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2020 Star Ratings – Pharmacies Likely to Feel Pressure for Greater Efficiency and Improved Patient Outcomes

The Centers for Medicare & Medicaid Services (CMS) has announced that during 2020, an increased number of senior citizens will have access to higher quality Medicare Advantage (MA) and Part D prescription drug plans.  That announcement came as the agency released 2020 Star Ratings for plans operating under these programs, which indicated improved performance averages on the determinative star rating index.

“Most people with Medicare will have access to Medicare Advantage and Part D plans with four or more stars in 2020,” CMS explained in a press release, “and approximately 81 percent of Medicare Advantage enrollees with prescription drug coverage will be in plans with four and five stars in 2020, an increase from 69 percent in 2017.”

Specifically, CMS expects 52 percent of Medicare Advantage plans that offer prescription drug coverage to have an overall rating of four stars or higher, compared to approximately 45 percent during 2019.  Further, the agency notes the average star rating for all Medicare Advantage plans with prescription drug coverage has improved to 4.16 out of 5 stars, increasing from 4.02 in 2017.

With regard to Part D plans, analysis by AARP found that while scores are “much lower than those of the MA plans,” they too had shown improvement over the past year, “mainly because beneficiaries have moved from plans with lower scores to those with higher ratings.”

Overall, CMS estimates that during 2020, 28 percent of individuals enrolled in stand-alone Part D plans will be covered by plans with four or five stars, compared to three percent covered by such plans in 2018.  The average star rating for a stand-alone prescription drug plan has improved from 3.34 in 2019 to 3.50 in 2020.

In announcing these improvements, CMS Administrator Seema Verma noted improvements that have been made to Medicare Advantage and Part D programs.  “Due to recent actions CMS has made to protect and strengthen Medicare Advantage, plans are better able to compete on the basis of cost and quality,” Administrator Verma noted.  “As a result, beneficiaries are benefiting from more plan choices, lower costs, and increased quality.”

While this improvement among Medicare Advantage and Part D plans is certainly positive news, it does hold important implications for pharmacies – even though pharmacies are not specifically part of the CMS Star Rating system.

Let’s explain that.

In 2008, the Centers for Medicare and Medicaid Services (CMS) created the Five-Star Quality Rating System as a way to assess Medicare health and drug plan performance on a number of key criteria.  The purpose is to provide patients and their families with an easy way to compare plans, and ensure access to high-quality choices for their Medicare coverage.

In addition, by rewarding strong performers with financial benefits, the star ratings system seeks to incentivize low-scoring plans to improve performance.

Medicare plans are rated on a scale of 1 to 5 with, according to  CMS, a 1-star rating representing poor performance, and 5-stars representing excellent performance.  The official scoring matrix breaks down as follows:

5-star rating:  Excellent

4-star rating:  Above Average

3-star rating:  Average

2-star rating:  Below Average

1-star rating:  Poor.

High performers receive significant rewards for their good ratings that include major incentive bonuses (for Medicare Advantage Drug Plans)  and the ability to enroll patients year-round.  A poor performing plan will naturally not be eligible for financial bonuses, but runs the greater risk of losing eligibility to serve as a Medicare plan.

In addition, highly rated plans will attract larger numbers of patients, while poor performers will tend to lose members.  Dr. Zac Renfro, PharmD. explained in an Elements Magazine article why the ability to attract new members is critical to today’s health plans.  “Due to the Affordable Care Act (ACA), health plans and pharmacy benefit managers (PBMs) can now only keep a certain percentage of their profits,” he explained.  “The remaining amount must be used to cover the cost of the services they provide, as well as reinvesting back into the health plan or PMS’s program.”

Which is where plan enrollment becomes a factor.  “The only way that they can increase their profits,” Renfro noted, “is by increasing their patient numbers in their health plan.  Health plans that have a lower star rating tend to have a lower number of patients choosing them over higher rated plans that have similar costs.

“With pharmacies impacting a plan’s star rating so much,” Renfro added,  “they’re starting to put an emphasis on pharmacy quality scores to determine preferred networks and other performance contracting programs.”

