In September, hundreds of healthcare professionals logged in from their home offices to attend the 2020 Pharmaceutical Care Manufacturer’s Association (PCMA) Annual Meeting. This year’s meeting was held in a virtual format due to the COVID-19 pandemic, with sessions presented over video and meetings and networking held via teleconference.
J.C. Scott, PCMA president and CEO, addressed the precarious state of the pharmaceutical care industry — and the world — in his opening remarks, saying he was proud of the resiliency he’d seen across industry stakeholders.
“The PCMA Annual Meeting has always been a platform designed to foster discussion and collaboration. This year is no different,” Scott said. “In fact, discussion and collaboration among all of us in the drug supply and payment chain are more important than ever.”
Scott continued that there is much work still to be done, and we are far from out of the COVID-19 pandemic. The sessions to follow addressed additional topics Scott mentioned in his opening:
● The upcoming election;
● Healthcare policies; and
● Helping patients access medications through trying times.
Certainly exacerbated by this year’s unique circumstances is the continued need for change and innovation in healthcare, a priority recognized in several sessions. In his session “The Long Game Strategy for Transforming Pharmacy from Volume to Value — A Call to Action for all Stakeholders,” Chronis Manolis, senior vice president of UPMC Health Plan, addressed the need for value-driven management at the pharmacy.
“Innovative clinical management is mostly undervalued,” Manolis said. “Why? Because it’s really hard work.”
While Manolis said most healthcare technology today is focused on price, rebate and benefit, it should rather be focused on clinical value, total care and cost to really change prescriber and patient behavior. And, he added, all of the stakeholders involved in real-time benefit check need to be involved.
“We’re going to need all the players at the table,” Manolis said.
CoverMyMeds’ own Kyle Grimslid, Pharm D., echoed the need for continued innovation in his session, “The Path Forward for Medication Access and Patient-Centered Care.” Grimslid addressed current patient medication access barriers that have been exacerbated by the COVID-19 pandemic and related economic fallout.
The path forward, Grimslid said, includes more options for patient choice along the patient journey, as well as continued progress in prescription decision support — throughout the entire patient journey. Crisis-proofing chronic-care conditions with specialty support services was also of note in this session.
“The chronic condition population, who depend on consistent care and medication access, likely most stands to benefit from evolving, nimble technology,” Grimslid said. “For this group, the next frontier likely includes remote patient-monitoring tools and artificial intelligence to enhance the virtual care experience.”
You can read more about moving forward in healthcare’s new normal in our COVID-19 report and about prescription decision support solutions from CoverMyMeds.
Given the ongoing election season, legislative changes, executive orders and drug regulations were a hot topic at the 2020 PCMA Annual Meeting.
In the session “Drug Pricing Reform Efforts: Administration EOs and Political Dynamics,” Joe Grogan, former assistant to President Trump and director of the Domestic Policy Council, shared insights and projections on the executive orders President Trump signed in July, including one pertaining to Medicare Part D drug rebates.
Grogran stressed the importance of PBMs and drug manufacturers uniting to support Americans’ concerns over drug pricing imbalances seen at the pharmacy counter. He also addressed the four executive orders signed recently, indicating they are a possible sign of a bigger drug pricing reform movement.
“The executive orders should be interpreted as directional,” Grogan said. “The president isn’t getting out of the drug pricing game.”
Also discussed was last year’s proposed rule from the U.S. Department of Health and Human Services to prevent pharma manufacturers from paying rebates to pharmacy benefit managers (PBMs), Medicare Part D plans and Medicaid managed care plans.1
In the session “Drug Price and Affordability Challenges: Market Solutions and Efforts in Washington,” Kent Rogers, senior vice president, chief pharma contracting and procurement officer at OptumRx and Amy Bricker, senior vice president, supply chain and drug procurement at Express Scripts, addressed this rule from the PBM standpoint. Their primary concerns were around a lack of infrastructure to adjudicate Medicare Part D claims, supply chain issues and the fact that patient out-of-pocket costs weren’t addressed.
“In effect, there really is not an infrastructure in place to adjudicate those claims on behalf of (Centers for Medicare and Medicaid Services) for Medicare patients,” Rogers said. “That would then have to fall to pharmacies who are not fully equipped to do that.”
The Congressional Budget Office released a report in May 2019 predicting prescription drug prices would not decrease through this rule.2 Instead, the report said, discounts would be in the form of chargebacks, only available for Medicare Part D and Medicaid managed care.
“We talk a lot with lawmakers and policy makers around ensuring that a patient’s out-of-pocket (cost) is something that’s reasonable,” Bricker said. “We hear a lot about insulin being unaffordable for seniors — having to choose between rent or food and insulin, and we find that absolutely unacceptable.”
Bricker referenced a new patient assurance program to cap insulin costs.3
“That (program) is what we think is actually progressive and a step in the right direction for all Medicare beneficiaries,” Bricker said. “It should be something that’s predictable, something that is affordable and something that’s simple to understand.”
While the Trump administration withdrew the proposed rule, Rogers and Bricker said they are prepared for a new or updated version of the rule to be put into effect in the near future.
As Scott mentioned in his opening remarks, the industry will likely be dealing with the COVID-19 pandemic for the foreseeable future. Doug Long, vice president of industry relations at IQVIA, provided a data deep dive on trends impacting the pharmaceutical market in his session, “Trends, Issues & Outlook during COVID-19.”
Long addressed weaker market dollar sales in 2020 compared to the previous two years, noting there were fewer price increases and lower pain medication sales, with some attribution to COVID-19.4 He noted retail and mail areas of the marketplace are trending stronger than the overall marketplace, likely due to lower oncology drug sales, as many patients were unable to visit the oncologist during pandemic shutdowns.
Long also noted retail prescription numbers, while initially dropping after shutdowns during COVID-19, are recovering, comparable to trends from the previous year. Although mail prescriptions saw a bump during March and April from COVID-19 shutdowns, they are coming down to previous trend numbers.
Telehealth has certainly played a bigger role in healthcare this year than ever before, with some health systems seeing an 8,000-percent increase in visits.5 Long addressed telehealth as well, showing an inverse relationship between in-office and telehealth visits in March and April. While office and institutional visits have started to increase again, they are still below baseline visit levels. And while telehealth visits have dropped by around 30 percent since their peak earlier this year, they are up by over 50 percent compared to normal baseline levels.4
However, Long pointed to data that showed when it comes to appointments resulting in prescriptions, telehealth visits are behind office visits. He noted this could be due to fewer labs and diagnostic tests in telehealth appointments and prescribers may be less willing to initiate new therapy remotely.
You can read more about how telehealth is affecting patients and providers in our article, Telehealth in the time of a pandemic.
Attendees and presenters of PCMA’s 2020 Annual Meeting rose to the challenge of a virtual conference to keep each other safe while still moving the pharmaceutical industry forward — and it’s clear they have the same care in mind for patients.
Learn more about how CoverMyMeds is also helping patients access the medications they need.
- Proposed Rule, U.S. Department of Health and Human Services
- Incorporating the Effects of the Proposed Rule onSafe Harbors for Pharmaceutical Rebates in CBO’s Budget Projections, Congressional Budget Office, May 2019
- Cigna and Express Scripts Introduce Patient Assurance Program to Cap Out of Pocket Costs at $25 per 30-Day Insulin Prescription, Cigna, April 2019
- Monitoring the Impact of COVID-19 on the Pharmaceutical Market, October 2020, IQVIA
- WVU Medicine to waive telehealth co-pays through May 31, May, 2020, WVU Newsroom