Insight provided by Bryan Klazinga, VP of Pharmacy Benefits. 1 1. Precision medicine targets specific genes, based on the patient’s condition. Genetic information is gathered through genome sequencing where researchers are able to identify specific abnormalities and come up with drugs and therapies targeted towards them. Nine specialty drugs have lost their patent however only six of them have actually launched a biosimilar due to patent protection, patent litigation and manufacturing challenges. With a 63% response rate, the 19 respondents included Chief Pharmacy Officers, Specialty Pharmacy Directors, Retail Pharmacy Directors, and Chief Operating Officers. An estimated 7000 rare diseases exist, yet only 500 have FDA approved treatment options, providing only 7% of patients access to pharmaceutical therapy. Specialty products and services were considered the most profitable among all the pharmacy trends for this year, and 2020 will see a bigger market for these medications as they become part of the top pharmacy trends for 2020. Healthcare will … In 2019, the FDA approved 54 specialty drugs, 31 of which the FDA considered new molecular entities. Collaboration between payers, providers and manufacturers is possible, and most likely the best strategy to ensure cost effective access to quality care. Novartis has agreed to annuity payments for Zolgensma over five years. Unique Reimbursement Models for High Investment Therapy. Health plan sponsors are rightly concerned about the possibility that their medical costs could skyrocket if a few of their members started treatment. These high investment therapies have stretched current reimbursement models beyond their capacity. 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. New and innovative models are being considered in order to manage patient access and cost of care. It would not address short term budget issues but would prevent hospitals from marking drug costs up significantly and avoid issues with DRG payments. Specialty pharmacies are designed specifically to manage the necessary handling, storage, and distribution of complex therapy drugs that require high-touch patient management. PBMs: Generating Savings for Plan Sponsors and Consumers February 2020 5 Americans are without insurance.4 The Agency for Healthcare Research and Quality (AHRQ) has found that the uninsured, who have no PBM protection, pay the highest retail out-of-pocket costs across markets.5 PBMs and their clients guide how actively pharmacy benefits are managed within the context of applicable ... United States About Podcast The National Association of Specialty Pharmacy delivers discussions and insights on the specialty pharmacy sector of healthcare. 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. 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. I review: They estimate a savings of over $470M over the next five years in addition to a reduction of medical costs to treat progression of the disease. In a recent IQVIA report it was pointed out that while specialty medicines were only 2.2% of prescription volume it is projected that by the end of 2020 specialty medications will account for nearly 50% of the nation’s drug spending. ... Growth of specialty market (2015-2020) THE SHIFTING LANDSCAPE CERTARA TRENDS BRIEF 5 US specialty drug spending saw … Some pharmacy benefit managers (PBMs) are restructuring their DIR fees for Medicare Part D drug claims. Value based arrangements and risk sharing across plan sponsors, PBMs, Payers and manufacturers is being considered in order to sustain affordability, ensure access to care and continue to incentivize manufacturer research and development efforts. These therapies bring life changing treatment options and hope to many people who are dealing with rare genetic diseases. Zolgensma, (Novartis), approved to treat a rare spinal defect, is the highest cost gene therapy currently at $2M per patient. Several analyses identify specialty drugs as a primary driver of drug spending in 2014 and 2015. Specialty drugs are chemically more complex and are referred to as biologics because they are derived from living organisms or their products, such as a human or animal protein, hormone or antitoxin. Expert panelists review the causes, diagnostic work-up, management, and emerging therapies inherent in the evolving paradigm of irritable bowel syndrome. Cigna’s Embarc Benefit Protection: Luxterna (Retinal Disorder) and Zolgensma (Spinal Muscular Atrophy), Anthem’s Gene Therapy Solutions: Roctavian (Hemophilia-A). Spark Therapeutics has agreed to VBR for its gene therapy, Luxturna, which cures a retinal disease causing blindness. SPECIALTY PHARMACY. Cancer (oral) and autoimmune treatments were the most influential drug categories in driving higher trend for all lines of business with trends in the double digits. Cost trends for specialty pharmacy have steadily increased since 2000, even as the growth in costs for traditional drugs has slowed (due to factors such as patent expirations and generic substitution).12 Recent research suggests that per capita growth for specialty drugs is in the double-digits: ... 