Star Ratings – Key Criteria

While many factors contribute to a health plan’s star rating, Medicare.gov offers a “summary” of key considerations that include:

  • Staying healthy – screening tests and vaccines: Whether members receive various screening tests, vaccines, and other check-ups to help them stay healthy.  For example, plans are assessed based on percent of plan members who receive flu vaccinations each year, the percent of female members who have regular mammograms, and the percent of plan members screened for colon cancer.
  • Managing chronic conditions: How often members with certain conditions undergo recommended tests and treatments to manage their conditions.  This includes ensuring patients with diabetes receive recommended care; that patients with high blood pressure follow recommended treatments, and that patients with bone fractures are treated for brittle bones.
  • Member experience with the health plan: Based on member ratings of a particular plan.
  • Member complaints and changes in the health plan’s performance: How often members had problems with the plan.  Includes how much the plan’s performance improved (if at all) over time.
  • Health plan customer service. How well the plan handles member calls and questions.

Prescription drug considerations

Medicare plans that cover prescription drugs are assessed on factors that include:

  • Drug plan customer service: How well the plan handles member calls and questions.
  • Member complaints and changes in the drug plan’s performance: How often members had problems with the plan.  This includes how much the plan’s performance improved (if at all) over time.
  • Member experiences with the drug plan: Member ratings of the plan.
  • Drug safety and accuracy of drug pricing. Assesses accuracy of the plan’s pricing information, and the frequency with which members are prescribed drugs in a way that is safe and clinically recommended for their condition.

Within these broad categories are several considerations that directly relate to pharmacy performance.  These factors include:

  • Ease of getting prescriptions filled when using the plan.
  • Accuracy of the plan in providing drug pricing information: This is a score based on prices members actually pay for drugs, compared with prices listed on the plan’s website.  Higher scores in this category generally mean the plan accurately listed drug prices.
  • Diabetes, blood pressure, and cholesterol medication adherence: Percent of plan members with prescriptions for these conditions “who fill their prescription often enough to cover 80 percent or more of the time they are supposed to be taking the medication.”
  • Members who had a pharmacist (or other health professional) help them understand and manage their medications. This is especially relevant for patients with medication therapy management programs.  Programs are assessed to determine frequency and quality of interactions and discussions between the pharmacist and patient.
  • Extent to which patients with diabetes are taking drugs to treat high cholesterol. As a way to lower the risk of developing heart disease, most people with diabetes should take cholesterol medication.  This rating is based on the percent of diabetic plan members who take the most effective cholesterol-lowering drugs.
  • Plan members’ complaints about prescription drug coverage: Every year, Medicare surveys people who leave their plan to determine reasons behind that decision.  Patients are specifically asked if problems with prescription drug coverage played a role with regard to:
    • Any change in medications covered by the plan
    • Any problems getting the plan to pay for their medications
    • Any problems obtaining medications, including brand name drugs; or
    • Frustration with the plan’s approval process.
  • Comprehensive medication reviews (CMRs) were added to the list of star rating categories in 2017, as a way for Centers for Medicare & Medicaid Services to assess the quality of medication therapy management services provided to Medicare beneficiaries.
  • The list was further expanded in 2019, when CMS announced that statin use for treating diabetes had been added to the list of performance indicators. According to McKesson, plans will be assessed based on the number of diabetes patients ages 40-75 who receive a statin.  For pharmacies, this means identifying diabetes patients who are not currently on a statin, and contacting their physician to recommend that one be prescribed.

According to analysis by McKesson, pharmacy-related measures are weighted heavily, and can impact up to 50 percent of a Medicare plan’s overall star rating.  It’s easy to see then, why plan administrators scrutinize pharmacy performance, and only want to engage with high-performers.

This high level of scrutiny is likely to become even more intense in 2020, as the average star rating among Medicare Advantage and Part D plans continues to increase.  Plans wishing to improve their attractiveness among beneficiaries will look to continue to improve their star ratings, with pharmacy performance an important part of that success.

