Drug Pricing, Retail Trends, and More on 2019 ASAP Meeting Agenda

Monday, January 28, 2019

Marsha K. Millonig, MBA, BPharm

As I write this blog, I am wrapping up participating in the annual meeting of one of my favorite organizations: The American Society of Automation in Pharmacy (ASAP).

ASAP's mission is to foster understanding of the role technology plays in assisting pharmacists to promote patient safety and the proper use of medications, comply with laws and regulations, and operate their practices more efficiently by providing a forum for sharing diverse knowledge and perspectives on the modern practice of pharmacy. Their semiannual meetings are great because they offer 30-minute updates on current practice/technology issues over the course of two days, with plenty of time left over for business meetings and networking.

This year’s annual meeting, held January 23-25 in Kiawah, South Carolina, included podium presentations across a variety of topics:

  • Pharmacy Trends, Issues and Forecasts
  • Next-Generation Data Metrics for Pharmacy Comparisons
  • Drug Prior-Authorization Trends and Responsibilities
  • IMPACT: Diabetes Prevention
  • The Amazon-Berkshire-JPMorgan Health Venture
  • Legislative Update: 2019
  • What’s Going on With Compounding?
  • Measuring E-Prescribing Accuracy
  • AI in Healthcare: Current Applications and Future Directions

Keynote: Pharmaceutical Market Trends

Sarah Keefer, Industry Relations Consultant for IQVIA, provided the keynote, reviewing current pharmaceutical market trends. Of great interest was data she provided on market growth in the U.S.:

  • U.S. medicines growth slowed to 0.6% in 2017 on a net basis
  • Branded pharmaceutical prices grew slower than inflation at 1.9%
  • Gross-to-net reductions for brand-name drugs reached $153 billion (rebates, off-invoice discounts, copay assistance, 340B discounts, and other discounts)
  • Generic drug prices continue to deflate at a rate of 5.2% through October 2018
  • Specialty drug market growth continues to outpace traditional market growth, reaching a 45.1% share of total non-discounted spend for the 12 months ending in September 2018

The market is rebounding from the boom from Hepatitis C medications in 2014/2015. That category continues to decline. The pain medication category has also been declining since 2015 and was down 8.8% through September 2018, reflecting legislation and regulations addressing the opioid crisis.

On the flip side, the 2018 flu season was one of the highest ever in terms of impact on the market. When it comes to growth, oncology, autoimmune and HIV agents lead the specialty category, while diabetes, respiratory and anticoagulants led the traditional market last year.

Keefer noted six key issues that are impacting her business’s internal market teams:

  • Tighter, more consolidated payer management, including more formulary exclusions
  • Higher patient out-of-pocket payments, with a 14% average commercial copay increase in 2016-2017 and an increase in high deductible insurance plans
  • Amplified public pressure and demand for price transparency with numerous federal and state proposals being discussed
  • More stringent medical benefit management to address drug prices paid through that benefit
  • Increase in value-based models with pay-for-performance drug outcome agreements by drug manufacturers
  • Evolving provider landscape with more accountable care organizations and integrated delivery networks and vertical market models

Within the retail arena, chain/mass merchants continue to capture the majority of prescription transactions, followed by food stores, independent pharmacists, and long-term care. Mail order share declined. Consolidation in the retail sector continued, Keefer reported, with a reduction of 923 pharmacies through October 2018. She ended by sharing examples of continued emphasis of bringing clinical services into the community/retail pharmacy environment.

Hot Topics: Performance, Prevention, Pricing

At other sessions during the meeting, speaker Don Dietz of PHSI picked up on that same retail clinic trend, noting that the traditional performance measurement metrics of prescription growth, prescription filling turnaround time, and prescriptions margins increasingly do not accurately reflect a pharmacy’s business mix. He challenged the group to think through how the pharmacy can refocus to also measure metrics such as:

  • Point-of-care testing
  • Comprehensive medication management
  • Therapeutic interventions
  • Vaccine services

Along that line, APhA Foundation SVP Ben Bluml, BPharm, outlined components of the new Project IMPACT: Diabetes, which the foundation is operating with the Centers for Disease Control and the Kroger Company. The project will be delivering the National Diabetes Prevention Program curriculum to over 7,500 at-risk adults in underserved communities in the U.S. over the next 5 years. Cutting-edge workflow and workforce innovations are being implemented to make this happen, including using pharmacy technicians to deliver patient education and deploying health coaches.

Brad Kile, PhD, of the Dumbarton Group addressed a number of the administration’s efforts to address drug pricing during his scan of the 2019 federal legislative and regulatory environment, including progress on the White House’s drug pricing plan: "Reforming Biopharmaceutical Pricing at Home and Abroad". Brenda Jensen of Compounding Consultants, LLC, provided an updated on USP efforts to address compounding and hazardous drugs through Chapters 795, 797 and 800. Progress on both e-prior authorization and e-prescribing were also provided.

I have the good fortune to present on the Amazon-Berkshire-JPMorgan Health Venture, which I will address in future blog. I also hope to dive deeper into many of the other healthcare issues addressed at the ASAP Annual Meeting. Stay tuned!

Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.

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