BOSTON—With specialty medicine comprising about half of all drug spending on the market in the United States today, the concept of getting necessary prescriptions in the hands of patients with life-threatening illnesses can, at times, seem daunting for providers, patients, and policymakers alike.1 Fortunately, a panel discussion held here at the 6th Annual NCODA Oncology Institute offered some tips for those in attendance to help them do just that, taking a comprehensive look at the process involved in actually getting needed prescriptions to these patients and offering some suggestions on how healthcare providers can ease the process for patients.
Sharita Howe, PharmD, who is associate director of Partner Development and Strategy at NCODA, noted several phases of the prescription-to-patient journey, moving from the initial writing of the prescription, to clinical verification, to insurance verification, financial counseling, preparation of the product, patient education, medical delivery, and then continued postdelivery, clinical monitoring. She said that in each step of these phases, there are chances to introduce barriers or opportunities to address those barriers.
The panel, which included Kathy Oubre, MS, of Pontchartrain Cancer Center; Christie Smith, PharmD, of Cencora; Bill Karnes of BeiGene; and Jason Noto, MBA, of Aveo Oncology, discussed each part of these phases, and spoke to ways that pharmaceutical companies like BeiGene and Aveo are incorporating multifactorial processes to get needed medications to patients.
All panelists spoke to increased efficiencies they have seen using coordinated, limited distribution pharmacy networks that exclude PBM-owned specialty pharmacies. They noted these networks allow for a medically integrated approach, mitigating barriers and fragmentation that can be seen when medication fulfillment occurs outside of the medically integrated pharmacy.
According to the 2019 State of Specialty Pharmacy Report, about 85% of manufacturers manage their products through limited distribution models.2
When considering limited distribution pharmacy models, Noto said that “most importantly the product needs to be highly effective and safe. Once we pass that barrier, then we need to talk about the retention rates, and the margin that’s retained in the practice (using limited distribution models) is beyond meaningful.” Beyond retention, the data that can be gathered by utilizing limited distribution models, and these medically-integrated pharmacies are often in a better position to educate patients about the product.
Karnes agreed, noting that where a product will fall once the price-setting provisions contained within the Inflation Reduction Act (IRA) are implemented is an important consideration. The IRA, signed into law in 2022, is aimed at lowering healthcare costs, but there have been some that charge the IRA may have adverse effects on drug development. Karnes’ comments came less than 2 weeks after the White House rolled out prices for 10 prescription medications affected by Medicare negotiations mandated by the IRA.3 “It is important to think about when thinking through [the] next product launch; where do we want to be when we enter the IRA, and where will we be,” he advised companies considering entering into limited distribution models.
Oubre said the limited distribution model has enabled her center to reap the benefits of better patient outcomes, due to increased adherence to medication regimens and less “financial toxicity. It’s an overwhelmingly better business model for us as well as the patient.”
Oubre noted that the medically integrated pharmacy in her center has enabled better tracking of patients along their medical journey.
“When we’re able to dispense the drug within our own pharmacy, it helps,” Oubre said. “With prior authorizations, you’re looking at 24 to 48 hours, whereas if you have to send it out to the specialty pharmacy, you’re looking at 5 to 15 business days, and we do see outliers of up to 20 and 30 days. With a cancer diagnosis, that is just adding to your stress.”
References
- Howe S, Karnes B, Noto J, et al. Deep Dive 2: Distribution. Presented at: 6th Annual NCODA Oncology Institute. August 20, 2024. Boston, MA.
- CSI Specialty Group. 2019 State of Specialty Pharmacy Report. Accessed September 3, 2024. https://academynet.com/sites/default/files/csi2019spreport.pdf
- US Department of Health and Human Services. Biden-Harris administration releases final part two guidance to help people with Medicare prescription drug coverage manage prescription drug costs. Press release. Accessed September 3, 2024. www.hhs.gov/about/news/2024/07/16/biden-harris-administration-releases-final-part-two-guidance-help-people-medicare-prescription-drug-coverage-manage-prescription-drug-costs.html