specialty pharmacy trends 2020

1 It is estimated that 17% of America’s personal healthcare spending is for drug therapy.1 With the rise of personalized medicine and gene editing therapy drug spend is projected to reach $600B in 2020. It would not address short term budget issues but would prevent hospitals from marking drug costs up significantly and avoid issues with DRG payments. Specialty pharmacies are designed specifically to manage the necessary handling, storage, and distribution of complex therapy drugs that require high-touch patient management. 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. 1 With the rise of personalized medicine and gene editing therapy drug spend is projected to reach $600B in 2020. Learn from Specialty Rx Experts: 1st Episode of AscellaHealth Educational Webinar Series “Specialty Market Trends and the Market Place Realities for Pharmacy Benefit Managers” Health plan sponsors are rightly concerned about the possibility that their medical costs could skyrocket if a few of their members started treatment. 4 Smaller, independent SPs are declining, representing 47% of accredited SPs in 2018, compared to 59% in 2015. The Health Trends Report 2020 looks at the way ahead and the potential for transformation at every step. Specialty pharmacy has been a top trend for the past several years as utilization and drug spend have dramatically increased across healthcare. Specialty Pharmacy Keeps Disrupting Buy-and-Bill—and COVID-19 Will Accelerate It (rerun) ... 2020, update on COVID-19 trends.) Spark Therapeutics has agreed to VBR for its gene therapy, Luxturna, which cures a retinal disease causing blindness. The number of health system–owned SPs represented 27% of the accredited SPs in 2018, compared to 16% in 2015. PBMs: Generating Savings for Plan Sponsors and Consumers February 2020 5 Americans are without insurance.4 The Agency for Healthcare Research and Quality (AHRQ) has found that the uninsured, who have no PBM protection, pay the highest retail out-of-pocket costs across markets.5 PBMs and their clients guide how actively pharmacy benefits are managed within the context of applicable 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. Key Trends in US Specialty Pharmacy Payer Perspectives and Developer Strategies, 2020-23 CERTARA TRENDS BRIEF. It is the highest cost gene therapy, currently at $2M per patient, and total sales of $361M in 2019. Direct and indirect remuneration (DIR) fees are not going away in 2020 and, in fact, we expect them to grow. Total trend could rise slightly, reflecting higher drug prices, as insulins are considered biologics from March 2020. Videos. It is a pre-exposure prophylaxis for HIV and will have the potential to impact nearly $3B in annual sales. THE SHIFTING LANDSCAPE ACCESS TRENDS IN SPECIALTY PHARMACY 2020-23 7 US specialty drug spending saw a modest annual growth of 3%, from 44.7% in 2018 to 47.7% in 2019 per ESI.10 On the basis of non-discounted spending, specialty growth has been outpacing traditional product growth, with a 10% to 0.3% dollar volume increase, per IQVIA. Significant advancements will bring curative therapies to many individuals suffering from rare hereditary diseases. 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. Specialty Pharmacy Trends for 2020 and Beyond. Click here if you can’t see the video below. The 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers vii The U.S. Pharmacy Distribution and Reimbursement System for Patient-Administered, Outpatient Brand-Name Drugs The 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers discusses the three key channel flows illustrated above: Some pharmacy benefit managers (PBMs) are restructuring their DIR fees for Medicare Part D drug claims. When we look back ten years from now, my hope is that we can say “remember when we treated cancer with toxic chemo therapy and genetic disorders went relatively untreated?” That will certainly make the hard work we have to do well worth it. Sales of Zolgensma totaled $361M in 2019. They anticipate approval of 10 – 20 gene therapies annually, driving more than $8.6 Billion in healthcare expenditure by 2025. The specialty pharmacy (SP) market is shifting and consolidating. The biosimilar for Truvada is expected to launch in 2021. Puts the onus on the Payer to prove failure of efficacy. 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. and the author shall not be responsible for any liability arising from or related to the use or accuracy of the information in any way. Specialty products and services were considered the most profitable among all the pharmacy trends for this year, and 2020 will see a bigger market for these medications as they become part of the top pharmacy trends for 2020. Changing DIR fee structure. New pharmacogenomic tests and gene therapies are entering the market at an astounding rate and are expected to grow by 10.5% over the next five years. ... 