Friday, April 16, 2021

Choosing the Optimal Pharmacy Model for Retail and Specialty-Lite Products

Today’s guest post comes from Jeff Spafford, President and CEO at AssistRx.

Jeff discusses aspects of our drug pricing system that lead to decreased new and refill prescription volume, higher out-of-pocket costs for patients, and therapy abandonment.

To learn more about AssistRx’s technology solutions register for their Optimizing Program Performance: An Innovative Approach for Retail and Specialty Products webinar series.

Read on for Jeff’s insights.

Choosing the Optimal Pharmacy Model for Retail and Specialty-Lite Products
By Jeff Spafford, President and CEO, AssistRx

Two main factors drive decreased margins for manufacturers: a growing competitive market and increased costs. To address both challenges, manufacturers look to differentiate their products by delivering high-quality experiences to healthcare providers (HCPs) and patients while also improving access and better results from care.

In the last decade, the Food and Drug Administration (FDA) approved more drugs annually on average than it did in the prior two decades, resulting in increased competition. This is compounded by a widening divergence between a brand’s list and net prices. 

According to a recent Wall Street Journal article, securing formulary positions costs more every year. One company saw the average list price for its insulin product up 141% since 2012, but average net price down 53% over the same period. Another company found nearly half its gross sales went to third parties as discounts last year. A decade ago, that tally was around 27%.

This gross-to-net squeeze causes a cascade of cost shifts that ultimately lands on the patient. As patients’ out-of-pocket costs increase, so does abandonment, driving down new and refill prescription volume. A 2019 Kaiser Family Foundation study found that 29% of patients don’t take medications as prescribed due to cost, and patients are five times more likely to abandon a $250 prescription than a $20 prescription. Higher costs also result in more therapeutic substitutions or switches to generics at the pharmacy.

To combat increased competition and gross-to-net squeeze, manufacturers primarily take one of two approaches:
  1. invest in preferred formulary status—which can be expensive and time consuming—or
  2. differentiate the brand through best-in-class services.
If choosing option B, some manufacturers face a dilemma. Although traditional patient solutions models help some products overcome these challenges, specialty-lite and retail products typically don’t require high-touch services or have the budget to stand up a people-powered program. Thus, specialty-lite and retail product manufacturers who want to differentiate their brand through services usually choose between two models: a large pharmacy network or a non-commercial pharmacy that triages the script.

Using the first model, manufacturers can lose control over switches, face slower speed to therapy, and receive less visibility into patient status and program health due to the wide range of software used by pharmacies. With the second model, prescriptions are often triaged without proactively knowing whether a prior authorization (PA) or other services are needed. With this approach, many HCPs and patients face delays in therapy initiation and suboptimal experiences.

Both of these models fail to kick off e-support services at the point of prescription and meet the HCP in their workflow. Their limitations also prevent them from delivering real-time insights back to the HCP and manufacturer. Most impactfully, they create rework, process inefficiencies, unnecessary complexity, and, ultimately, delayed or even lack of access to therapy. 

For products that are not as complex or costly as a specialty product, but still require some support, a technology-driven pharmacy platform can make the largest impact on improving uptake, visibility and outcomes. This model automates therapy initiation and fulfillment by integrating with a selective pharmacy network to:
  • Kick off automated e-support services from the hub at the point of prescription
  • Intake a script from the EHR, fax, phone and other entryways
  • Reduce therapy switching through a selective pharmacy network
  • Provide real-time feedback and actionable insights to the HCP and manufacturer
Through the right technology, specialty-lite and retail products can simplify the process, speed access to therapy and gain real-time visibility. In fact, a survey conducted among life sciences organizations during an AssistRx webinar found that 88% of participants are addressing the squeeze by researching and/or investing in technology to improve processes and patient and HCP experiences. AssistRx is doing just that.

We layered a pharmacy under our already-proven technology—e-support services that include e-Consent, e-Prescribing, e-Enrollment, Advanced Benefit Verification (ABV), Real-time e-PA and more—to create CoAssist. This automated, technology-driven pharmacy platform speeds the process, removes barriers to access, eliminates switching/substitution at the pharmacy, and provides real-time insights. 

For example, in under 60 seconds and using just five patient identifiers, ABV pulls patient coverage, out-of-pocket cost, access restrictions (e.g., PA required), coverage alerts (e.g., age limit) and fill options for all therapies. Another example is our Real-time e-PA solution, which enables the HCP to submit pre-populated e-PAs specific to the product and patient’s plan and receive a decision in just minutes.

Using this platform, retail and specialty-lite products can deliver solutions that initiate e-support services at the point of prescription, automatically identify the best fulfillment route for the patient based on their benefit design, and triage the script to a controlled network of pharmacies—whether that be a non-commercial, commercial or cash-only pharmacy. Thus, all patients are able to gain timely access to therapy at the best fulfillment option for them. This results in improved primary and ongoing adherence and better results from care.

Learn more about CoAssist by attending one or more of the sessions in the Optimizing Program Performance: An Innovative Approach for Retail and Specialty Products webinar series. Past sessions are available on demand.

Sponsored guest posts are bylined articles that are screened by Drug Channels to ensure a topical relevance to our exclusive audience. These posts do not necessarily reflect our opinions and should not be considered endorsements.

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