Improving Pharmacy Performance with an Integrated Technology Solution

As pharmacies look to improve performance, technology will play an integral role.  Most pharmacies already rely on technology to perform at least a perfunctory level of pharmacy-related services.  But in recent years, tremendous advances in pharmacy system capabilities allow extensive data analysis, tracking and reporting functions that simply did not exist as recently as a few years ago.

With regard to improving pharmacy performance on 5-Star related categories, technology can be especially helpful in ways that include:

  • Medication Adherence. Pharmacists have a clearly-defined role in helping meet CMS directives for overseeing medication adherence for patients with chronic conditions including diabetes, high blood pressure and high cholesterol.  This is because of pharmacists’ unique position to engage patients about the importance of taking medications as prescribed, and to facilitate the adherence process.

With regard to technology, a pharmacy-specific solution can maintain patients’ prescription histories, which means a pharmacist can have immediate access to patient records when filling a prescription, or speaking with a patient about a particular medication.  Ready access to this information can help a pharmacist explain how a particular drug works, and discuss any potential side effects, which can allay patient concerns.

In addition, a pharmacy can automatically generate outbound text messages, emails and phone calls, as a way to remind patients about renewals and pickups.  These simple messages can have a tremendous impact in reminding patients that a prescription is about to run out, thereby helping to avoid a missed dosage, or even worse, a patient simply deciding to forego renewing a prescription.

  • Comprehensive Medication Review. According to the American Journal of Health-System Pharmacy, CMS directs that medication therapy management programs target patients who have two or more chronic diseases, take Medicare Part D-covered drugs, and have estimated drug spending that exceeds a CMS-established threshold.

Pharmacists may perform the CMR, which must include an action plan for improving the patient’s medication use.

Similar to technology’s role in addressing adherence, an integrated system can manage the CMR process in key ways that include:

  • Identification of eligible patients
  • Determination of ideal medication dosage and usage schedule
  • Synching of all medications so that all pick-ups occur on a single day
  • Availability of information describing purpose of each medication, along with information about potential side effects
  • Tracking of all pharmacist-patient interactions
  • Outbound texts and phone calls to remind patients about scheduled refills.

 

  • Ease of Obtaining Medications. According to Surescripts 2018 National Progress Report, 85 percent of all prescriptions were delivered to pharmacies electronically during 2018, a greater than 500 percent increase since 2015.  For patients, e-prescriptions eliminate an extra step in the process, since it is no longer necessary to travel to the pharmacy to drop off a prescription.  Instead, a patient can wait until notified that the prescription is ready, and then set out for a quick pick up.  One study found patient adherence improves by 10 percent when the medication is e-prescribed, compared with written prescriptions.

A comprehensive technology system ensures seamless processing of the prescription from the point it is received and recorded, entered into the queue, filled and marked for pickup.

Use of Statins.  With CMS now assessing information about diabetes patients who are prescribed statins, a pharmacy’s technology system can easily identify eligible patients, notify them about the role of statins in diabetes management, and initiate the process for obtaining a prescription.

 

At the same time CMS released its overall 2020 star ratings, it also released the average rating for each area of measurement.  Among areas that directly affect pharmacy performance, “medication adherence for diabetes medications” carries an average star rating of 3.9; “medication adherence for cholesterol (statins)” increased to 3.6, and “getting prescription drugs” showed an average rating of 3.5.

As beneficiaries become savvier about the importance of star ratings as a way to compare plan effectiveness, plan administrators will want to ensure their preferred pharmacy partners will help improve their ratings.  Smart pharmacy managers in turn, understand the critical role a fully-integrated technology system can have in helping to improve patient outcomes, and to document all star-related services provided to patients.

 

 

 

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How Do Pharmacy Benefit Managers Cost Medicaid?

Drug costs are rising at an alarming rate and there is no end in sight—or at least that’s what a recent study finds. The past six years has seen a substantial increase in the cost of many prescription drugs, especially those used to treat major health conditions like diabetes and cancer.

According to a study published in the journal JAMA Network Open, one of the biggest culprits for this seemingly unending problem is the lack of regulation in the price increases happening in the pharmaceuticals market.

