Innovations in Pharmacy and Its Impact on Managed Care | AMCP 2023

Managing Directors of L.E.K. Consulting, Joe Johnson, Todd Clark and Brendan Mitchell introduce the innovations happening in pharmacy, more specifically disruptive innovations, and how they affect managed care. The team explained some of the innovations to be on the lookout for in the future, also.

Johnson explained the pharmacy market has worked continuosly to tackle affortability and access issues, especially through price transparency, for better patient adherence.

"I think the other thing that's changed in the ecosystem is that we're trying to empower the physician to have more data at the point of care in order to make informed decisions around real time benefits and what's covered. So, that ultimately, the patient can have greater affordability and therefore coverage, lower out of pocket costs, lower co pays associated with with the pharmacy scripts that they'll be filling," he said. "Then also at the point of care, I think, helping steer the patient to the right pharmacies that will have the product to be filled immediately, as opposed to having to wait to start treatment."

Clark added disruptive innovations are working their way into pharmacy care as you see new pharmacy developments like Amazon and Mark Cuban's Cost Plus Drug Company.

These two organizations are examples of disruptive innovations in pharmacy as they aim to serve larger populations like people or large number of paying entities. The entities can include middle-market, self-insured employers, or where the dollars are in specialty pharmacy, Clark added.

"The thing about Specialty Pharmacy is it really is specialty by specialty, therapeutic area by therapeutic area, disease state by disease state," Clark said. "That game is won by building those on top of each other and winning one hand at a time."

Innovations the LEK team are anticipating focus on the lower-end of the self-funded employer market.

"I think we we may be entering a part of the economic cycle where cost sensitivity goes up and employers are more interested in than ever in looking at innovative models that can ultimately help manage costs (and) keep their employees healthy," Mitchell said. "Sometimes, with a difficult downturn, there's a lot of innovation on the edges it's something to keep an eye on."