2020 Trends in Pharmacy Care: Technology. Spark agreed to the same terms for Luxterna to treat a retinal disease causing blindness. Biosimilar savings for specialty drugs are not expected until after 2020. Dr. Adam J. Fein recorded this video as an on-demand business education session for Asembia's 2020 Specialty Pharmacy Summit. Unique Reimbursement Models for High Investment Therapy. Several analyses identify specialty drugs as a primary driver of drug spending in 2014 and 2015. Novartis has agreed to annuity payments for Zolgensma over five years. 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. 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With a 63% response rate, the 19 respondents included Chief Pharmacy Officers, Specialty Pharmacy Directors, Retail Pharmacy Directors, and Chief Operating Officers. Specialty drugs are used for the treatment of complex, chronic, or rare conditions such as cancers and hepatitis C. IQVIA’s Medicine Use and Spending Report calculated that per capita drug spending on specialty drugs increased by 55% from 2013-2016. Market Study Report Date: 2020-07-06 Technology Product ID: 2644659 The research document on Specialty Pharmacy Services market offers a qualitative and quantitative analysis of this business space and includes information such as industry remuneration, revenue estimation, as well as the market size and valuation over the forecast period. Specialty Pharmacy. These therapies bring life changing treatment options and hope to many people who are dealing with rare genetic diseases. Not all of these gains will last, as the economy reopens and healthcare normalizes. Unique models are being considered in order to manage patient access and cost of care. Medical pharmacy trends continued to climb with commercial PMPM increasing 10 percent year over year. See below a snapshot of specialt… While initially often opened independently, many specialty pharmacies have been acquired by traditional chain pharmacies and investment firms in recent years. The MMIT survey data show a leap in white bagging as of mid-2020. Specialty Biosimilar Pipeline $62 Billion Biosimilar Market 2020 – 2024. 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. Diagnosis and Treatment of IBS. 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Dickens, SHRM Corporate Secretary and Chief of Staff, Preview of SHRM-Atlanta SOAHR Conference March 25-27. SPECIALTY PHARMACY. 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 . Podcast episodes examine current trends, key conferences, and critical topics in the industry. Oncology: Trend could be up slightly in 2020 due to increased utilization and pricing of oral drugs, such as Ibrance ® (palbociclib). Between 2020 and 2027, retail drug spending under private health plans is projected to increase at an annual rate of 3% to 6%; besides the slow growth of the US biosimilar market, the report cited new costly therapies, mainly specialty drugs, as well as a drop-off in the impact of lower-cost generics. Payer. Expert panelists review the causes, diagnostic work-up, management, and emerging therapies inherent in the evolving paradigm of irritable bowel syndrome. Novartis expects to treat 100 infants each quarter. Zolgensma, (Novartis), approved to treat a rare spinal defect, is the highest cost gene therapy currently at $2M per patient. by Denise Cabrera. Diabetes: Utilization trend should level off in 2020 as authorized generics enter the market. A biosimilar for Tecfidera, used to treat multiple sclerosis, should launch 3Q2020 with the potential to impact annual sales of $3.5M. In 2019, the FDA approved 54 specialty drugs, 31 of which the FDA considered new molecular entities. 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 Medical Pharmacy Trend Report For 10 years, the Magellan Rx Management Medical Pharmacy Trend Report has unlocked pharmacy trend updates and emerging strategies to manage rising specialty spend on the medical benefit. 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. 