The study conducted by researchers from the Scripps Research Transitional Institute assessed claims from Blue Cross Blue Shield Pharmacy from 2012 to 2017 and they discovered that almost all of the drugs included in the study had an annual or biannual cost increase. 36 of the drugs included in the study increased in cost by as much as 50% over a six-year period.

The median cost of these drugs increased by up to 76%, which is a lot for patients who are suffering from chronic health conditions that demand long-term medication compliance.

Pharmacy benefit managers and their role in rising drug costs

 According to the researchers, “given the median annual cost increase of 9.5%, our results suggest the costs for popular brand-name drugs would double every 7 to 8 years.”

With these findings affecting the quality of healthcare that’s provided to patients in the United States, 33 states across the country have passed laws that will somehow help control the rising costs of prescription drugs and they are setting their eyes on pharmacy benefit managers or PBMs who have a big role to play in addressing the issue.

What are pharmacy benefit managers?

A pharmacy benefit manager is essentially a professional who serves as an intermediary between employers, insurers and other members of the healthcare system. PBMs offer services that aid patients including educational programs, counseling and administering drug coverage.

Medicare Part D drug plans, health insurance companies, large employers and other businesses usually hire pharmacy benefit managers to help them control and manage different prescription benefits. PBMs play an important role in the distribution of drugs because they close deals with pharmaceutical companies that affect the prices and availability of prescription medication for more than 266 million Americans, according to the Pew Charitable Trusts.

Major payers like Medicaid and Medicare also work closely with pharmacy benefit managers and rely on them for drug procurement rather than do the task themselves.

In fact, the deals made by PBMs will help consumers and health plans save at least $654 billion between 2016 and 2025, according to the Pharmaceutical Care Management Association, which is a national advocacy group for PBMs.

What are the responsibilities of pharmacy benefit managers?

Being the middleman between consumers and healthcare providers, PBMs have the responsibility to ensure patient’s compliance to prescription medications, operate mail order so drugs are delivered to the right patients and negotiate rebates with pharmaceutical companies so consumers can have the most affordable options.

PBMs also have the responsibility to manage formularies to help consumers know what drugs are covered by their health plans and they help ensure the accessibility of prescription drugs through proper distribution across a network of pharmacies.

Some pharmacy benefit managers also offer specialty services where they connect consumers or pharmacists with biologic manufacturers and orphan drug suppliers.

Who are the three biggest PBM companies in the US?

These three largest PBM companies in the United States cover a good chunk of patients with pharmacy benefits:

    • ExpressScripts

ExpressScripts is not linked to or owned by any pharmaceuticals company, which is why it’s the most reliable when it comes to consumer benefits. The company offers novel solutions for improving patient care and managing pharmacy costs.

    • CVS Caremark

A growing PBM, CVS Caremark offers a comprehensive drug benefit service to more than 2,000 healthcare plan beneficiaries and sponsors all over the country.

    • Argus

Being one of the last independent providers of healthcare information and services that support Medicare Part D and Medicaid, Argus has a wide range of clients and the company serves some of America’s most vulnerable populations.

What are the roles of PBMs in effecting drug prices?

Pharmacy benefit managers effect the availability and price of prescription drugs in three ways:

    • Formularies

PBMs have a list of prescription drugs that are covered by health plans known as formularies. These formularies will determine which medications can consumers under Medicaid and other health plans use and how much they need to may for them.

    • Purchasing power

Because pharmacy benefit managers procure drugs in bulk, they have the purchasing power to negotiate discounts and rebates from drug manufacturers, especially those who want their drugs to be added to the PBMs’ formularies.

    • Reimbursement

As part of their job pharmacy benefit managers work with pharmacies in reimbursing drugs that were sold and dispensed to consumers.

What are the issues thrown at PBMs?

Over the last few years, PBMs have faced scrutiny over consumer complaints and issues on rising drug prices.

    • Lack of transparency

Pharmacy benefit managers have been called out for not having enough transparency in their operations where both consumers and regulators are not aware of how deals are closed and if rebates and savings are really passed down to consumers.

A recent study conducted by the Pew Charitable Trusts found out that “PBMs passed through 78% of manufacturer rebates to health plans in 2012 and 91% in 2016.”

