Pharma needs to refocus on what matters most

March 23, 2015

Three of the most heavily invested players in the pharmaceutical industry are at odds. Pharma manufacturers need to recoup R&D costs and demonstrate accountability to leadership and shareholders, keeping drug prices as high as possible before their patents expire. PBMs are responsible for driving down costs for their plan sponsors, frequently engaging in hard negotiations with manufacturers. Pharmacists are often afterthoughts to the conversation, even though they are arguably the healthcare providers with more ability to influence patient outcomes and maximize the value of high-cost medication therapies than any other member of the care continuum.

Three of the most heavily invested players in the pharmaceutical industry are at odds. Pharma manufacturers need to recoup R&D costs and demonstrate accountability to leadership and shareholders, keeping drug prices as high as possible before their patents expire. PBMs are responsible for driving down costs for their plan sponsors, frequently engaging in hard negotiations with manufacturers. Pharmacists are often afterthoughts to the conversation, even though they are arguably the healthcare providers with more ability to influence patient outcomes and maximize the value of high-cost medication therapies than any other member of the care continuum.

Results of this disconnect include acerbic, adversarial relationships among industry colleagues that consume resources and energy that should be put to better use focusing on improving the lives of patients. Patient medication adherence should be the focus to reduce healthcare costs overall, improve patient outcomes, and keep PBM and manufacturer returns steady.

Medication management done right

In few conversations or presentations I’ve heard at industry events this year, including the JP Morgan Healthcare Conference and more recently the sPCMA Summit, has the patient been the primary focus. The healthcare business, yes. The patient, no. That must change and the answer is medication management done right.

So how does it work and how will it align manufacturers, PBMs, and pharmacists to achieve improved patient outcomes?

There are several objectives to achieving effective medication management with the ultimate goal of improved adherence to medication regimens.

 

Pharma sharing the risk

For pharmaceutical manufacturers, medication management (and even more specifically medication therapy management) puts patients in “near-trial conditions” that have demonstrated improved outcomes, thereby validating the value of the manufacturers’ breakthroughs. As more manufacturers are asked to go “at risk” with their medication therapies (basically accept lower prices, or in some cases, no payment if the medication does not work), programs that deliver high levels of medication adherence and near-trial-like conditions are advantageous.

For PBMs, improvements in drug adherence driven by diligent, effective medication management means more refills, more prescriptions, and more claims to adjudicate. Last week at sPCMA, a pharmaceutical manufacturer told me that adherence to oral oncological therapies is 40%. In other words, 60% of those dying from cancer are nonadherent to their treatments! UBC, United BioSource Corporation, recently reported a 37% nonadherence rate to oral cancer agents.

According to an IMS Health study, $105 billion in avoidable U.S. healthcare expenditures is directly related to nonadherence. If our PBM colleagues engage more closely with industry leaders capable of improving adherence, the number of PBM claims to process increases, lives improve and people are able to get back to work, improving productivity for their employers.

Pharmacists make a difference

Pharmacists are among the most under-utilized, under-appreciated providers of healthcare in the United States. In an internal assessment of 600 patient calls, our clinical pharmacists averaged 21 minutes per patient call. These are highly consultative calls designed to discover and resolve patient barriers to adherence.

 

Putting the patient front and center in a way that aligns the pharmaceutical community in its entirety is a cause I will advocate strongly during the foreseeable future, including during my presentation at the Armada Specialty Pharmacy Summit in Las Vegas this May.

I encourage any and all pharmaceutical manufacturers and PBMs to join me in the endeavor to fix this disconnect for the benefit of all concerned.

  Marc O’Connor is chief operating officer for Curant Health, a provider of enhanced medication therapy

Marc O'Connormanagement and specialty pharmacy services. O’Connor is also a board member of the Team Type 1 Foundation, an organization established with the mission to “instill hope and inspiration for people around the world affected by diabetes.”