With the manifestation of the small-molecule
brand patent cliff, specialty pharmacy drug spend, including high cost
biologics, represents an increasingly large part of the pharmacy budget. Furthermore,
specialty drug costs continue to rise at rates in excess of 15% annually, and
substantial product innovation in specialty categories will likely contribute
to sustained levels of spending as similarly high-priced pipeline products
receive approval. As a result, pharmacy benefit managers and plan sponsors are
focusing their attention and management acumen on the specialty market.
Companies with an interest in this report
include any company with a multiple sclerosis (MS), oncology, and rheumatoid
arthritis (RA) agent on the market or in development, with a particular focus
on those with biologics and/or current or emerging oral agents. Additionally,
companies with strong portfolios in other specialty categories may be
interested in considering market analogue scenarios.
This report will explore perceptions of the
current and future state of the market for specialty pharmaceuticals in the MS,
oncology, and RA, therapy areas. These categories represent some of the highest
per-member-per-year specialty spending, and all have a substantial number of
R&D candidates that will reshape the landscape in coming years,
particularly given that these R&D candidates represent traditional
injectable or infusible biological specialty products as well as oral
formulations, biosimilars, and companion diagnostics. In the context of the
current and expected market environment, this report will evaluate the
evolution of product access and utilization strategies and managed care specialty
pharmacy management approaches.
Insights provided in this report will be
derived from an analysis of survey responses from 149 prescribers (neurologists,
oncologists, and rheumatologists) and 41 pharmacy and medical directors at managed
care organizations (MCOs). By understanding how product innovation and
experimentation in management of specialty pharmaceutical products will shape
the market for specialty products in market-leading therapeutic classes, drug
developers may begin to identify areas on which to focus in order to maximize
opportunity and mitigate risk. This report will also provide insight on how the
therapeutic areas of MS, oncology, and RA may serve as an experimentation
proving ground indicative of models that will be followed in specialty pharmacy
management and utilization across other categories.
Questions Answered in This Report:
Emerging stakeholders and evolution of
- Advent of both internal and external specialists in reimbursement
- Development of accountable care organizations and their ability
to influence access and utilization of specialty pharmaceutical products.
- Perceptions of the function of specialty pharmacy providers and
specialty distributors, and their role and relationship in the value chain.
Experimentation in managed care
- Application of traditional management tools such as prior
authorization, step therapy/sequencing requirements, and differential cost-sharing
requirements to specialty categories.
- Introduction of new reimbursement models that seek to align
incentives and prioritize patient outcomes and value: pathway-aligned financial incentives, the move of some medical benefit speciality drugs to the pharmacy
benefit for more control, shifts in reimbursement models for physician-administered
This U.S. Physician & Payer Forum reveals physicians’
and payers’ insights into prescribing and reimbursement decisions for high-cost
biologics in the United States. This report will provide
results from a survey designed to explore how access to high-cost biologics is
being shaped by payer-led strategies and other industry issues that include
sequestration, clinical pathways, and drug delivery methods. Through an
examination of specialty drugs across multiple indications, this report provides
insight into how payers and physicians compare in their use, opinions of, and
responses to trends regarding specialty drugs in their respective indications.
Markets covered: United States.
Primary research: Online survey of 50 oncologists, 49 neurologists,
50 rheumatologists, and 41 MCO pharmacy or medical directors.