialty pharmacy accreditation, Commentary on PBM’s role in the specialty industry. Institute for Clinical and Economic Review. Yet, within that medical benefit drug spending, specialty drugs account for a majority of that total. “Once the prescription is dispensed, and the patient receives it, we need to make sure that they are getting the benefit out of it,” Zeglinski says. But for biologics, the situation is more complicated, and more challenging. 7. Health care data, analytics and technology, https://www.fda.gov/drugs/biosimilars/biosimilar-product-information, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606858/, https://www.reuters.com/article/us-abbvie-amgen-humira/abbvie-amgen-settlement-sets-humira-u-s-biosimilar-launch-for-2023-idUSKCN1C32G5, https://www.biopharmadive.com/news/amgen-allergan-launch-first-us-biosimilars-of-roches-herceptin-and-avasti/559130/, https://www.evaluate.com/thought-leadership/pharma/evaluatepharma-orphan-drug-report-2019, https://icer-review.org/wp-content/uploads/2018/02/ICER_Amyloidosis_Final_Evidence_Report_100418.pdf, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485616/, https://icer-review.org/wpcontent/uploads/2017/06/MWCEPAC_VORETIGENE_FINAL_EVIDENCE_REPORT_02142018.pdf, https://www.ncbi.nlm.nih.gov/books/NBK538378/, Language Assistance / Non-Discrimination Notice, Asistencia de Idiomas / Aviso de no Discriminación. Webinar, 4. For example, Optum Specialty Pharmacy's hemophilia and bleeding disorders-specific program provides new hemophilia patients with a dedicated nurse navigator and concierge teams in order to deliver a world-class member experience. An overview of the drivers of change in specialty pharmacy. Asembia’s Specialty Pharmacy Summit remains the undisputed champion for conducting business in the specialty marketplace. “Voretigene Neparvovec for Biallelic RPE65-Mediated Retinal Disease: Effectiveness and Value.” Accessed at: https://icer-review.org/wpcontent/uploads/2017/06/MWCEPAC_VORETIGENE_FINAL_EVIDENCE_REPORT_02142018.pdf 10,11 There was a 60.4% increase in utilization, a 37.4% increase in costs and a 4.9% increase in new medications. While these treatments represent new and potentially life-altering options for the people who use them, they can be extremely expensive. David Lassen, chief clinical officer at Prime Therapeutics, discusses important developments in specialty pharmacy . In addition to the type of specialty medicines now in the marketplace, it is important to understand how and where specialty medicines are administered and how they are paid for. Health plan sponsors are rightly concerned about the possibility that their medical costs could skyrocket if a few of their members started treatment. Although similarities exist, biosimilars face several unique challenges that have combined to limit their usage in the U.S. Generics drugs are exact copies of the small molecule innovator brand drugs that have lost patent exclusivity. This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. Where a given drug must remain under the medical benefit, OptumRx has created a specialty guidance program to help manage these costs. These therapy programs seamlessly merge member education, digital tools, and clinical expertise dedicated specifically to a given disease. Pharmacy Outlook. Roughly half of specialty drugs are administered in the hospital, and half at a physician’s office, with a small percentage dispensed at specialty pharmacies, infusion centers or in the home. provider and stakeholder should have a specialty pharmacy strategy.1 In 2018, specialty drugs accounted for more than one-third of the pharmacy industry’s total prescription-dispensing revenue. Total cost management, Pharmacy care services, Tag: Share: Share on LinkedIn Share on Facebook Share on Twitter Share on Pinterest Share via Email Print. By 2007 specialty costs began to drive pharmacy trend. These new therapies have resulted in eradicating diseases, or extending the lives or quality of those lives of millions of individuals. Accordingly, we have identified five primary drivers of change in the specialty marketplace: Complex biologically engineered drugs (“biologics”) are among the most expensive drugs on the market. The five-year trend is 68% — the highest jump in 9 years of reporting. 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