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Prescription Drug Rate Growth to Slow in 2019, Increasing 4.92%

Biosimilar and generic drug competition will slow prescription drug rate growth in 2018, but prices will still rise almost 5 percent, experts predict.

Prescription drug rates

Source: Thinkstock

By Jacqueline LaPointe

- Hospitals and health systems should anticipate prescription drug rates to increase by 4.92 percent in 2019, researchers from the healthcare improvement company Vizient recently estimated.

Prescription drug rates for hospitals and health systems are growing at a slower rate compared to the previous year, the purchasing data from hospitals and non-acute facilities in the Vizient Pharmacy Program revealed. In 2018, researchers projected drug prices to rise 7.61 percent.

“While the projected increase for 2019 is less than 2018, it is still growing quickly,” said Dan Kistner, PharmD, Senior Vice President of Pharmacy Solutions for Vizient. “Two key themes we saw were the continued growth of specialty pharmacy products as a share of total spending and the critical importance of ongoing, robust generic and biosimilar competition on restraining overall price growth.”

New biosimilar and generic competition primarily constrained prescription drug rates, the report showed. With the approval of 11 biosimilars by the Food and Drug Administration (FDA) as of June 15, 2018, increased market competition should help to restrain healthcare drug spending.

CMS also recently decided to assign each biosimilar a unique reimbursement code and pass-through status. The federal agency’s actions promote biosimilar use and, therefore, market competition, which will work to lower prescription drug rates.

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But the impact of increased generic and biosimilar competition is limited, researchers pointed out. Biosimilar adoption is still low, with the drugs only accounting for three percent of the infliximab market, one of the most commonly used biologics in clinical practice.

However, increased competition would lower prescription drug rates. About 79 percent of the projected price inflation in 2019 will stem from drugs with no competition, researchers reported.

While increased market competition for biosimilars and generic drugs will work to restrain prescription drug prices, spending on specialty pharmaceuticals will probably grow, the data showed.

Spending on disease-modifying antirheumatic drugs (DMARDs), MS pharmaceuticals, agents for the treatment of hepatitis C, oncology products, and other common specialty drugs is nearing 50 percent of the total US drug spend.

Currently, national statistics show that the percentage of spending on the specialty pharmaceuticals is at 46.5 percent, researchers reported using data from the IQVIA Institute for Human Data Science.

READ MORE: How Part B Drug Changes Could Impact Provider Reimbursement

“Based on the total amount of spend across care environments, the types of molecular entities approved by the FDA, and the investigational products in the development pipeline, it is certain that specialty pharmaceuticals will continue to play an increasingly important role in pharmacy budgeting,” the report stated.

Data from investigational drug pipelines support the theory that specialty drug spending will increase in next year. More than 60 percent of the products with applications currently on file with the FDA and in phase 3 clinical trials are considered specialty drugs.

As the percentage spent on specialty drugs increases, hospitals and clinics alike need to develop specialty pharmaceutical management capabilities in order to succeed, researchers advised.

“It is important to focus on expanding proficiency and documenting clinical and operational results (e.g., abandonment rate, time to fill, compliance and persistence) that are superior to those of third-party specialty pharmacy providers,” they wrote.

A health system that is already implementing specialty pharmaceutical management systems to reduce their drug spending is the University of Utah, the report highlighted. The academic medical center developed a centralized 24/7 support line for patients taking specialty drugs.

READ MORE: Target Prices to Control Prescription Drug Spending, AHA Advises

The support line is one component of the University of Utah’s effort to create a pharmacy services call center that will improve engagement for outpatient care through non-pharmacy locations, two outpatient clinics, and a specialty pharmacy program.

“The support line has enabled a focused and more integrated approach to meet the demands of the health system’s growing specialty pharmacy service, offering a centralized way to address prior authorization and billing questions, provide medication education and answers to clinical questions, respond to refill requests and coordinate medication delivery,” the report explained. “The support line also enables better coordination with patients’ specialty clinics.”

Since implementing the specialty pharmaceutical management initiative, the University of Utah reported higher levels of patient satisfaction, with 95 percent of patients rating the service as excellent and 99 percent saying a staff member was available to answer their questions all of the time.

“It is this level of integration and connectivity that can distinguish health system–based pharmacy practice from other, less integrated providers,” researchers stressed.

Pharmacists in the health system setting also need to restructure their workflows in light of rising specialty drug spending.

“Pharmacists, particularly those working in health-system settings, must not only be active participants in the monitoring, delivery and management of these agents, they must also be able to measure their professional contributions to improved patient outcomes,” researchers advised.

They should also expand their view beyond the acute care setting. “The realities of existing and future practice mandate competency in caring for patients in all settings. The cost of many pharmaceuticals increases the need for that competency. It is therefore critical for members to sustain their development and investment in this area,” the report stated.

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