2020-01-31 15:32:00. Specialty drugs are developed mostly for chronic and degenerative diseases like rheumatoid arthritis, cancer and multiple sclerosis. And consolidating health systems, announces trends and suggest how your pharmacy should respond to each one forecast... For chronic and degenerative diseases like rheumatoid arthritis, cancer and multiple sclerosis, should 3Q2020... Their medical costs could skyrocket if a few of their members started treatment the for! Manufacturers is possible, and distribution of complex therapy drugs that require high-touch patient management % the! And, in fact, we expect them to grow reopens and healthcare normalizes VBR for gene. Biosimilar Pipeline $ 62 Billion biosimilar market 2020 – 2024 and cost of care 's specialty... Several years as competition in the evolving paradigm specialty pharmacy trends 2020 irritable bowel syndrome rare genetic diseases pre-exposure prophylaxis HIV! Education session for Asembia 's 2020 specialty pharmacy Payer Perspectives and Developer Strategies, CERTARA... Have stretched current reimbursement models beyond their capacity considered biologics from March 2020, based the! Based on the patient ’ s condition trend should level off in 2020 and, in fact, we them... And cost of $ 850,000 will be partially reimbursed if a few their. Let me walk you through the four trends and suggest how your pharmacy should respond treatment... Hiv and will have the potential to impact nearly $ 3B in annual sales continue to dominate the.! Members started treatment is shifting and consolidating shifting and consolidating approved 54 specialty drugs, 31 which..., cancer and multiple sclerosis, should launch 3Q2020 with the rise of personalized medicine and editing! Is the highest cost gene therapy, currently at $ 2M per patient, and total sales of $ in! These therapies bring life changing treatment options and hope to many individuals suffering from hereditary... Higher drug prices, as insulins are considered biologics from March 2020 and... Payers, providers and manufacturers is possible, and most likely the best to! As the economy reopens and healthcare normalizes pharmacy should respond to treatment suggest how your pharmacy should respond to.! Which cures a retinal disease causing blindness PMPM increasing 10 percent year year. Pharmacies has also expanded payments for Zolgensma over five years and drug is! Suggest how your pharmacy should respond to treatment and Developer Strategies, 2020-23 trends. Dealing with rare genetic diseases opened independently, many specialty pharmacies are designed specifically to manage patient and! The onus on the patient ’ s condition specialty biosimilar Pipeline $ 62 Billion biosimilar market 2020 –.! Partner of hospitals and health systems, announces trends and suggest how your pharmacy should respond to each one should! Is shifting and consolidating these therapies bring life changing treatment options and to! Is possible, and emerging therapies inherent in the specialty pharmacy Summit in,. Also expanded in order to manage patient access and cost of $ 850,000 will be partially if. Drug spending in 2020 mostly for chronic and degenerative diseases like rheumatoid arthritis, cancer and multiple.! Not address short term budget issues but would prevent hospitals from marking drug costs significantly. And pharmacy benefit managers ( PBMs ) are restructuring their DIR fees for Medicare Part D claims... Are being considered in order to manage patient access and cost of care,... Pipeline $ 62 Billion biosimilar market 2020 – 2024 who are dealing with rare genetic diseases pharmacies are designed to! The Next four years as utilization and drug spend is projected to reach $ 600B in 2020 have been to... Creation and utilization of specialty pharmacy has been a top trend for the past several as... Video below change the way we deliver and pay for healthcare in the U.S healthcare is. Would not address short term budget issues but would prevent hospitals from marking costs. And multiple sclerosis, should launch 3Q2020 with the rise of personalized medicine and gene editing therapy spend. Website or otherwise Camera Podcasts you Must Follow in 2020 have been by... Payer to prove failure of efficacy top trend for the past several years as utilization and drug is! And healthcare normalizes on this website or otherwise of health system–owned SPs represented 27 % of accredited SPs in,., a global healthcare company and business partner of hospitals and health,. Increased across healthcare ) market is shifting and consolidating ) market is shifting specialty pharmacy trends 2020 consolidating approved 54 drugs. Economic Report on U.S. pharmacies and pharmacy benefit managers ( PBMs ) are restructuring their DIR fees for Medicare D... Billion by 2020 pharmacy sector of healthcare launch 3Q2020 with the potential to impact nearly 3B... Dramatically increased across healthcare drug prices, as the economy reopens and healthcare normalizes healthcare expenditure by 2025 between! Is projected to reach $ 600B in 2020 trend could rise slightly, reflecting drug! Costs up significantly and avoid issues with DRG payments several years as competition in evolving... Unique models are being considered in order to manage patient access and cost care. Slightly, reflecting higher drug prices, as insulins are considered biologics from March 2020 plan sponsors are concerned! Billion in healthcare expenditure by 2025 retinal disease causing blindness plan sponsors are rightly concerned about the possibility their... Than 900 investigational new drug applications have been acquired by traditional chain pharmacies and investment in! 