Key Takeaways from the 2023 Asembia Specialty Pharmacy Summit

Our team recently attended Asembia’s 2023 Specialty Pharmacy Summit and returned with plenty of insights for market access professionals. The conference brought together multiple stakeholders from the pharmaceutical industry and the opportunity to connect on several hot industry topics. Kimberly Tsai, Dionna Arnold, and Vanessa Hannafin from our sister companies, Valuate Health Consultancy and Entrée Health, captured the takeaways that are likely to be most meaningful for our clients:

1. General Trends

• Expect and adjust for a clash over revenue streams between vertically-integrated payer and health system conglomerates
• As investment in home care continues to expand (yet another unintended consequence of the Inflation Reduction Act (IRA) as home care will be a comparatively less-regulated and, therefore, attractive opportunity), health systems will fight to keep home care within their own models while payers will push to move it out
• Adopt a Value-Based Care mindset to encourage innovation, improve outcomes, and ensure the sustainability of our healthcare system
• Employers are eager for all opportunities to generate savings –strategies being adopted include shifting more drugs under the pharmacy benefit, asking for medical benefit rebates, site-of-care programs, and new-to-market formulary blocks
• Alternative funding programs present attractive immediate savings opportunities for employers, but it’s still unclear what the actual programs’ sustainability and true value will be
• Affordable cell and gene therapies are a particularly tough challenge to offset: value propositions will need to be much more precisely tailored to metrics that are meaningful to employers (productivity, absenteeism/presenteeism, employee retention, etc.) to drive coverage

2. Inflation Reduction Act

Plan to feel an impact from the IRA, even if you aren’t selected for negotiation: Unintended consequences from the IRA are expected to hit virtually all manufacturers – consider commercial spillover, the introduction of MFP as a new price benchmark, how the negotiation will impact formulary preference, 340B implications, interaction with AMP cap elimination, and more.

Keep in mind that sponsors of non-negotiated drugs have the opportunity to submit evidence for consideration during the negotiation process. Expect Part D risk adjustment to play a more significant role in benefit design. Plans are expected to react to increased liability from Part D benefit redesign by making changes on multiple fronts, including one of which is narrowing their formulary coverage decisions.

• • Ensuring adequate risk-adjustment payments with an accurate model will be critical in mitigating adverse selection
  • Set up patients to successfully understand Out of Pocket (OOP) ‘smoothing’ as soon as possible. OOP smoothing of the $2,000 rebate cap can lead to tremendous savings and access opportunities for Medicare Part D patients, but only if they fully comply with the program
  • OOP smoothing is an opt-in program, and patients can become immediately ineligible if they miss one payment (basically, everything that contradicts “nudge theory”)
  • Additional operational considerations include accommodation for late-year enrollees, managing and tracking payments, and how to handle polypharmacy

3. Integrated Delivery Networks

• • Recognize and adjust for the increasing expectation among IDNs for personalized collaboration
  • The rising complexity and price of drugs in today’s market are increasing barriers to access and, ultimately, driving up IDNs’ criteria for value
  • We would be remiss if we didn’t evoke the age-old saying: “If you’ve seen one IDN, you’ve seen one IDN” – each IDN has its own unique set of value drivers as well as influences; therefore, segmentation and influence mapping is critical to ensure that the right levers are being pulled
  • Omnichannel is not just a buzzword: an effective way to build relationship equity with an IDN partner is in-person touchpoints that are reinforced digitally

4. Health Equity

• • Embed Health Equity into day-to-day market access thinking
  • Health equity can be vital to activating providers (potential value opportunity with IDNs), given the increasing recognition of the economic burden stemming from these gaps in care
  • However, building adequate health equity demands cross-ecosystem effort: partnerships are necessary to execute health equity strategies

5. Final Impressions

• • We definitely felt a lot of zest and aspiration for a value-dominated future of healthcare payments, especially during the fireside chat with Seema Verma, who pushed for more aggressive innovation via investment in technology, interoperability, and infrastructure.
  • Value-based care has the potential to address high-priority issues, including the eventual explosion of the cell and gene therapy pipeline, expansion of the Medicare population, and state-level pressures toward Medicaid spending
  • And a final note – one quote we heard over and over again was that the “biggest disruptor in healthcare is going to be the member,” as patients are the ultimate decision-makers of product adoption, program uptake, and plan enrollment

Asembia always leaves our cups full and our minds buzzing. If any of these hot topics resonate with you or you need to re-evaluate your business strategy, Archbow can help. We have the right advisors with decades of commercial planning experience to make a difference in your commercialization efforts.

Learn more about Team Archbow and the methodology that matters most to successful programs, and contact us today for assistance with your strategic and tactical patient support needs.

Archbow Consulting helps pharmaceutical and biotech companies in the USA and Europe design, build, and optimize product distribution and patient access strategies. Archbow was founded by industry veterans to meet a need in the marketplace for consulting options that offer diverse real-world experience, are able to leverage deep connections across the industry, and can also provide actionable strategic guidance. We invite you to learn more about our team, services, and clients’ success, and connect with us via email, LinkedIn or subscribing to this blog which you can do below.

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