Insights from the ASAP Annual Meeting Kick off the Year

Monday, February 26, 2018

Marsha K. Millonig, MBA, BPharm

Shortly after the New Year kicked off, I had the opportunity to participate in one of my favorite organization’s annual meetings: The American Society of Automation in Pharmacy (ASAP).

ASAP’s mission is to foster understanding of the role that 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. These two-day, semiannual meetings are great because they offer 30-minute updates on current practice/technology issues with plenty of time for business meetings and networking.

This year’s annual meeting, held January 10-12, 2018, in Naples, Florida, included podium presentations on a variety of topics:

  • Pharmacy Trends and Insights
  • Innovative Practice Models for Improving Public Health
  • New Revenue Streams for Pharmacy
  • Future Considerations for Pharmacy System Vendors
  • Direct Secure Messaging
  • Legislative Update: 2018
  • Value-Based Payment Models
  • DIR Fees: Current State of Affairs
  • Apply Technology to Clinical Care to Improve Population Health

Doug Long, VP Industry Relations for IQVIA, provided the keynote address reviewing current pharmaceutical market trends, including:

  • Growth in the specialty category
  • Lower branded drug price inflation
  • Generic drug price deflation
  • Faster and increasing number of ANDA approvals
  • Opioid agent scrutiny
  • High out-of-pocket costs for consumers
  • New oncology agents and biosimilars

Of great interest was data he presented showing that growth in the U.S. pharmaceutical market continues its single-digit trend with an annualized rate of 1.5% through October 2017. Gone are the double-digit growth figures that were primarily attributable to the advent of hepatitis C medications several years ago. Unadjusted prescription volume data also points to decelerating growth, with -0.1% as of October 2017. Long observed that, in spite of all the talk of increasing prescription drug prices, overall market data shows growth slowing.

Autoimmune and diabetes agents are among the fastest growing therapeutic categories by dollar, followed by anticoagulants and oncology products. Therapeutic areas seeing the slowest dollar growth are lipid agents, viral hepatitis agents, and pain products. When data on prescription growth is reviewed, the fastest growing areas are mental health, nervous system disorders, respiratory, diabetes, and cough/cold — the latter recently being boosted by a very widespread flu season. The slowest growing areas based on prescription volume were pain therapies, antihypertensives, anti-ulcerants, and lipid regulators. Long noted government and industry action on the opioid crisis is impacting the market.

Market share by dollars shows the retail market at 70.8% and the institutional market at 29.2%. Within the retail arena, sales break down thusly:

  • Chain/mass merchants: 30%
  • Mail order: nearly 24%
  • Independent pharmacy: 11%
  • Food stores: nearly 6%

Institutional market leaders are:

  • Clinics: 15%
  • Hospitals: 7.5%
  • Long-term care: 3.7%

Share by prescription transactions tells a different story, with the retail market capturing a 91.2% share, followed by the institutional market’s 8.8% share. Chains dominate the retail sector with the breakdown as follows:

  • Chains: 58%
  • Independent pharmacies: nearly 17%
  • Food stores: nearly 13%
  • Mail order: about 4%

New Revenue Opportunities for Retail

All but food stores saw negative year-to-year growth in prescriptions. This decline in transactional volume may have many retailers considering ways to more efficiently operate the dispensing process while looking for new revenue streams.

Speaker Don Dietz noted many opportunities exist to do so by expanding immunization services, implementing collaborative practice agreements, expanding opioid antagonist services, and considering pharmacogenomics testing services. Along that line, APhA Foundation SVP Ben Bluml, BPharm, outlined the successful Project IMPACT: Immunization pilot that evaluated how implementing an innovative care model that provides the pharmacist access to a patient’s vaccine history at the point of care impacts the pharmacist’s ability to identify unmet vaccination needs and increase vaccination rates for routinely recommended adult vaccinations.

Results across the eight pharmacies in the pilot program during its five-month period from October 2015 to March 2016 were striking:

  • 1,080 patient histories of vaccinations were reviewed
  • 1,566 vaccines were forecasted as due based on Immunization Information System (IIS) data
  • 1,334 unmet needs for vaccination were identified (36 contraindicated; 196 potential duplicates)
  • 41.4% administration increase in vaccines
  • 447 unmet needs addressed and documented in the IIS

Looking at the significant gaps between current vaccination rates and Healthy People 2020 goals, Bluml observed that significant increases of 10-25% in rates might be possible using this new model, especially when considering there are more than 280,000 pharmacists trained to immunize and there are more than 300 million visits to community pharmacies every seven days.

Innovative practice models and team-based care with pharmacists as core team members are growing along with the movement toward value-based healthcare, noted APhA VP of Professional Affairs Anne Burns. Technology to support these models of care and pharmacist’s expanding roles was addressed by Kevin Masci, PharmD, VP of Business Development and Population Health at FDS Rx. Both noted the continued move toward outcomes measurements in these models and how technology is supporting them.

These new models were also addressed by Brad Kile, PhD, during his scan of the 2018 federal legislative and regulatory environment. Other key issues he discussed were potential initiatives on drug pricing (a report was released this month by the White House on "Reforming Biopharmaceutical Pricing at Home and Abroad"), PBM/plan transparency, Medicare Part D changes, and FDA oversight of pharmacies. On the pricing issue, there will be much more to come, given that Medicare Part D/Medicaid paid for 41% of all prescriptions in 2016 — both growing annually while the commercial market’s share declines.

Clearly, there is no shortage of healthcare issues for the coming year. I’ll be addressing a number of them in future blogs.

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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