The theme of specialty pharmacy this year was best described by Jean-Baptiste Alphonse Karr in 1849 when he said “plus ça change, plus c’est la même chose.” Sorry, what’s that? Tu ne parles pas francais?
Translated to English, you have likely heard this many times before: “the more things change, the more they stay the same.” So, what has changed, and what has remained the same over the past year in the specialty pharmacy marketplace?
According to resources*, the number of accredited specialty pharmacies continues to grow, with the number of sites quadrupling since 2015 (378 to 1,207!). The rate of growth has slowed, with 145 new accredited entrants to the marketplace between 2019 and 2020. As you might suspect, this growth has largely been driven by health systems, which now make up 39% of the accredited specialty pharmacies. Most health systems have one accreditation (67%), some have two or three accreditations (12%), and a select few have four or more accreditations (4%).
However, a major challenge for health systems continues to be leveraging volumes to obtain a stronger marketplace presence. Despite the growing number of locations, the majority of health systems dispense less than 15,000 prescriptions and have annual gross revenue of less than $50M (53% and 55%, respectively).
On the other hand, Pharmacy Benefit Managers (PBMs) and health plan-owned pharmacies make up only 9% of the marketplace based on the number of accredited locations but account for approximately 75% of the overall specialty pharmacy revenues. Two trends are worth watching to see how this changes in the coming 12-24 months: one is state-driven PBM legislation aimed at broadening specialty pharmacy network access, and the second is manufacturer-driven limitations on the ability to achieve 340B discounted products through contract pharmacy networks. Both of these have the potential to drive business to internal health system specialty pharmacy programs.
These trends are similar to what we have seen in past years and continue to highlight the value that health systems can realize in developing internal specialty pharmacy programs. There are benefits to collaborative care of patients within the health system, improvements to clinic and provider efficiency, and financial benefits to patients and the organization through internal management of patients.
What will 2022 hold in store for your health system specialty pharmacy? Here are some New Year’s resolutions to consider:
- Fill for your employees! This is a great way to grow your program and raise awareness across your organization about your services.
- Shift white-bagging to your internal pharmacy. As you grow your program and achieve accreditation, collaborate with payers to identify opportunities to internalize white-bagged medications (even if it is for a select few to start).
- Increase those capture rates! Have difficulty reaching specific patient groups? This is the year to target efforts based on data and schedule routine meetings with providers and clinics to improve collaboration and take your program to the next level!
- Advocate. Many states and state professional organizations have ongoing efforts related to specialty pharmacy or white-bagging legislation. Get engaged in those efforts, share your perspectives with legislators and be a part of the change.
- Get started! Don’t have a program yet? We can help you understand the opportunity, put together a strategy, and execute!
* drugchannels.net and the ASHP National Survey on Health -system Specialty Pharmacies