The United States Government Accountability Office also said that pharmacy benefit managers passed nearly all of their Medicaid and Medicare Part D rebates on to consumers in 2016, but there are still questions on whether this is applied to the entire health care market.

    • Rising drug costs

Politicians have also started pointing their fingers at PBMs regarding issues of rising prescription drug costs. In fact, 33 states across the country have passed laws targeting pharmacy benefit managers.

Rep. Mary Felzkowski, R-Irma talked about a personal experience that led her to support a bipartisan bill aiming at lowering drug costs in Wisconsin: “I just got a prescription for a generic (drug) and my pharmacy benefit manager will not let me have the generic because they get a kickback on the formulary.

So instead of paying my $5 copay for the generic I paid $35. Now I’m very fortunate. I can afford that. Not everyone can. So this is a real issue.”

    • Spread pricing

Spread pricing has been a longstanding practice for PBMs. This model means that the PBM will charge a payer like an employer or health plan more than what it reimburses the pharmacy for a medication. The PBM then keeps the difference. This has become an issue for some because the exact difference has always been kept confidential from both regulators and health plans.

What changes will Medicaid be implementing for PBMs?

Although pharmacy benefit managers were once thought to help lower down the cost of prescription drugs that benefit patients, many state Medicaid programs are implementing changes to pharmacy benefits due to the different issues faced by PBMs lately.

For instance, the Medicaid program in Michigan is proposing to eliminate all PBMs that negotiate drug prices and handle its prescription drug claims. Beginning December 1, Medicaid will be handling all its drug coverage internally to try to manage the cost of prescription drugs in the state. This was after a study revealed that state Medicaid agencies didn’t really get the dramatic savings that they were promised by outsourcing negotiations and procurement of drugs through pharmacy benefit managers.

According to Michigan officials, the state would save at least $40 million by extracting bigger rebates from pharmaceutical companies and cutting operational costs in handling Medicaid drug benefits. This move could mean that companies like CVS Health, MedImpact and OptumRx could stand to lose business.

Other states are also following suit with bills regulating pharmacy benefit managers in the effort to reduce drug prices. According to the National Academy for State Health Policy, 47 states have already proposed 275 bills to address the issue of increasing drug prices. 123 of these bills were aimed at PBMs. In the state of Wisconsin, small pharmacies continue to push for the oversight of pharmacy benefit managers.

What reforms are being considered to regulate PBMs?

The issues with pharmacy benefit managers and their role in skyrocketing drug prices have resulted in a lot of bills trying to eliminate them as a part of the drug distribution process. But as Rep. Joe Sanfelippo, R-New Berlin pointed out, he is concerned about PBMs but he isn’t dismissing the fact that a lot of employers are relying on these professionals to control the cost of prescription drugs.

To address the issues with the operations of PBMs, there major reform ideas have been formulated by several states that will hopefully ensure that consumers get the best benefits from the deals they make with pharmaceutical companies:

    • Improving transparency

Several federal lawmakers are pushing to add new rules and regulations that would require PBMs to submit more information on how they negotiate prices and rebates. This will help the government determine if consumers get the largest portion of savings from rebates and negotiations.

    • End spread pricing

Several states are looking into creating legislations that would end the longstanding practice of spread pricing in pharmacy benefit managers. Instead of using the spread pricing model, legislators want PBMs to use a pass-through model where they would have to charge payers the same amount they reimburse to pharmacies with the addition of a fixed administrative fee.

The federal government is also now requiring all Medicaid fee-for-service programs to use the pass-through model and ditch the spread pricing model.

    • Rebates

Several policymakers are considering new rules that would require pharmacy benefit managers to pass through a bigger chunk of rebates to consumers. PBMs will still be allowed to keep part of these rebates in order to maintain the benefit of them negotiating for the price reduction of some of the most important prescription drugs in the market.

The Commonwealth Fund has suggested that 90% of all rebate savings should be passed on to payers.

