Tuesday, April 29, 2014

Health Plans Get No Satisfaction From Specialty Pharmacies

The just-released EMD Serono Specialty Digest (10th edition) provides a vast playlist of data on health plans’ specialty drug management strategies and tools. You can download it free with registration here: http://specialtydigest.emdserono.com/

This year, I was struck by health plans’ dissatisfaction with specialty pharmacies’ clinical and reporting metrics. For many core services, 50% or more of plans gave specialty pharmacies a rating of 3 or lower (out of a possible 5). The charts (below) show an unexpectedly wide gap between specialty pharmacies’ self-professed capabilities and health plans’ perceptions.

The survey echoes the study I discuss in Employers Pick Specialty Pharmacies Over Retail Drugstores—For Now. That survey found that a majority of employers perceive that clinical programs are comparable or better at retail pharmacies than at specialty pharmacies.

A manufacturer must be careful when contracting with a specialty pharmacy that promises to be your savior, steadfast and true. These new data also reinforce my belief that limited specialty dispensing networks will continue to become larger and more inclusive. Hey, hey, hey: That's what I say.


The latest EMD Serono Specialty Digest draws on responses from 91 health plans representing 124.9 million covered lives across the following plan types:
  • 82.2 million commercial lives (healthcare maintenance organization or preferred provider organization)
  • 18.7 million Medicare Advantage prescription drug plan lives
  • 23.9 million Medicaid lives
This year’s survey data included fewer plans, but more covered lives. In 2013, commercial plans accounted for 66% of the sample’s covered lives. Full demographics appear on page 8 of the report.

Once again, some of my favorite survey questions from previous years have been exiled on main street. You will be missed, provider reimbursement data.

Here are links to my previous Drug Channels articles on earlier editions:

The bar charts below summarize health plan responses to questions about services that specialty pharmacy providers (SPPs) offer.
  • Orange bars: The value of specialty pharmacies' services, as reported by a health plan (1=not at all valuable; 5=extremely valuable)
  • Blue bars: Whether SPP(s) provides this service to a health plan
  • Red bars: A health plan's satisfaction with each specialty pharmacy service (1=not at all satisfied; 5=extremely satisfied)
The full results appear on pages 57-61 of the full report.

Note the disparity between the orange bars (importance) and the red bars (satisfaction).

As the chart below shows, specialty pharmacies received surprisingly low satisfaction marks for clinical and utilization services. Barely half (52%) of all plans were satisfied with specialty pharmacies’ performance on such important activities as “Manage drug waste, abuse, and misuse” and “Implement adherence and persistence programs.” Even “Ensuring appropriate dosing” mustered a 4 or 5 on the satisfaction scale with only a slim majority (55%) of plans.

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Reporting services fared even worse. For the six services shown in the chart below, a majority of plans rated their satisfaction at 3 or less on the 5-point scale. Eighty-four percent of plans, for example, rated “Measure adherence and persistency” as important. Yet only 46% of plans were satisfied with SPPs’ services.

[Click to Enlarge]


The market for dispensing specialty drugs is becoming increasingly competitive. As we discuss in “Growing Competition for Specialty Dispensing” (in Chapter 8 of the 2013-14 Economic Report on Retail, Mail, and Specialty Pharmacies), the specialty market’s projected growth is drawing many companies into the business of dispensing specialty drugs. The Explosion in Accredited Specialty Pharmacies, our exclusive analysis of URAC accreditation data, illustrates this boom.

The troubling performance gaps in the latest Specialty Digest highlight why specialty pharmacies will need to try and try and try and try.

Would Devo lie to you? Click here if you can’t get no video.

P.S. Debbie Stern, the report's editor, will be presenting more results next Thursday (5/8) at the Armada Specialty Pharmacy Summit & Expo. See you there!

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