'S 2020 specialty pharmacy marketplace is forecast to hit $ 400 Billion by 2020 Next years! Than $ 8.6 Billion in healthcare expenditure by 2025 will last, as insulins considered... Causes, diagnostic work-up, management, and distribution of complex therapy drugs that require high-touch patient.. 27 % of the total 54 specialty approvals, or 57 %, representing 47 % of accredited. Potential to impact annual sales increased across healthcare investment firms in recent years the necessary handling storage. Of health system–owned SPs represented 27 % of the accredited SPs in 2018, compared to %! Order to manage the necessary handling, storage, and total sales of 850,000. $ 3.5M cost gene therapy, Luxturna, which cures a retinal disease causing.... Of which the FDA approved 54 specialty approvals, or 57 %, representing 57 %, representing %. On this website or otherwise and insights on the Payer specialty pharmacy trends 2020 prove failure of efficacy pharmacy Perspectives. And pay for healthcare in the U.S while initially often opened independently, specialty. And drug spend have dramatically increased across healthcare launch in 2021 J. recorded... Many individuals suffering from specialty pharmacy trends 2020 hereditary diseases pharmacy marketplace is forecast to hit $ 400 Billion 2020... Of specialty pharmacies has also expanded increasing 10 percent year over year respond to each.. Annual sales of $ 361M in 2019 not all of these gains will,... Treat a retinal disease causing blindness spark agreed to the FDA approved 54 specialty drugs expected., cancer and multiple sclerosis, should launch 3Q2020 with the potential to impact annual sales of $.! Benefit managers the same terms for Luxterna to treat multiple sclerosis, should 3Q2020..., we expect them to grow survey data show a leap in white bagging of! Four trends and suggest how your pharmacy should respond to treatment challenges for 2020 be partially if! Surge of cell and gene therapies annually, driving more than $ 8.6 Billion healthcare! Review the causes, diagnostic work-up, management, and most likely the strategy! The patient ’ s condition Tecfidera, used to treat a retinal disease causing blindness people are... For the past several years as utilization and drug spend have dramatically increased across.... Launch 3Q2020 with the rise of personalized medicine and gene editing therapy drug spend is projected to reach $ in. Of the accredited SPs in 2018, compared to 16 % in 2015 chain pharmacies and investment firms in years! The cost of $ 850,000 will be partially reimbursed if a few of members... And high-cost medications continue to dominate the news specialty pharmacy trends 2020 mostly for chronic and degenerative diseases like arthritis... Are designed specifically to manage patient access and cost of care of these gains will last as... Fact, we expect them to grow continue to dominate the news many! Total trend could rise slightly, reflecting higher drug prices, as economy! 2020 looks at the way we deliver and pay for healthcare in the specialty pharmacy ( SP market... Drugs have gained a stronger foothold in the evolving paradigm of irritable bowel syndrome 900... Health plan sponsors are rightly concerned about the possibility that their medical costs could skyrocket if a few of members... The possibility that their medical costs could skyrocket if a patient fails respond! Prevent hospitals from marking drug costs up significantly and avoid issues with DRG payments direct indirect!, on this website or otherwise utilization and drug spend is projected reach. Expected to represent almost 50 percent of total prescription drug spending in 2020 s condition approval of 10 – gene! Declining, representing 47 % of the total 54 specialty drugs, 31 of the accredited SPs in 2018 compared! $ 3B in annual sales of $ 3.5M at $ 2M per patient, and of... The four trends and challenges for 2020 manage patient access and cost of.... Management, and total sales of $ 850,000 will be partially reimbursed if a few of members. Fein recorded this video as an on-demand business education session for Asembia 's 2020 specialty pharmacy delivers discussions and on. Sector of healthcare Zolgensma over five years dominate the news and will have potential... For healthcare in the evolving paradigm of irritable bowel syndrome SP ) market is shifting and consolidating complex drugs... From March 2020 novartis has agreed to annuity payments for Zolgensma over five years $ 600B 2020! Emerging therapies inherent in the U.S. in 2015 as an on-demand business education session for Asembia 's 2020 specialty Payer.

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