The move to transform the healthcare system in the United States has got different legislators scrambling for rules that will help benefit consumers more. There have been numerous debates on whether there is still a need to hire pharmacy benefit managers or just take control of drug distribution internally. In Ohio, for instance, the legislative committee that manages the state’s $28 billion Medicaid program has conducted a meeting in September to review the progress of addressing the issues regarding pharmacy benefit managers profiting off the distribution of prescription drugs for the poor and disabled.

According to a Pew study this year, the rebates given by manufacturers to PBMs have increased dramatically from $39.7 billion in 2012 to a staggering $89.5 billion in 2016. The U.S. Department of Health and Human Services also stated that the average price difference between the list price of a drug and its cost after a rebate is between 26 to 30%.

Some pharmaceutical companies also admitted that they had to raise the list prices of some of their products due to the increasing rebates imposed by pharmacy benefit managers. If this amount is passed on to consumers, the prices of prescription drugs would definitely be lower than it is today.  There is also the issue of PBMs favoring more costly drugs because they get bigger rebates for them.

The bottomline

Whether there is still a need for pharmacy benefit managers or not is still up for debate. But at the end of the day, it will all boil down to what decision will benefit the consumers best.

After all, prescription drugs should be accessible to everyone because they are an important part of the treatment plan of patients, which will ultimately decide if they get to enjoy excellent prognosis or not.

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This is Medicine Redefined

This winter (December 13-15, 2019) will mark the American Academy of Anti-Aging Medicine (A4M) 27th Annual World Congress in Las Vegas, their Annual World Congress hopes to deliver world-class education focused on integrative health: through the most recent emerging clinical research, newly discovered therapies, and future scientific advances.

With an agenda specifically engineered to allow attendees to learn the newest, most innovative protocols and practices. This event is considered to be the largest event in Anti-Aging Medicine, every year the conference features a combination of unique programming, a diverse audience, and a collaborative learning environment.

The countdown begins: only 3 more weeks! This year, as the world prepares for the start of a new decade, The American Academy of Anti-Aging Medicine invites all to take part in leading the charge towards a new era of health care that puts patient health, first.

Join us and hear from the field’s foremost leaders and return home with real knowledge that can change the trajectory of patients’ lives. (Purchase ticket here https://www.a4m.com/world-congress-2019/home.html#register

Take part in an educational experience unlike any other:

  • Learn directly from the foremost thought leaders in Anti-Aging medicine
  • Network at the largest event in Anti-Aging medicine in the globe
  • Browse the latest products, services, and devices in the field
  • Take part in a patient-centered medical movement

Join thousands of healthcare practitioners and professionals from across the globe as A4M continues to redefine their mission and transform the field of modern medicine through top-tier education: with the ultimate goal of enhancing and enriching the entire landscape of health.

Learn more: https://www.a4m.com/world-congress-2019/home.html

 

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The Ten Pharmacy Trends to Watch Out For in 2020

Just like that, 2019 is coming to a close and what a year it has been for healthcare and especially for pharmaceuticals. This year, the industry has taken center stage, as governments, businesses and individuals are now recognizing the important role of good quality medications in maintaining an excellent healthcare system.

The use and cost of different drugs have also been a hot topic in debates and headlines for 2019.

From specialty medications to the use of technology to speed up the development of drugs, this year was all about innovation and breakthroughs for the pharmaceuticals industry.

The top pharmacy trends for 2020 and the year that was

 The end of 2019 is just right around the corner and people are already looking forward to what the top pharmacy trends for 2020 are. But before we look into what the coming year has to offer, let’s do a recap of some of the biggest pharmacy trends and advancements for 2019:

    • Artificial intelligence

The introduction of artificial intelligence into the development of new drugs has been one of the hottest pharmacy trends for 2019. Taking the lead in this area is IBM Watson, a computer that could interpret millions of pages of scientific literature and data that will help researchers and pharmaceutical companies speed up the development of new medications.

Artificial intelligence is set to be used in more areas of drug development and will be part of the top pharmacy trends for 2020.

    • Mobile health apps

Data gathering has always been one of the most challenging areas of clinical research. But this year, more pharmaceutical companies are taking advantage of mobile health technology to gather relevant data for clinical studies that will help in the development of new drugs.

