Radar on Specialty Pharmacy

While the COVID-19 pandemic and pharma’s efforts to counter it were the top pharma concerns in 2020, that wasn’t the only innovation within the specialty pharmacy arena. AIS Health spoke with a variety of industry experts on various trends over the past year.

What were some of the most notable developments within the specialty pharmacy industry in 2020, and why?

When the FDA approved BioCryst Pharmaceuticals, Inc.’s Orladeyo (berotralstat) last month, the drug became the first oral treatment for prophylaxis to prevent hereditary angioedema (HAE) attacks. According to Zitter Insights, payers with nearly three-quarters of covered lives plan to manage it at parity to other prophylactic treatments.

HAE is a rare but potentially fatal condition that causes swelling in various parts of the body, including the hands, feet, intestinal tract, face, larynx and trachea.

As we look back over the past year, the COVID-19 pandemic has been top of mind for many involved in pharma commercialization and coverage. Less than a year after scientists sequenced the COVID genome, the FDA granted emergency use authorization to vaccines from Pfizer Inc./BioNTech SE and Moderna, Inc. in December — an unprecedented time frame for vaccine development, testing and rollout. Shortly thereafter, vaccinations started to be administered. AIS Health spoke with a variety of industry experts on COVID-related trends over the past year.

Could you comment on the COVID-19 pandemic and its impact over the past year?

Dan Danielson, R.Ph., senior director of the access experience team at PRECISIONvalue: “I don’t think you [can] underestimate the economic and societal impact that COVID-19 has. In the U.S., the overall economy has contracted from the pre-pandemic period, with consummate contraction in GDP [i.e., gross domestic product] and job losses on a scale most of us have not seen before.

Centene Corp. celebrated the end of 2020 by closing on its acquisition of specialty pharmacy PANTHERx Rare, LLC on Dec. 30, then started 2021 with an agreement to acquire Magellan Health, Inc. The deals will strengthen Centene’s expertise in the specialty pharmacy space, particularly in the burgeoning orphan drug space by bringing onboard PANTHERx, an experienced company that’s shown remarkable growth over the past 10 years.

Centene and PANTHERx did not disclose terms of the deal, which was unveiled Dec. 15.

✦ HHS has moved ahead with its plan to eliminate rebates to PBMs and plans in Medicare Part D. The administration issued a final rule (85 Fed. Reg. 76666, Nov. 30, 2020) providing safe harbor to rebates given to beneficiaries at the point of sale and to certain PBM service fees. The move follows a proposed rule initially released Jan. 31, 2019 (RSP 2/19, p. 1). The final rule pushed back the implementation date from Jan. 1, 2020, to Jan. 1, 2022. View the rule at https://bit.ly/3gxs6Q3.

✦ Specialty drugs represented 48.5% of net costs in Medicaid in 2019 but accounted for only 1.3% of utilization, according to Magellan Rx Management’s fifth annual Medicaid Pharmacy Trend Report. Specialty trend mainly was driven by net cost per claim, which rose from 2018 by $141.12, while specialty drug utilization declined 0.9%. The report projects that specialty drugs will make up half of overall Medicaid net spend in 2020. Download the report at https://bit.ly/3mZKkvR.