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October 06, 2022

NASP 2022 Reveals a Pharmacy Landscape Shifting to Specialty

Kristen Dowd
Director, Pharmacy Management Services, Omnicell 

If the 2022 NASP (National Association of Specialty Pharmacy) Annual Meeting and Expo is any indication, we are approaching a time when specialty pharmacy simply becomes pharmacy – when complex, high-touch biologics become nearly as ubiquitous as their broad-spectrum counterparts. Many statistics shared during the four-day event held at the Gaylord Palms in Orlando reinforced this assessment.

For example, during a main stage session outlining industry trends, issues, and outlook, Doug Long, vice president of industry relations at IQVIA, showed specialty pharmacy growth outpacing traditional pharmacy growth, accounting for more than 50 percent of non-discounted drug spending. This trend is likely to continue with specialty medications expected to account for 65 percent of drug spending by 2025.

While this 50 percent spend is currently attributed to just 2 percent of filled prescriptions, evidence supports a shift in these metrics as well. Namely, there are currently more than 400 new cell and gene therapies under development, and 60 percent of the new molecular entities awaiting FDA approval are specialty pharmaceuticals.

The pipeline for specialty medicines is full, but access to these drugs is often challenging given that many are limited distribution drugs only available through closed distribution networks. In fact, according to Nephron Research, there are 150 more limited distribution drugs on the market today than there were five years ago, and 80 percent of pharmaceutical manufacturers use limited distribution networks for these medications.

Establishing entity-owned specialty pharmacies is an effective way for hospitals and health systems to improve access to specialty medications, gain control over the distribution process, and cut overall costs. However, there are several barriers that can make this move difficult for many hospitals. NASP 2022 examined many of these challenges and shared strategies to overcome them.

Lessen the impact of labor shortages on pharmacy staffing

Like most areas of healthcare today, pharmacy is experiencing widespread labor shortages. According to a survey from the NCPA (National Community Pharmacists Association), 1 in 10 pharmacies note a loss of 41% or more pharmacy technicians and 90 percent state they can’t find qualified pharmacy technicians to add to their staff. These labor shortages are having real repercussions, with more than 700 pharmacies in all channels (retail, mail order, and non-retail) closing within the past two years.

Stress and burnout resulting from the Covid-19 pandemic as well as lack of appreciation and pay are often cited as contributing factors to this labor shortage. In a NASP 2022 breakout session, Vijay Sawant, executive director of system pharmacy services at Yale New Haven Health, outlined strategies his organization has deployed to address employee turnover. These efforts include aggressive recruitment efforts (e.g., job fairs, email campaigns, training programs), establishing clear paths for career growth, and a multi-tiered program to address employee wellness and mindfulness.

Take pharmacy digitization to the next level

Another challenge facing pharmacies today is effectively collecting and analyzing therapeutic data to streamline drug distribution, assess treatment effectiveness, and improve patient outcomes. According to many NASP speakers, most pharmacy digitization is currently focused on improving patient communication and outreach – not on leveraging digital tools to collect, monitor, and digest data points to drive action.

“We need to move beyond communication and toward delivering care,” said Christopher Antypas, President of Perigon Pharmacy 360. “We need to use data to determine if drugs are actually working and we need to be held accountable and reimbursed based on the effectiveness of the therapeutic treatment.”

To date, pharmacy has largely been left out of the valued-based care equation, but this is likely to change. As value-based contracts become more prevalent, treatment effectiveness measures will be instrumental in determining outcomes and corresponding payments. As such, hospitals and health systems will look to launch more entity-owned pharmacies to ensure control over the patient’s therapeutic journey and the associated outcomes to better manage risk.

Optimize 340B savings 

Navigating the current 340B landscape is another challenge facing hospitals and health systems. Currently, 18 pharmaceutical manufacturers have placed 340B discount restrictions on the contract pharmacies many health systems use to obtain specialty medications for their patients. At the same time, many pharmacy benefit managers (PBMs) and insurers are requiring that specialty drugs be filled at specialty pharmacies within exclusive networks (often owned by the insurer/PBM). These specialty pharmacies often will not contract with 340B covered hospitals, eliminating 340B discount benefits.

I hosted a 340B point/counterpoint session at NASP 2022 with Peggy Tighe and Mark Ogunsusi from Powers Law to provide attendees with a detailed look at the 340B legal argument from the perspective of all parties involved – pharmaceutical manufacturers, contract pharmacies, and covered entities. The gist is that there is no quick and easy resolution to the volatility surrounding the program. Ensuring access to 340B drugs and maximizing associated savings in this environment requires a combination of contract pharmacies and entity-owned retail and specialty pharmacies.

A deeper dive into our proposed mitigation strategies to offset 340B challenges are presented in a webinar we conducted earlier this year with Penn Highlands Healthcare. Using our strategies, the hospital was able to reclaim $5 million in annual 340B savings.

While the barriers may seem daunting, establishing an in-house specialty pharmacy is an important step for any hospital looking to ensure access and optimize revenue in a landscape where specialty drug development in increasing and costs are skyrocketing. Omnicell’s suite of turnkey solutions for specialty pharmacy management with integrated 340B program administration can help a hospital address many of the challenges outlined at NASP 2022 – whether that be staffing, digital transformation, or 340B administration.

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The views and opinions expressed in this blog are those of the authors. They do not necessarily reflect the official policy or position of any other agency, organization, employer, or company. Assumptions made in the analysis do not reflect the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.