2019 Outlook: 4 Trends Making an Impact

Dec 13, 2018
This is an exciting time in healthcare with record numbers of novel therapies, new pricing strategies, and digital health in the hands of patients. Here’s what you need to know.

Innovation Lab 

In 2019, employers and plan sponsors will continue to face the challenges of supporting novel therapies and costly medications. As we noted recently, while spending on non-specialty medications is decreasing, specialty pharmacy drug spend continues to rise. Now at 41% of overall pharmacy drug spend, specialty is estimated to reach close to 50% in the next two years.

Innovations in medicine require equally innovative strategies for reimbursement and patient access. As we look ahead, we see an industry that is evolving and adapting to address the new challenges employers and plan sponsors will face, with a focus on whole-person health, choice, convenience, flexibility and connected care.

Here are 4 trends we see taking center stage in 2019 and examples of how we’re changing “what if” to “what is.”

1. Collaborative and Innovative Pricing Strategies

The current state of drug pricing is simply not sustainable. That’s nothing new. What is new is the way in which we’re creating solutions to better manage these costs and to improve patient access to medications. With the Administration’s Drug Pricing Blueprint and its proposed International Pricing Index, stakeholders are challenged to find solutions, drawing from a variety of strategies.

On Jan. 1, 2019, we’re offering The Express Scripts’ National Preferred Flex Formulary, which provides a way for plans to leverage changing dynamics in the market that can help lower their members’ out-of-pocket costs. The Flex formulary will prefer lower list price products, such as new authorized alternatives that drug makers are bringing to the market, and reduce reliance on rebated brand products. Asegua Therapeutics’ authorized alternatives for hepatitis C treatments Epclusa®(Sofosbuvir/Velpatasvir) and Harvoni® (Ledipasvir/Sofosbuvir) were the first authorized alternatives included on the National Preferred Flex Formulary. Recently, we added the authorized alternative to Repatha® (evolocumab) to the Flex formulary, which will be the exclusive PCSK9 inhibitor on that formulary.  Praluent® (alirocumab) will remain the preferred, exclusive PCSK9 inhibitor on our National Preferred Formulary.

2. Personalized Care When, Where and How Patients Want It

While the healthcare industry has lagged behind others in offering convenient, connected customer service, we are making great strides with meaningful changes that improve patient outcomes. Still expectations for more patient-centric care will continue to rise. Digital solutions, such as electronic prior authorizations, clinical direct messaging and real-time prescription benefit information will be the norm, not the exception. Greater adoption of this technology will be critically important as the specialty drug spend is estimated to reach close to 50% in the next two years. These new, high-cost therapies require plans to better manage appropriate use via prior authorization.

3. Adherence Tools in the Hands of Patients

Nonadherence to medication continues to be our nation’s costliest healthcare challenge. The U.S. wastes hundreds of billions of dollars annually from treating medical complications that could have been avoided if patients had taken their medications as prescribed. Predicting and preventing nonadherence will be the fastest route to solving this costly problem.

We learned from a survey of patients that nearly one-third of those taking prescription medications for chronic conditions say they are not concerned about forgetting to take their medications, and they still gave themselves high marks for taking their meds, even if they miss a dose or two. The survey also told us they don’t want to be nagged by their spouse/partner and instead see technology-based medication reminders as helpful tools.

Patients are looking for more ways to take the driver’s seat in their own care. Personalized digital devices allow patients with chronic conditions, like diabetes and hypertension, to better manage their nutrition, stress and medication adherence. Putting the right tools in the hands of patients will improve clinical engagement, resulting in better care experiences, better health outcomes and lower costs year-over-year.

4. Cross-benefit Utilization Management

Integrating medical and pharmacy data is not a new concept. However, during this unprecedented time of increasing healthcare spend, integrating medical and pharmacy data is critical now more than ever to manage the total cost of patient care. To bring this to life in practical terms, in 2019 Express Scripts will launch OnePA, a singular platform for managing utilization across medical and pharmacy benefits.OnePA is the first step in the future of trend management across medical and pharmacy benefits. Strategic benefits include consistent application of benefits and a streamlined experience for patients and providers and increased savings for payers in reducing the level of effort required to execute. Following the launch of initial capabilities in 2019, Express Scripts will deliver on-going enhancements to transform the way the industry manages patient total cost of care. Current enhancement under way includes applying advances in data science to the patient, physician, pharmacy and medical data currently available to ensure prior authorization requests are reviewed and approved in the most efficient and accurate way possible.

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Lab Staff
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