Financial assistance

Innovative patient-centric approach improves patient journey and mitigates rising rare disease drug costs

A patient’s ability to pay for specialty drugs will continue to be an issue because drug costs are prohibitive and add barriers to accessibility.

Specialty drugs generally account for more than 50% of all drug expenditure, but represents less than 2% of total use. For this reason, specialty pharmacy (SP) has attracted increased attention from stakeholders across the continuum of care, including patients, payers, life sciences, and providers.

For specialty medicine manufacturers, this is a positive trend, as greater attention in this area will help ensure that prescribed patients can access specialty medicines seamlessly and that efficacy, compliance and adherence to treatment will be monitored.

As the industry examines key MS trends in 2022, it will be important to consider these issues:

  • Continued use and increased costs of specialist agents.
  • Emergence of ultra-expensive specialty agents and cell/gene therapies for rare and orphan diseases.
  • More targeted management of patients requiring high-cost specialty medications to ensure adherence and optimize outcomes.
  • Vertical integration of specialty pharmacies into healthcare organizations.

In this environment, a patient’s ability to pay for specialty drugs will continue to be an issue because drug costs are prohibitive and add barriers to accessibility. In fact, the direct costs of specialty drugs have grown faster than gross domestic product (GDP) growth over the past decade. This signals a greater need for financial assistance programs, which are essential for patients to start and continue treatment as prescribed.

For MS companies and practices, the proper delivery and management of specialty medications is a key part of a patient-centered approach to caring for patients with rare diseases, in which every care decision is based on what which is best for the patient. This strategy also enables all stakeholders to connect effortlessly, rather than operating independently to achieve a higher level of continuity of care that strengthens communication, produces rich data to optimize outcomes, and improves the overall patient experience. patient.

Patients First 2022 Trends

Continued use and rising costs of specialist agents

An innovative MS solutions partner will utilize patient care coordinators and pharmacists with the broad specialized therapeutic expertise needed to quickly identify financial resources, such as co-payment and foundation assistance to help make specialized products more affordable. Some organizations may also offer unique financial solutions for gene/cell therapies to help offset the costs of these potentially curative therapies.

Emergence of ultra-expensive specialty agents and cell/gene therapies

The increasing pace of innovation made possible by emerging scientific breakthroughs and new understanding of diseases has led to the development of new therapies, although many rare diseases remain incurable. The number of new patients entering the care pipeline is steadily increasing, with some having multiple conditions requiring specialized medication.

Given the level of transparency and communication it promotes, a patient-centred approach creates the best environment for managing rare diseases and ensuring that the right treatment is prescribed, at the right time and in the right setting.

More targeted management of patients requiring high-cost specialty medications to ensure adherence and optimize outcomes

Patient-centered SP solutions must be uniquely designed to engage the services of specialized professionals who have the experience and capabilities to reduce costs and improve outcomes. Specialized expertise is required to transcend the breadth of skills provided by traditional and legacy care organizations, which are often designed exclusively for scale.

The most innovative MS solutions organizations offer a patient support/counselling center model that includes a dedicated and branded team. This is important to overcome the limitations of standard SP and hub providers, who often rely too heavily on technology solutions that fail to meet human needs and variability, and customizations based on customer needs. .

It is also important that the solution offers care coordination with a team approach that includes pharmacists, clinicians, nurses and other MS-focused support staff, all focused on the state of the disease, the patient community and therapy. This adds a layer of personalized care coordination and telehealth solutions to foster discussion between patient, pharmacist and other clinicians.

By incorporating assessments and interventions at key points in therapy, the healthcare team is able to manage side effects and gather concrete evidence regarding the patient’s therapy, condition and quality of life.

Vertical integration of specialty pharmacies into healthcare organizations

More … than three quarters specialty drug distribution revenues in 2020 were found to be with SPs owned by Pharmacy Benefit Managers that are part of vertically integrated consolidated operations. In particular, 9 out of 10 large hospitals now have their own internal PS.

In healthcare, a vertically integrated system can provide a wide range of patient care and support services. For example, PSs are the main provider of oncology-related drug therapy.

However, SPs within an integrated organization may lack flexibility and can benefit from partnering with a patient-centric SP solution to create more holistic decision support, reduce variation in care, improve access to evidence-based information, create a better healthcare experience, and produce optimal outcomes.

Other trends

With many plan sponsors now excluding specialty drugs from medical and pharmaceutical benefits, it’s obvious that the primary goal is to reduce costs. But with the increased availability of specialty drugs and documented improvement in patient health outcomes, payers will need appropriate drug therapy management and utilization management programs that can be customized and aligned with each sponsor. diet to achieve their multiple goals.

Additionally, in 2022, biosimilars are expected to trend upward due to the loss of patent protection for a number of additional blockbuster drugs. The growing burden of various chronic diseases, such as cardiovascular disease, diabetes, and cancer, will continue to drive the biosimilars market, with affordability impacting market uptake.

Patient First, Pharmacy First

It is important that pharmaceutical manufacturers align with a patient- and pharmacy-focused hub provider that serves as a true collaborative partner, supported by a team that has a deep understanding of the makeup and value of payers in several specialty categories. Ideally, the partner should offer:

  • Extensive experience and expertise in payer reimbursement and strategy development.
  • Thorough understanding of the competitive environment.
  • Programs designed to drive branded volume and provide data-driven cost savings analyzes that result in optimal patient access to products in key specialty and rare disease categories.
  • Personalized clinical support programs and interventions that result in improved treatment adherence.
  • Limited distribution of drugs with national reach and centers of excellence in many specialty conditions.

High-touch, technology-enabled capabilities to further enhance the patient experience and improve outcomes, ensuring patients can seamlessly access medications and get the high-touch support they need.

A patient-centered approach provides a “more human touch” to people facing chronic illness and uncertainty, transcends the limitations of the retail pharmacy approach, improves the level of care and clinical outcomes, and improves the patient experience.

About the Author

Dea Belazi is President and CEO of AscellaHealth.