After more than two years of hybrid and pared-back events, the Asembia Specialty Pharmacy Summit was back in full force this year in its regularly-scheduled springtime slot. Over 6,000 pharmaceutical professionals gathered last week in Las Vegas to learn more about the specialty pharmacy market. Read on to learn more about what was sparking conversation this year at Asembia.
1.Employers want to be more informed
This year at Asembia, we heard from many payer perspectives and learned how they’re approaching the dynamic specialty market. For example, while employers are closely tracking the specialty drug pipeline, many are waiting to know more about complex gene therapies before including them in benefit design.2 In the meantime, pharma must support payers with more education, specifically on pricing.
Employers also want to learn more about bottlenecks to care. According to presenters in the Wednesday session entitled “Plan Sponsors Speak: Viewpoints and Trends in Specialty Drug Benefit Design,” many employers have begun to closely track prior authorizations and denial rates for their plan members.2 In order to do so, many plan sponsors are investing energy and resources into robust data tracking to get a better picture of the health of their plan.
2. A handful of PBMs continue to dominate the specialty pharmacy market
Adam Fein’s Tuesday session on the outlook of the specialty pharmacy market analyzed how the dollars flow within the specialty pharmacy landscape. It’s perhaps no surprise to learn that four PBMs are earning well over half of all dispensing revenue generated in the specialty market. One reason for this is that the major PBMs (plus Walmart) own 73% of all 340B contract pharmacy relationships, which drives a notable portion of earnings in the specialty market.3
This leaves little space for independent pharmacies and wholesalers to capture specialty market share, even when independent pharmacies have more than double the number of locations with specialty pharmacy accreditation than PBMs. Independent pharmacies have the theoretical ability to serve a broad slice of the specialty market, but they’re unable to drive the revenue that CVS, Express Script, OptumRx, and Walgreens collect from specialty dispensing.3
3. Vertical integration in the market is changing
The pharmacy landscape has been dominated by vertical integration over the past several years. PBMs are now frequently integrated with an insurer, specialty pharmacy, and other provider systems, such as minute clinics or hospice providers. Over the past three years, we’ve seen a new trend in the market: more independent physicians are now joining hospitals and health systems, and more hospitals and health systems are now requiring patients and employees to dispense from their internal specialty pharmacy.3
On the other hand, the market has recently seen a few examples of the pharmacy system taking a step back from vertical integration.3 Centene, a major insurer, recently announced the sale of two of its pharmacy arms, Magellen Rx and PANTHERx, a specialty pharmacy. Centene intends to now use external vendors for pharmacy services, including specialty dispensing.
4. All eyes are on biosimilars
Many sessions at Asembia this year addressed biosimilars, and for good reason. In the past three years, the market has seen profound success of biosimilars in the oncology space. With this breakthrough, pharma manufacturers have heavily invested in developing new biosimilars for other indications.
Notably, many manufacturers are in the process of developing biosimilars of the #1 selling drug Humira (annual sales in 2021 were $20.7B1). As these Humira biosimilars launch over the next several years, many will be watching to see how these new drugs attract and retain patients – and contend with other heavyweight products on the market today.
While biosimilars represent a major medical innovation and revenue opportunity, there’s still work to be done to educate the market on their merits. Payer relationships, physician education, and patient affordability will prove incredibly important for this new category.
5. Cell and gene therapies are calling current payment structures into question
Cell and gene therapies were also top of mind this year at Asembia. These intensive treatments add to or alter a patient’s genetic code to effectively cure rare disorders housed in human DNA. This is a breakthrough for the millions of Americans suffering from rare genetic diseases like hemophilia and muscular atrophy. However, these curative treatments come at a price point of several hundred thousand dollars per dose.
The burden this price point puts on payers is forcing the industry to change how pharma, payers, and specialty pharmacies work together. Stakeholders are considering creative ways to pay for these treatments – including having pharma contract directly with payers, rather than working through a variety of third parties and creating value-based purchasing agreements.
6. Sales reps are no longer the only reps in the field
With care complexity increasing, pharma manufacturers are deploying more subject-matter experts into the field. Many pharma manufacturers have bolstered their in-field team to include not just sales reps, but specialists who can help providers and patients navigate complex specialty drug treatments. For example, we heard in the “How Market Access Has Changed the Way we Think About Launch Strategies” session on Wednesday that manufacturers have begun to hire and train account managers, patient guides, nurse liaisons, and more.4
This ongoing system of support helps pharma shift from transactional drug sales to building more experience and education around a specialty medication. Manufacturers are now focused on creating a white-glove approach to care to shine light on the value of the entire treatment journey.
Concluding thoughts from Asembia 2022
The specialty market is rapidly evolving. New innovations like gene therapies, cell therapies, and biosimilars are creating breakthroughs for health. While these complex medications are providing hope for millions of Americans, the high price tags of specialty drugs are putting stress on payers, patients, and the providers who prescribe them. In response, we’ll likely see new models of payment, care, and patient access in the coming years. As these shifts occur, these parties will increasingly lean on data and technology to guide decision making.
2. Sharon Phares, Michael Lonergan, Tracy Spencer, and Renee Rayburg, Asembia 2022 session entitled “Plan Sponsors Speak: Viewpoints and Trends in Specialty Drug Benefit Design”
3. Adam Fein, Asembia 2022 session entitled “The Specialty Pharmacy Industry Update & Outlook”
4. Jon Haas, Adrian Garcia, and Tony Lanzone, Asembia 2022 session entitled “How Market Access Has Changed the Way we Think About Launch Strategies”
A special thank you to the Asembia team for another excellent summit.