Se ee SPEC CIA AL REPORT mon nograph polybagged with this issu ue
Serving managed care, health-system and specialty decision makers Volume 9 • Number 6 • November/December 2020 • specialtypharmacycontinuum.com
A Rare Opportunity
POLICY PAPs help hospitals recover lost funds .............
6
CLINICAL Payors have a stake in ensuring efficacy of ART for HIV ...................
ICER among stakeholders addressing high cost of rare disease therapy
11
OPERATIONS & MGMT Health systems band together to strengthen specialty reach ................
32
TECHNOLOGY Data help drive successful specialty launches .............................. 36
Real-World Data A New Force In Managed Care
A
s the introduction of costly new targeted cancer therapies continues to increase, health care payors are turning more to real-world evidence (RWE) to help resolve formulary and patient coverage dilemmas, according to speakers at the AMCP Nexus 2020 Virtual meeting. “We’re starting to see more and more managed care organizations use realworld data to inform their decisions,” said Daniel Malone, PhD, RPh, a professor at the University of Utah College of Pharmacy, in Salt Lake City. Real-world evidence includes information drawn from electronic health
REVIEW ARTICLE
Continued on page 14
Medicaid Moves To Gain Control Over Drug Prices Fertility Treatments: The Role of Specialty Pharmacy See page 27.
NEW PRODUCT
Fagron launches first sterile topical anesthetic LET Gel produced in CGMPcompliant operations. See page 36.
S
reparing for a packed rare disease drug pipeline and a new method for assessing the efficacy and value of the high-cost medications were two of the main themes to emerge from sessions on this challenging area of specialty pharmacy practice at the AMCP Nexus 2020 Virtual meeting. Sometimes referred to as single or short-term therapies (SSTs), some of these treatments can cost six figures, with just a few affected patients taking a huge bite out of a provider and/or payor’s bottom line. It’s therefore not surprising that the Institute for Clinical and Economic Review (ICER) is developing modifications to its existing analytical approaches to evaluating the value of a new drug or therapy. “These SSTs challenge us to think about how we assess them, price them, pay for them and make them available,” ICER Founder and President Steven D. Pearson, MD, MSc, said during the AMCP Nexus meeting.
tate Medicaid programs have been winning some key battles in the fight against soaring drug prices, including a $95 million rebate that Massachusetts wrested from a manufacturer under a negotiated value-based deal, and $300 million in rebates resulting from similar efforts in New York State. But on a national level, many challenges remain, including the huge cost of breakthrough therapies, stakeholders reported at the AMCP Nexus 2020 Virtual meeting. In the past two years, the Centers for Medicare & Medicaid Services has given Medicaid programs in eight states the authority to negotiate for
Continued on page 10
Continued on page 8
Managed care pharmacy has its eye on high-cost specialty medications for hemophilia, spinal muscular atrophy, choroideremia, AADC deficiency and other rare diseases.
P
The stories behind the market players Special advertising section begins on page 15.
Corporate Profiles
2021