Politics and policies were among the main topics at the meeting in Las Vegas. But the 6,000 attendees also heard about biosimilars, the gross-to-net gap and the ripple effects of the CMS’ Aduhelm coverage decision.
Las Vegas is famous for its buffets. The 6,000 pharmacists, healthcare executives and other professionals who attended the 2022 Asembia Specialty Pharmacy Summit this week in “Lost Wages” were treated to large helpings of a buffet of topics in specialty pharmacy and healthcare overall.
The meeting rooms and hallways of the deluxe Wynn Convention Center were teeming. Attendees had to show proof of COVID-19 vaccination to attend. Only a handful of people wore face masks. Attendees shook hands and exchanged hugs.
Government policy and politics were featured topics of many sessions, although there was little, if any, discussion of the leak of the Supreme Court opinion that seems to signal that thethe Roe v. Wade abortion will be overturned by the court this summer.
On Wednesday, Avalere healthcare policy experts discussed the politics and prospects of a pared-down “skinny” Build Back Better legislation and Part D benefit design. Part D benefit also came up on Tuesday during a session on the impact of government policies on specialty pharmaceuticals and their patients.
“After you spend $7,000, there really put to be a hard out-of-pocket cap. This really is the most bipartisan proposal that is really on the table,” said Joel White, president and founder of Horizon Government Affairs.
Biosimilars came up often. Keynote Speaker Scott Gottlieb, MD, a former FDA commissioner, heralded them as being “largely a success story.” In an interview with Managed Healthcare Executive® Cardinal Health’s Sonia Oskouei talked about interchangeability improving clinical confidence and operational efficiency and helping make biologics more affordable.
The 340B program, which gives some hospitals and the pharmacies they have contracted with, a substantial discount on drug prices, was another topic of the day. Adam Fein, an expert on drug costs and distribution channel and a consultant, described the ballooning of the program, its meaning for specialty pharmacy and the recent decision by drugmakers to curtail 340B discounts to the networks of pharmacies that some of the participating hospitals have contracted with. Timothy Paine, a consultant with the Blue Fin Group, also delivered a bit of history lessons — and a warning. The drug companies are running the risk of bad publicity and a narrative that cast the drugmaker’ role in the 340B program in a negative light, he said to a standing-room-only audience Monday afternoon.
“There are some rural hospitals that can only offer extra hours or certain clinics because of the dollars they get from this program,” said Paine “Imagine what it looks like to the lay public when their hospital closes.”
The gap between the list (sometimes called gross) price of pharmaceuticals and net price, which takes into account rebates and other discounts, was a leitmotif. “List price is meaningless number as it relates to pharmaceuticals,” Doug Long of IQVIA, said in an interview with Managed Healthcare Executive.®
Long’s IQVIA colleague, Lucas Greenwalt, talked about coverage limitations and the increasingly narrow path for new drugs. To get a foothold in the market, manufacturers have become the de facto payers for their newly launched drugs with coupons and other means of financial assistance. “It is no longer that we see patient assistance coming in as a secondary strategy as products come into the market,” Greenwalt told the audience. “It is now the primary strategy for brand success as you are launching a product.”
Payers, and Medicare more specifically, were on Jayne Hornung’s mind when she talked to Managed Healthcare Executive® before the meeting about her presentation on digital therapeutics. Legislation that would extend Medicare coverage to prescription digital therapeutics is crucial, said Hornung. “Once Medicare says it is a thing, we have to address this thing,” Hornung said.
Gottlieb also talked about Medicare coverage but not in a flattering light. The CMS decision to limit coverage of Aduhelm (aducanumab) to people enrolled in clinical trials set a dangerous precedent for other drugs that have received accelerated approval, he said.
“Now CMS has opened the barn door to this kind of policy making,” Gottlieb said. “You are going to see state Medicaid plans follow suit and you are going to eventually see commercial plans and they are going to use accelerated as the sole basis for not putting a drug on formulary.”
Gottlieb said another long-term effect of the CMS Aduhelm decision may be Medicare Part B as a market for new drugs. Historically, he said, Part B was seen as a reliable avenue to coverage and that CMS was a price taker. “I think more and more companies are going to realize that maybe Part B is not such a good deal anymore.”
By no means were all the sessions at the meeting devoted to the witches’ brew of government policy, drug prices and payment.
There were two dozen continuing education sessions devoted to clinical topics ranging from long-chain fatty acid oxidation disorders to treatment of lower-risk myelodysplastic syndromes to new treatments for cystic fibrosis.
And some of the business sessions had a somewhat softer edge — not so many dollar figures and fewer slides. Amazon Pharmacy executives talked about taking about Amazon’s consumer-first approach and how they are applying that to their business. Sarah Freedman of Walgreens and Srulik Dvorsky of TailorMed talked about prescription abandonment and how Dvorsky’s financial navigation platform helps solve the problem by connecting patients to financial assistance program.
Freedman said experience goes beyond the dollars. “It is really important to have a patient be a managing partner in their own healthcare,” she said. “Having that autonomy, that control, means so much when you have a condition that is just taking over your life. Being able to make decisions on your own and feel educated and empowered is really important — and that is what this does.”