2020 Trends in Pharmacy Care: Technology. As specialty drugs have gained a stronger foothold in the United States, the creation and utilization of specialty pharmacies has also expanded. Paying a fixed fee for use of the drug, over the next five years, will allow them to treat over 30,000 individuals by 2024. Significant advancements will bring curative therapies to many individuals suffering from rare hereditary diseases. Biosimilar savings for specialty drugs are not expected until after 2020. by Denise Cabrera. 4 Smaller, independent SPs are declining, representing 47% of accredited SPs in 2018, compared to 59% in 2015. increasingly innovative strategies. THE SHIFTING LANDSCAPE ACCESS TRENDS IN SPECIALTY PHARMACY 2020-23 7 US specialty drug spending saw a modest annual growth of 3%, from 44.7% in 2018 to 47.7% in 2019 per ESI.10 On the basis of non-discounted spending, specialty growth has been outpacing traditional product growth, with a 10% to 0.3% dollar volume increase, per IQVIA. Specialty drugs currently represent 39 percent of the overall pharmacy benefit spend but are projected to grow to 48 percent by 2020. Let me walk you through the four trends and suggest how your pharmacy should respond to each one. The MMIT survey data show a leap in white bagging as of mid-2020. Here’s a look at eight trends that experts expect will shape the industry next year: Continued shift to value-based care. Gene therapy is designed to correct inherited genetic defects therefore it is curative and preventative for future generations.The FDA has approved 4 gene therapies to date, including Zolgensma (Novartis), approved to treat a rare spinal defect. Can Formulary Management Bring It Down to Earth?, Managed Care, 2019, FAQs About Rare Diseases, Genetic and Rare Diseases Information Center, U.S. Department of Health and Human Services, 2017, https://www.cigna.com/newsroom/news-releases/2019/pdf/cigna-health-services-business-pioneers-an-innovative-solution-to-affordably-bring-life-changing-therapies-to-patients.pdf, http://image.messageinsite.com/lib/fe5615707d600c747210/m/2/757027d4-dff0-4c1b-a50a-ce78326b9917.pdf, 5 Ways Talking to Strangers May Boost Your Emotional Intelligence, Driving Optimal Results Through Individual/Team Performance-Based Incentive Compensation Plans, The Future of Benefits Administration Technology for HR Professionals, Most Brokers Say They Have All the Answers, COVID-19 and Mid-Year Plan Amendments – Employer Compliance Checklist, 7 Steps to Take When a Star Employee Disengages, University of Memphis – Academic Training in HR Management, Is Western Governors University Accredited | Read the Latest World News - News World, The Three Top Challenges to Earning a Degree, Factors in Assessing Your Hiring Strategy - HRProfessionalsMagazine, Recruiting Tips During Times of Uncertainty, Gloria Sinclair Miller, SHRM-SCP, SHRM Field Services Representative, Dr. Kathy Tuberville Recipient of 2020 HR Professional Excellence Award, Profile: Emily M. Dickens, SHRM Corporate Secretary and Chief of Staff, Preview of SHRM-Atlanta SOAHR Conference March 25-27. Specialty and high-cost medications continue to dominate the news. Between 2020 and 2027, retail drug spending under private health plans is projected to increase at an annual rate of 3% to 6%; besides the slow growth of the US biosimilar market, the report cited new costly therapies, mainly specialty drugs, as well as a drop-off in the impact of lower-cost generics. It is the highest cost gene therapy, currently at $2M per patient, and total sales of $361M in 2019. The first biosimilar was launched in the U.S. in 2015. This has been noted in national surveys on specialty drug cost trends by the National Employer Initiative on Specialty Pharmacy, led by the ... Planning a Specialty Drug Strategy Through 2020 . Nothing on this website should be interpreted as an opinion by Pembroke Consulting, Inc.. or the author on the investment prospects of specific companies. Specialty Pharmacy. 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... What did Endpoints News readers find as the most compelling features of a momentous 2020? Oncology: Trend could be up slightly in 2020 due to increased utilization and pricing of oral drugs, such as Ibrance ® (palbociclib). do not make investment recommendations, on this website or otherwise. They anticipate approval of 10 – 20 gene therapies annually, driving more than $8.6 Billion in healthcare expenditure by 2025. Medical pharmacy trends continued to climb with commercial PMPM increasing 10 percent year over year. Volume Based Purchasing – the Netflix Model. Dr. Adam J. Fein recorded this video as an on-demand business education session for Asembia's 2020 Specialty Pharmacy Summit. Top therapy areas, which contributed to trend, are autoimmune/anti-inflammatory drugs, along with cancer drugs for lung and breast cancer, due to increased costs over older treatments and brand inflation. Trends in FDA approval of Specialty Drugs 1990 through 2017, RJ Health, 2018. Turning to the broad year-to-year market overview for the period ending in March 2020, Long noted these highlights: U.S. medicines’ total market growth reached 6.7%, less than the growth of 7.4% in the retail and mail order segments. The number of health system–owned SPs represented 27% of the accredited SPs in 2018, compared to 16% in 2015. More than 900 investigational new drug applications have been submitted to the FDA in 2020. 