It’s estimated specialty medications account for 75% of the approximately 7,000 prescription drugs currently in development. By 2022, more than 60% of the 600 drugs expected to gain FDA approval will be specialty medications. This seismic shift toward specialized therapies has put a spotlight on specialty pharmacies to help meet this demand by providing patients the support they need to ensure adherence and outcomes.
Advanced technology will prove imperative in 2021 and beyond as specialty pharmacies take on the role of facilitating patient engagement, managing prior authorizations and patient adherence, and demonstrating outcomes.
Krishnanjan Alaparthi, senior director of strategic initiatives at Wilco Source, predicts cloud-based technology will become table stakes for specialty pharmacies, especially if they want to remain competitive in the years to come.
How do you see specialty pharmacy evolving in the coming years?
In the next five to eight years, the pharmacy industry will need to evolve to meet the new digital standard in healthcare technology as the current infrastructure of many pharma organizations is quickly becoming obsolete. The demand for personalized treatment and better patient outcomes is growing every day, especially after the unforeseen Covid pandemic. The specialty pharmacy landscape will continue to evolve by keeping pace with innovation, market dynamics and legislative and regulatory changes.
What technologies do specialty pharmacies need to consider if they are to remain competitive?
Overall, specialty pharmacies will need to embrace tech-enabled hub services solutions to not only support manufacturers in bringing new drugs to market, but also support patients with education, adherence and reimbursement. These will also prove critical in tracking and reporting outcomes data to payers and providers.
Aside from a tech-enabled hub services solution, here are three additional key technologies I believe will make the biggest impact on a specialty pharmacy’s ability to remain competitive:
Electronic prior authorization. Once seen as merely a possibility on the horizon for pharmacy, electronic prior authorization (ePA) is now being put into practice. Timing is everything in specialty pharmacy and the process of obtaining prior authorization often delays getting mission-critical therapies to the patients who need them most. Electronic prior authorization will streamline that process.
Real-time pharmacy benefit. Real-time pharmacy benefit (RTPB) is still in beta testing, but we can expect it to become available soon. RTPB will be an important tool in eliminating surprise costs for patients and also bring greater efficiency to medication prescribing.
Medication therapy management technology. While medication therapy management is not new –– providers and pharmacists have been providing these services to patients to ensure optimal outcomes for more than a decade –– tech-enabled management of this service will become more prevalent. Digital solutions will become necessary to engage with patients, and provide them tools like portals with access to education about their condition and the therapy, and other omnichannel tools like push notifications to remind them of dosing schedules and procedures.
How will technology solve some of the biggest challenges in specialty pharmacy right now?
For specialty pharmacies to see growth in the coming years, the processes that serve to connect patients with their specialty therapies must utilize current technology to boost efficiency. Why? Therapy eligibility, authorization, adherence, patient assistance, bridge, and other common process requirements within specialty pharmacies tend to be prone to human error and inefficiency. Current technology can partially –– and at times –– fully automate these processes, significantly reducing speed-to-therapy and operational costs. As technology continues to drive efficiency and adaptability, pharmacies will become increasingly more prepared to compete with industry growth, increasing therapy development costs, challenges related to distribution, declining insurance coverage and reimbursement rates for specialty therapies.
Has specialty pharmacy made the digital transformation or is there still room for improvement?
Digital transformation is rapidly changing the role specialty pharmacies will play in connecting patients with therapies, and many players in the pharma world have made significant progress in digitally transforming their workflows. Industry challenges, however, will continue to change, meaning the technology that drives the digital transformation of today will also continue to change. So, yes specialty pharmacy as a whole has turned a corner in digital transformation, but there will always be room for improvement just as newer, better iPhones and Androids are released each year to enable smartphone users to remain current in their personal technology needs.
What do specialty pharmacies need to do now to start preparing for the tremendous growth that’s predicted for the industry?
Given that the growth of the specialty pharmaceutical market is expected to continue for many years, discussions about the key trends with respect to Utilization Management (UM) reach across seven key areas:
Prior Authorization (PA) and Reauthorization –– All commercial payers plan to expand the use of more stringent PA criteria for specialty medications.
Designating preferred specialty products on medical benefits –– Going forward, all payers will likely expand, or in the case of integrated delivery networks (IDNs) continue, this model of preferred medical treatments.
Product exclusions of specialty drugs –– Payers across the board anticipate expanding the use of this tactic to more covered commercial lives in the next few years.
Split-fill programs –– Split fills are important in reducing waste and cost by providing a half month’s worth of the medication to patients. This will likely remain strong in the industry to help keep costs down. Managing this, however, will require technology to help organize and streamline the process to avoid potential errors or missed refills.
Manage specialty drugs –– 60% of payers, half of which are large health plans, are likely to implement evidence-based pathways that specify which drugs to use in the near future. Again, this will make outcomes data tracking critical.
Quantity restrictions –– Quantity restrictions and step edits (or step therapy) are among the most implemented UM tactics with the latter seeing further expansion across all payer types in the future. To make the case for specific dosing instructions, specialty pharmacies will need to demonstrate positive outcomes and efficacy, as well as drug adherence.
Limited distribution for specialty pharmaceuticals –– Increasingly, manufacturers will opt to work through limited distribution networks in which the specialty pharmacies are selected based on their expertise and ability to offer optimal patient experiences and outcomes. For specialty pharmacies with tech-enabled hub services solutions, this will be easier to manage and demonstrate.
If specialty pharmacies did one thing today to make themselves more competitive, what should they do?
There is more competition than ever before with the rise of specialty mail-order pharmacies. Consumers are increasingly shifting their buying behavior and want the convenience of goods shipped to their doorsteps. Specialty pharmacies will now have to compete with this, making continual innovation of the patient experience critical.