Future of Specialty Pharmacy and More

Pills falling

Future of Specialty Pharmacy – Recent events involving Valeant and Philidor have caused an uproar in the marketplace along with the Turing Pharmaceutical (and generics) mess around pricing. Now the NY Times casts the light on Horizon and Linden illustrating the bad without much good around stakeholder relationships that pharma firms have utilized.

Due to the evolution in drug therapies and the variety, it is difficult to maintain a single definition of what is a specialty pharmacy. Given that all pharmacies have the same type of State and Federal licensing, what we are really dealing with is class of trade determinations that is more of a manufacturer regulatory or FTC and CMS enforcement issue.

Specialty pharmacies have never really established their value proposition or clear definition and consistency on their service offerings. That lack of clarity opens the door to political attacks and scrutiny via public hearings but also the opportunity for third-party payers to shut-off access to reimbursement.

Impacts on pharma are multi-fold due to the nature and levels of contracting that has occurred in the marketplace during the past 5 years.

Part of the issue for manufacturers is tied to the degree of control they can have in sales information or tracking in their relationships with downstream vendors. This has always been a tricky area from a legal and regulatory perspective to a manufacturer. Another part is dealing with the patient services to assure initial use – avoid product abandonment – as well as persistency in medication taking.

At a minimum, it exposes bad marketing practices that represent a bad image for pharma firms with consumers at a time when consumers are the new key to product success in a post-ACA environment of managed care in the U.S.  Other impacts effect contractual relationships with specialty pharmacies, of all types, as well as with third-party payers who may be as complicit in nefarious deals as the specialty pharmacies have been with manufacturers.

The net result of all these revelations will most likely be a demand for (1) different and more ethical business practices, (2) more transparency throughout all contracted stakeholders to purchasers (private employer plans and public sector programs) and consumers, and (3) a clearer focus on collaborations that deliver plan performance to improve population health at a reasonable economic total cost.

AMI works with all key healthcare stakeholders and can provide valuable insights that would aid in moving into those new business collaborations that the purchaser market is looking for going into 2016. Just as specialty pharmacy, health plans and PBMs are searching for their value proposition independent of pharma, manufacturers need to take the effort independent of those traditional business “partners”. AMI offers that outside and independent resource to achieve success in the new market landscape.

In addition, NICH (National Institute of Collaborative Healthcare) is affiliated with AMI and offers innovation, incubation and implementation. Along with AMI, NICH works with start-up to Fortune 500 companies on a variety critical business issues in order to take appropriate actions that move the needle.