2 Emerging Trends in the Specialty Drug Industry Brought to you By: S ... $400 billion by 2020.3 Clearly, the use of and spend on specialty drugs in ... snapshot of specialty pharmacy mergers and acquisitions in 2016.4 To properly serve their patients, pharmacists working in the outpatient setting—whether or not The biosimilar for Truvada is expected to launch in 2021. Market Trends. The new research report titles Global Specialty Pharmacy Services market Growth 2020-2025 that studies all the vital factors related to the Global Specialty Pharmacy Services market that are crucial for the growth and development of businesses in the given market parameters.The report highlights the important elements related to the market such as the market size, share, company … Payer. Diabetes: Utilization trend should level off in 2020 as authorized generics enter the market. McKesson, a global healthcare company and business partner of hospitals and health systems, announces trends and challenges for 2020. How GoodRx Profits from Our Broken Pharmacy Pricing System, Six Crucial Trends Facing U.S. Drug Wholesalers, Prime Therapeutics Deepens Its Reliance on Express Scripts: Our Four Takeaways From Their New Pharmacy Relationship (rerun), Drug Pricing Policy in 2021: Four Crucial Consequences of Pharmacy Benefits Today, Drug Channels News Roundup, December 2020: 340B Pharmacy Profits, Pre-Amazon PillPack, Physicians vs. Accumulators, Maine’s Importation Fail, and Vaccine Humor. Here are six developments we believe are worth watching and the ways that action today can help people and communities across the United States on their path to better health. Click here if you can’t see the video below. High investment therapies have stretched current reimbursement models beyond their capacity. Specialty Pharmacy Keeps Disrupting Buy-and-Bill—and COVID-19 Will Accelerate It (rerun) ... 2020, update on COVID-19 trends.) Medical Pharmacy Trend Report For 10 years, the Magellan Rx Management Medical Pharmacy Trend Report has unlocked pharmacy trend updates and emerging strategies to manage rising specialty spend on the medical benefit. Podcast episodes examine current trends, key conferences, and critical topics in the industry. Puts the onus on the Payer to prove failure of efficacy. Videos. There is a $62B market for biosimilars over the next four years as competition in the specialty drug market increases. Spark agreed to the same terms for Luxterna to treat a retinal disease causing blindness. While initially often opened independently, many specialty pharmacies have been acquired by traditional chain pharmacies and investment firms in recent years. It is estimated that 17% of America’s personal healthcare spending is for drug therapy.1 With the rise of personalized medicine and gene editing therapy drug spend is projected to reach $600B in 2020. Learn from Specialty Rx Experts: 1st Episode of AscellaHealth Educational Webinar Series “Specialty Market Trends and the Market Place Realities for Pharmacy Benefit Managers” Market Study Report Date: 2020-07-06 Technology Product ID: 2644659 The research document on Specialty Pharmacy Services market offers a qualitative and quantitative analysis of this business space and includes information such as industry remuneration, revenue estimation, as well as the market size and valuation over the forecast period. New pharmacogenomic tests and gene therapies are entering the market at an astounding rate and are expected to grow by 10.5% over the next five years. When we look back ten years from now, my hope is that we can say “remember when we treated cancer with toxic chemo therapy and genetic disorders went relatively untreated?” That will certainly make the hard work we have to do well worth it. It is a pre-exposure prophylaxis for HIV and will have the potential to impact nearly $3B in annual sales. The cost of $850,000 will be partially reimbursed if a patient fails to respond to treatment. The 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers vii The U.S. Pharmacy Distribution and Reimbursement System for Patient-Administered, Outpatient Brand-Name Drugs The 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers discusses the three key channel flows illustrated above: 2019. Specialty Pharmacy Trends for 2020 and Beyond. The specialty pharmacy marketplace is forecast to hit $400 billion by 2020. Total trend could rise slightly, reflecting higher drug prices, as insulins are considered biologics from March 2020. Pharmacy Outlook. 1 With the rise of personalized medicine and gene editing therapy drug spend is projected to reach $600B in 2020. Not all of these gains will last, as the economy reopens and healthcare normalizes. Stanton D. In the pipeline: Surge of cell and gene therapies likely in 2020. 2020-01-31 15:32:00. 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