2021 Managed Healthcare Executive® Pharmacy Survey: Biggest Driver in Specialty Drugs, Contract Changes Between Plan Sponsors and PBMs
In this part four series, participants give their opinions on the biggest driver of specialty drug expenditures this year and what the most significant change in contracts between plan sponsors and PBMs could be in the near future. MHE's annual pharmacy survey had over 225 respondents. We will be posting the results over the next few days.
In this portion of MHE's survey, respondents answered a couple more questions about specialty drug spending and what is likely to be the most significant change in contracts between plan sponsors and PBMs in the near future.
First, when asked about what will be the biggest driver of specialty drug expenditures in 2021, the majority (26%) of respondents said the biggest driver will be the shift from traditional to specialty medications for treatment of common diseases. Another driver that ranked closely below, (23%) is growing demand because of an aging population with multiple chronic conditions. Seventeen percent of respondents said COVID-19 dynamics affecting specialty drug prescribing and patient utilization would be another driver. Following, 15% each said orphan drug approvals by the FDA and price increases by manufacturers would also be drivers. Lastly, only 5% believed limited number of biosimilars on the market would be the biggest driver of specialty drug expenditures this year.
In the following slide, participants were asked which of the following changes would likely be most significant in contracts between plan sponsors and PBMs in the near future. Most respondents (29%) said a decreased emphasis on rebate guarantees and a shift toward lowest net-cost formularies would be a more likely change. Other respondents (20%) said the change in contract would include a greater emphasis on transparency, while 18% responded that a greater emphasis on financial penalties for operational execution could be a change in contracts between the two. Eighteen percent said an increased demand for pass-through rebates and network pharmacy pricing could be a change between sponsors and PBMs and 13% believe there could be more emphasis on trend and cost-based guarantees and shared savings contracts. Lastly, only 2% believe a full-risk capitation could be the most likely change in these contracts.
Just over 225 people responded to our online survey between April 5 and May 10.
David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
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Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization’s innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company.
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The deliberate disconnection of Change Healthcare to ring fence a cyberattack entered its seventh day today. Prescribers are finding ways to get pharmacy claims processed, and UnitedHealth Group says disruption to the dispensing of prescriptions has been minimal. But independent pharmacies want more information and protection from financial consequences from pharmacy benefit managers.
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