During a presentation at the AMCP Annual Meeting, Douglas M. Long, BS, MBA, vice president of industry relations at Iqvia in Ponte Vedra Beach, Florida, discussed the latest trends in health care.
Specialty growth is outpacing traditional growth and now has 45.4% share of total nondiscounted spend in the most recent 12 months, and oncology, autoimmune conditions, and HIV are leading the specialty absolute value growth. Meanwhile, diabetes, respiratory conditions, and anticoagulants are leading the traditional absolute value growth, while mental health and pain have contributed most to the value decline.
Mr. Long then discussed key market trends, including tighter, more consolidated payer management; higher patient out-of-pocket payments; public pressure and demand for price transparency; more stringent medical benefit management; increase in value-based models; and an evolving provider landscape.
Patients are facing increasing financial pressure as payers continue to transfer a higher percentage of costs. In 2016 to 2017, the average commercial copay increase was 14%. Since 2013, the proportion of patient costs paid through deductibles and coinsurance has grown: In 2017, 44% of patients’ out-of-pocket costs was copay, 29% was coinsurance, and 26% was the deductible. This higher cost-sharing is leading to greater abandonment, affecting patients with deductibles, coinsurance, and specialty copays.
With this has come a growing demand for price transparency, and a number of recently introduced state bills have taken on this issue. There will be an increasing push for companies to communicate a clear rationale for pricing decisions, said Mr. Long. In addition, there is mounting political pressure aimed at lowering drug prices.
He also said that drugs managed through the medical benefit will no longer be protected as payers are developing new capabilities to manage the medical benefit. Vertically integrated payer models are being developed to manage the increasing pharmacy and medical costs. In addition, the number of value-based contracts is increasing to also address rising cost concerns.
In another attempt to streamline care and costs, providers are merging to form integrated delivery networks and accountable care organizations. However, this may blur the lines between providers and payers.
Next, Mr. Long quickly gave an update on the opioid crisis, noting that while opioids are the third leading cause of overdose deaths, opioid prescribing is declining across the country, while the use of medically assisted treatment has sharply increased.
Amazon’s entry into health care was also a topic of discussion. In early 2018, Amazon joined J.P. Morgan Chase and Berkshire Hathaway in announcing the development of a health care initiative. In mid-2018, Amazon acquired Pill Pack and Xealth, further expanding the company’s reach into the health care system.
Medication adherence is an important component of health care, and adherence in the United States is not regionally uniform. Ninety-day prescriptions are an effective way to increase adherence rates, said Mr. Long.
Presentation H1: AMCP Headline Session: 2018-2019 Pharmaceutical Marketplace Trends. AMCP Annual Meeting 2019.