These apps are considered to provide accurate information on a patient’s health status, which is why they’ve been used to study diseases like Parkinson’s disease, diabetes, breast cancer, asthma and cardiovascular disease.

    • Gene-specific drugs

 Precision medication is one of the most significant pharmacy trends for 2019 because it targets specific genes based on the patient’s health condition.

Genetic information is gathered through genome sequencing where researchers are able to identify specific abnormalities and come up with drugs and therapies targeted towards them.

This trend, which will also be part of the top pharmacy trends for 2020 helps increase the efficiency of drugs to help patients get better outcomes for their treatment.

    • Printable medication

This year, the drug Spritam made history as the first 3D-printed drug to be approved by the FDA. Manufactured by Aprecia Pharmaceuticals, the drug is created through a 3D printing process that allows the pill to be porous enough to be dissolved quickly while delivering the dosage required for the patient.

One of the most talked about pharmacy trends this year, printable medication is expected to pave the way for the future of drug development and lower the cost for manufacturing drugs.

These breakthroughs have created a better landscape for the pharmaceuticals industry. And the best part is, more advancements are coming as we welcome another year. Here are some of the top pharmacy trends for 2020?

    • Specialty medication

Specialty products and services were considered the most profitable among all the pharmacy trends for this year, and 2020 will see a bigger market for these medications as they become part of the top pharmacy trends for 2020.

Specialty drugs are developed mostly for chronic and degenerative diseases like rheumatoid arthritis, cancer and multiple sclerosis.

They are so rare and highly in-demand because of the complexity and cost of creating them. But they are also very important in helping treat the symptoms of chronic diseases so patients can enjoy better quality of life.

One of the top pharmacy trends for 2020 is the growing spending for these specialty medications where system pharmacies will procure them so they can be made available to patients and health plans will reimburse these pharmacies after.

    • 340B drug discount program

The 340B drug discount program has been part of the pharmacy trends for many years, and the ongoing discussion for its improvement is not expected to die down in 2020. In fact, the coming year will see more focus on the program’s path for pharmacies: compliance and performance.

As a pharmacy, it’s very important to monitor the efficiency of your existing 340B program to know how to make the most of helping patients and your health system. You also need to stay on top of new rules, enforcements and audits so you can easily adjust your program for compliance.

    • Over the counter medications

According to research, the average American household spends about $338 on over the counter products every year. With the growing cost of hospital treatments and health insurance plans, more Americans are turning to self-medication as a way to treat minor health issues.

Over the counter medications are easily accessible and don’t require a prescription, which helps in cutting down time and cost for treatment.

Their popularity will continue to grow as part of the top pharmacy trends for 2020, so it’s very important for pharmacies to ensure that staff members are well trained to guide consumers in buying the best over the counter medications. They should be able to offer the best options for their customers so they don’t need to see a physician.

    • Next-door healthcare

The world has never been more fast-paced than it is today, especially with the advent of mobile apps and other technological advancements. This also means that consumers are now expecting on-demand care, especially with the procurement of medications.

Next-door healthcare will be one of the top pharmacy trends for 2020 where pharmaceutical services will be made more easily accessible to consumers.

Pharmacies need to find ways to not only extend their hours of service but also offer ways for patients to easily fill their prescriptions and comply with their medications after they leave the pharmacy. Some pharmacies will even start to offer deliveries for patients who have difficulty going to the establishment to buy their medications.

    • Virtual healthcare

With more people relying heavily on technology, virtual healthcare is expected to be one of the most significant pharmacy trends for next year. The pharmaceuticals industry will see an increased use of e-commerce and mobile channels for marketing, and the competition will definitely be stiff.

But virtual healthcare also transcends to other services like apps, online prescription forms, patient portals and even delivery services that will be the future of procuring medications.

With its significance in shaping the landscape of pharmaceuticals, virtual will healthcare will not only be part of the top pharmacy trends for 2020 but also in the coming years.

    • Data tracking and management

All health system pharmacies will surely agree that data tracking and management can be one of the hardest tasks in the business—but it is also one of the most important. As an integral part of the healthcare system, pharmacies should be able to use their data wisely to make smarter decisions for patients.

