specialty pharmacy trends 2020

Intercept Pharmaceuticals filed an NDA for obeticholic acid to treat fibrosis in patients with non-alcoholic steatohepatitis (NASH). Expert panelists review the causes, diagnostic work-up, management, and emerging therapies inherent in the evolving paradigm of irritable bowel syndrome. While the race to develop vaccines and treatments for COVID-19 dominated headlines in 2020, the pandemic also intersected with many existing trends in pharmacy in significant ways. Our specialty pharmacy readers are amongst the most informed in health care. SPECIALTY TREND DRIVERS Utilization of specialty drugs continued to be the largest driver of trend, as specialty drugs represented 37% of Prime’s pharmacy benefit spend. Novartis has agreed to annuity payments for Zolgensma over five years. McKesson, a global healthcare company and business partner of hospitals and health systems, announces trends and challenges for 2020. The American Journal of Pharmacy Benefits. An estimated 7000 rare diseases exist, yet only 500 have FDA approved treatment options, providing only 7% of patients access to pharmaceutical therapy. This product if approved will be an oral agent and a likely specialty pharmacy play. DIGITAL TRANSFORMATION is advancing industries, altering consumer behavior, and reinventing society at every level. In response to these expected price tags manufacturers are getting creative and coming up with new strategies designed to help make these products accessible to patients. The 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers vi • The federal government and multiple states are pursuing new policies aimed at introducing the commercial importation of drugs intended for foreign markets. IQVIA Institute. 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. 1 With the rise of personalized medicine and gene editing therapy drug spend is projected to reach $600B in 2020. They anticipate approval of 10 – 20 gene therapies annually, driving more than $8.6 Billion in healthcare expenditure by 2025. Significant advancements will bring curative therapies to many individuals suffering from rare hereditary diseases. Medical pharmacy trends continued to climb with commercial PMPM increasing 10 percent year over year. Year-over-year growth in specialty drug revenue and new drug applications for specialty therapeutics at the FDA underline the persistent industry trend toward specialty. High investment therapies have stretched current reimbursement models beyond their capacity. The cost of $850,000 will be partially reimbursed if a patient fails to respond to treatment. 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. 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 Fortunately, there are several other agents currently in development for NASH, which potentially affects 3-12% of the US population. Biosimilar savings for specialty drugs are not expected until after 2020. Unique models are being considered in order to manage patient access and cost of care. Collaboration between payers, providers and manufacturers is possible, and most likely the best strategy to ensure cost effective access to quality care. Specialty Pharmacy Trends for 2020 and Beyond. Specialty drugs are expected to represent almost 50 percent of total prescription drug spending in 2020. Drug Channels Institute estimates that in 2019, the 10 largest specialty pharmacies owned by health systems had specialty pharmacy revenues of $190 million to $470 million. Sales of Zolgensma totaled $361M in 2019. See below a snapshot of specialt… Spark Therapeutics has agreed to VBR for its gene therapy, Luxturna, which cures a retinal disease causing blindness. The biosimilar for Truvada is expected to launch in 2021. Hospitals are integrating with medical practices, … It’s no secret that technology is constantly evolving within the health care landscape, in which harnessing the power of data and automatization can spur significant progress in patient care, reimbursement, and overall efficiency. There have been 2 chimeric antigen receptor (CAR-T) approvals for certain kinds of non-Hodgkin lymphoma: Kymriah (tisagenlecleucel) and Yescarta (axicabtagene ciloleucel). 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. 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. It is estimated that 17% of America’s personal healthcare spending is for drug therapy. One particularly significant gene therapy candidate is BioMarin’s valoctocogene roxaparvovec, a therapy for severe hemophilia A in patients aged 18 years and older that is expected to be approved sometime in  2020. 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 . 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. As we enter a new decade, the healthcare industry will continue to address challenges like reimbursement for high investment therapies and the impact of social determinants of health. Digital disruption and big data are shifting the way businesses interact with consumers and accelerating change at a … ... Growth of specialty market (2015-2020) THE SHIFTING LANDSCAPE CERTARA TRENDS BRIEF 5 US specialty drug spending saw a modest annual growth of 3%, from 44.7% in 2018 [4] The Evolution of Specialty Pharmacy Today, this number has increased to over 400. 80% of new drug approvals are considered specialty (Source: Walgreens, CBI, January 2016). EOC 2020 Update. There are dozens of gene therapy products on the near horizon. Spark agreed to the same terms for Luxterna to treat a retinal disease causing blindness. changes . 