Serving managed care, health-system and specialty decision makers Volume 9 • Number 4 • July/August 2020 • specialtypharmacycontinuum.com
One plan’s proactive strategy
CLINICAL Early SP check-in with myelofibrosis patients pays off ...................................
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The ‘rare pharmacy’ model for orphan diseases ..................................
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Gene Therapy Doesn’t Have to Break the Bank
OPERATIONS & MGMT Adherence help: the case for compliance consultants ............................ Health systems, payors duel over specialty access .............
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OPINION A call for more drug pricing stability ................ Rx preapproval process: a failure to communicate? .............
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Role of Specialty Pharmacists in Treating Patients With HIV See page 12.
hanges that are taking place during the COVID-19 pandemic could persist and significantly reshape the specialty pharmacy industry, experts believe. “This is an interesting time, and the question is, how much of the changes we’re seeing now are going to last?” said Adam Fein, PhD, the CEO of the Drug Channels Institute, a subsidiary of Pembroke Consulting Inc., during a recent webinar hosted by his firm. One possible realignment of the iindustry could come from an increase in sspecialty prescriptions, Dr. Fein said. As patients have had to stay at home, many p physicians have moved from prescribing p
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Tempering the cold chain during COVID-19 ............. 22
REVIEW ARTICLE
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POLICY Generics ‘wall’ a billiondollar problem ..................
Will COVID-19 Reconfigure The SP Industry?
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y the time a member of Blue Cross and Blue Shield hield of Kansas inquired about covering a new prescripscription gene therapy for spinal muscular atrophy (SMA) MA) last spring, the pharmacy management team had been well ll prepared. d In fact, the team had been planning for gene therapy requests since late 2017 with the approval of voretigene neparvovec-rzyl (Luxturna, Spark), said Kenneth Mishler, PharmD, MBA, the insurer’s chief pharmacist, even though they had no members with retinal eye disease at the time. Anticipating a wave of gene therapies, Dr. Mishler and others at the payor built a work group to handle requests for the potentially high-cost treatment. The team included the company’s medical director and chief medical officer, as well as representatives from provider relations, sales and marketing, actuary, risk management, and customer service. Their eyes were on the 2019 expected approval of onasemnogene abeparvovec-xioi (Zolgensma, AveXis), a prescription gene therapy for young children with SMA, because they already had four members on nusinersen (Spinraza, Biogen), another therapy for the condition. One member was younger than 24 months old. “As small plans, we’re going to have to get this right the first time, because we might only have one patient [in need], and unless one is born into our plan, we may Continued on page 18
New Approval First CAR T-cell therapy okayed for MCL. See story, page 21.
M Multipronged S Strategies Boost R Rx Compliance
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n 2012, avoidable U.S. health care costs related to inefficient or inappropriate medication use amounted to a staggering $475 billion, according Doug Long, MBA, the vice president of industry relations at IQVIA, a global health information company. By far, the biggest contributor to that nearly half-trillion dollars in lost savings opportunities was medication nonadherence, Mr. Long noted during a recent AMCP virtual meeting. Patients’ failure to take prescribed medicines, he said, accounted for 57%, or $269 billion, of those avoidable costs, Continued on page 8