The first step to a more efficient data management system is to make data more accessible. One of the top pharmacy trends for 2020 will be the use of a single platform to integrate all health IT systems.

This will help pharmacies cut down on costs for managing different information systems and increase efficiency in pulling out data to use for research and in creating better treatment plans for patients.

Integrated IT systems will also help pharmacies save time in performing day-to-day activities, as they help in optimizing inventories, generating more accurate reports and managing customer loyalty programs.

    • Drug approvals

The development of new drugs has always been a long and sometimes tedious process for pharmaceutical companies, especially with the FDA being at odds with them. But this time, the FDA under Commissioner Scott Gottlieb, MD promises that the agency’s Center for Drug Evaluation and Research will be supportive of the industry throughout the process of developing new drugs.

Considered to be one of the top pharmacy trends for 2020, the onslaught of drug approvals started as one of the pharmacy trends for 2018 where drugs like Patisiran for treating polyneuropathy in hereditary transthyretin-mediated amyloidosis and Migalastat for treating Fabry disease have been approved.

This year, drugs like Selinexor and Quizartinib have also been approved. At the beginning of 2020, Mirvetuximab soravtansine for ovarian cancer and Pegilodecakin for pancreatic cancer are set to be approved by the FDA.

    • Health care megamergers

2019 has been the year of the healthcare megamergers. From Aetna and CVS Health to Prime Therapeutics and Walgreens with AllianceRx, these megamergers have been one of the top pharmacy trends for this year and their impact will surely be felt throughout 2020.

According to the CEO of CVS Larry Merlo, the primary goal of their merger was to lower down the coast of medication to increase adherence, offer better services in stores and build the pharmacy’s member base. Other big names in the industry are expected to follow suit, which will surely make healthcare megamergers one of the top pharmacy trends for 2020.

    • Public policy

There has been a longstanding discussion on the transparency of healthcare costs for patients and payers. In fact, things heated up this year as more pressure is placed into making the cost of healthcare services more transparent to the public, especially the real prices of drugs.

More health plans are expected to become more critical in reimbursing medications, especially for specialty drugs that are limited in supply and are more expensive than regular drugs.

Manufacturers should also notify healthcare providers about shortages or plans of discontinuing drugs because many of these specialty drugs are life saving. This means that any disruption to the supply chain could put many lives at risk.

    • Biosimilar

The biosimilar market has not only been a part of top pharmacy trends for many years, but it has also been controversial topic in the industry. In its essence, biosimilar is a medical product that’s almost an identical copy of the original but manufactured by a different company.

The biosimilar market in America has been behind from other markets due to approval restrictions. But 2020 will see more of these biosimilars making their way into the market, thanks to the FDA’s commitment to increasing the competition, especially for specialty pharmacies.

While the use of biosimilar medication has been subject to some scrutiny due to misconceptions about the efficacy of generics, it will be one of the top pharmacy trends for 2020 because of how the FDA is working on raising the bar for makers of biosimilar products. The coming years will also see more money being invested in the biosimilar market, especially with the increasing rate of approvals for drugs from the FDA.

2019 felt like a “déjà vu” moment for the pharmaceuticals industry with both new and longstanding discussions brought to the table. The cost and use of different medications has taken center stage as well as the introduction of methods that will help speed up drug development.

As a pharmacy, it’s very important to remember a few things as you look into the top pharmacy trends for 2020 and create your game plan for the year ahead. For one, consumers are now smarter than ever. They will be more critical of everything including the price of medications because it will affect their compliance to treatment and the outcome of their health condition.

Pharmacists will also play a bigger role as part of the healthcare team and better distribution models will be implemented to increase the efficiency of delivering medications, especially for patients with chronic and debilitating diseases.

At the end of the day, the evolution of the pharmaceuticals industry will be a huge factor in the overall landscape of the world’s healthcare system. These top pharmacy trends for 2020 are a good way to kickstart another big year for the industry, and we can only look forward to bigger things ahead as we say goodbye to the year that was and welcome the year that is 2020.

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