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. by Denise Cabrera. Specialty and high-cost medications continue to dominate the news. In 2020, specialty pharmacies must embrace initiatives to quantify improved clinical outcomes, lower costs, and create more value for all stakeholders to obtain maximum compensation for their services. It is a pre-exposure prophylaxis for HIV and will have the potential to impact nearly $3B in annual sales. Denise CabreraLicensed Clinical PharmacistNational Pharmacy Practice Leader   McGriff Employee Benefit Solutions813-682-1515Denise.Cabrera@mcgriffinsurance.com, Specialty Pharmacy Trends for 2020 and Beyond, Register: Online HRCI | PHR | SPHR Certification Exam Prep Class, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet, https://bioprocessintl.com/bioprocess-insider/therapeutic-class/in-the-pipeline-surge-of-cell-and-gene-therapies-likely-in-2020/, Specialty Drug Spend Soars. Several trends will further address the need to change the way we deliver and pay for healthcare in the U.S. [6] Trends in FDA approval of Specialty Drugs 1990 through 2017 Obviously stated, the pharmacy industry thrives on new drug approvals—but this statement is especially true for specialty pharmacy as drug spend in this area continues to increase. And that’s how we’ll change pharmacy benefits for the better. As more innovative products come to market, it’s critical for specialty pharmacies to continuously plan around offering the latest therapies and drugs available. Direct and indirect remuneration (DIR) fees are not going away in 2020 … /publications/specialty-pharmacy-times/2020/February2020/editors-note-top-trends-for-2020-in-specialty-pharmacy, Copyright Specialty Pharmacy Times 2006-2019, 2 Clarke Drive Suite 100 Cranbury, NJ 08512 P:609-716-7777 F:609-716-9038, https://www.iqvia.com/en/insights/the-iqvia-institute/reports/medicine-use-and-spending-in-the-us-a-review-of-2018-and-outlook-to-2023, https://payorsolutions.cvshealth.com/insights/pipeline-preview-2020. 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. Accredited residency programs meet specific standards and guidelines. Specialty pharmacies are designed specifically to manage the necessary handling, storage, and distribution of complex therapy drugs that require high-touch patient management. The specialty pharmacy marketplace is forecast to hit $400 billion by 2020. As specialty drugs have gained a stronger foothold in the United States, the creation and utilization of specialty pharmacies has also expanded. In 2020, spend will nearly double and specialty will represent half of all drug spend. This product will be a one-time injection, uses a viral vector, to deliver a functional copy of the gene to the patient’s cells. Specialty Biosimilar Pipeline $62 Billion Biosimilar Market 2020 – 2024. Axicabtagene ciloleucel is also approved for relapsed or refractory acute lymphoblastic leukemia. Supplemental indications on existing specialty therapies has led to an increase in use, as well as an aging population of baby boomers contributing to the increased use or volume of specialty drugs being prescribed. The first biosimilar was launched in the U.S. in 2015. Health plan sponsors are rightly concerned about the possibility that their medical costs could skyrocket if a few of their members started treatment. Editor's Note: Top Trends for 2020 In Specialty Pharmacy, Dan Steiber, RPh, Directions in Specialty Pharmacy® Editor-in-Chief. Zolgensma, (Novartis), approved to treat a rare spinal defect, is the highest cost gene therapy currently at $2M per patient. Although our name is new, our history isn’t. Increasingly blurred lines between care settings. Unique Reimbursement Models for High Investment Therapy. Newly approved medicines, including gene therapies, cell therapies as well as orphan drugs targeting rare conditions, continued to enter the market in 2020. Chaguturu S. Pipeline Preview 2020. 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, 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, Profile: Emily M. Dickens, SHRM Corporate Secretary and Chief of Staff, Preview of SHRM-Atlanta SOAHR Conference March 25-27. Stanton D. In the pipeline: Surge of cell and gene therapies likely in 2020. These lifesaving products work by removing T-cells from the patient and genetically re-engineer those cells to target a specific cancer cell as diagnosed by the patient’s health care team. These high investment therapies have stretched current reimbursement models beyond their capacity. A biosimilar for Tecfidera, used to treat multiple sclerosis, should launch 3Q2020 with the potential to impact annual sales of $3.5M. The following . Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023. Oncology: Trend could be up slightly in 2020 due to increased utilization and pricing of oral drugs, such as Ibrance ® (palbociclib). Specialty drugs currently represent just under 2% of the prescriptions, but nearly 40% of spending in the same channels. State of Louisiana’s contract with Asegua/Gilead allows unrestricted access of the drug Epclusa, to treat and cure Hepatitis-C, for their entire Medicaid and prison population. It targets the farnesoid X receptor, which plays a key role in regulating metabolism of fats and glucose, as well as liver inflammation and liver cancer. Healthcare will be a … 1,2 Despite accounting for less than 2 percent of all U.S. outpatient prescriptions, it is projected that nine out of ten top-selling drugs will be specialty by 2020 and specialty drugs will account for 47 percent of pharmacy revenue … The evolving paradigm of irritable bowel syndrome it easier to find the information you need management, and sales. 2016 ), many specialty pharmacies have been made to your plan besides the changes below! The possibility that their medical costs could skyrocket if a few of their members started.... 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