Pfizer, AMCP Foundation Collaborate on Emerging Trends Assessment

Tampa—During the drug development process, Pfizer, Inc., follows the FDA’s guidance and conducts trials testing the safety and efficacy of medications. The company also communicates with health plans and other payers to ensure the products will be reimbursed if they get approved.

David Moules, vice president, US payer and channel access, Pfizer, said payers often request data and information on the economic value of the drugs. The questions continue even after the drugs are on the market, forcing Pfizer to prove that the costs of their drugs are fair and that their drugs are superior to newer products based on clinical and economic factors.

Several years ago, Pfizer and other large pharmaceutical companies did not pay as much attention to reimbursement and assumed their drugs would be covered, according to Mr. Moules. Now, since the introduction of the Patient Protection and Affordable Care Act (ACA), reimbursement is becoming much more important because of provisions that focus on improving the quality of care and cutting healthcare costs.

The ACA brought about other significant changes to the healthcare system, while the increase in expensive specialty pharmaceuticals and budget constraints of states are also changing the industry.

Details behind the Collaboration

At the AMCP meeting, Pfizer announced a partnership with the AMCP Foundation to conduct research and identify emerging trends in managed care pharmacy. The groups are interested in helping patients, payers, providers, and pharmaceutical companies better understand the landscape of healthcare now and in the future. Results will be announced at the AMCP Nexus conference in October in Boston and will be available to the public.

“The emerging trends assessment is a new, fresh look at what is happening in the healthcare industry today, especially around medication management,” said Edith Rosato, RPh, chief executive officer (CEO), AMCP, chairman, AMCP Foundation’s Board of Trustees. “We do not want to dwell on the things that are happening today, necessarily. What we are trying to do is put our crystal ball out there, try and figure out long-term where this industry is going, especially with the influx of specialty pharmaceuticals and how costly they are to the system. How do we obtain the best patient outcomes thinking about all of the different various factors out there, balancing cost and affordability to the patient, the taxpayer, the government? Also, how do we decide which drug, based on the clinical evidence, gives the best health outcome?...I think managing medications is going to become a much more important component of healthcare delivery.”

The process will begin with a thorough literature review to identify managed care pharmacy trends. IMS Health will conduct the research. After compiling a preliminary trends list and conducting primary and secondary research, AMCP and Pfizer plan on assembling an advisory panel of subject matter experts from payers, providers, patient advocates, and other groups. They will discuss the trends and put together a report. Details of the final document, such as the length and format, are still under discussion.

“We want it to be comprehensive, but we do not want it to be so theoretical that it cannot be practical, because the core users are going to be the providers [who] are going to essentially translate what we believe the trends are down into their day-to-day practice,” said Thanh-Nghia Nguyen, senior manager, payer channel access, Pfizer. “We want to make it actionable.”

Pfizer decided to get involved in the project because the company wanted more knowledge to help generate the necessary data and evidence to determine and demonstrate the value of its drugs and the appropriate use of its medications, according to Mr. Moules. He added that the trends assessment would also help Pfizer work with payers and communicate with them about reimbursement decisions.

“I think the whole healthcare industry, the whole sector, is undergoing transformational change driven a lot by policy and by the [ACA],” Mr. Moules said. “I think the 1 element that underpins everything is the element of value. Whether you are a pharmaceutical company or any stakeholder in the system, are you able to provide value into that system that will help achieve some of the goals of the [ACA]? Value will help improve quality, control costs, and ultimately help ensure that there is access to the tens of millions of Americans [who], even with the [ACA], still do not have access to health insurance.”

Pharmacist Integration into Healthcare

Although the subjects and topics of the research were being discussed, Mr. Moules and Ms. Rosato both mentioned that the report could include information on the issue of pharmacists as providers. The Social Security Act does not consider pharmacists as providers for Medicare Part B, so they are ineligible for reimbursement. States and health plans have followed suit and do not compensate pharmacists for providing healthcare services.

The ACA created accountable care organizations (ACOs) and other new healthcare delivery models in which physicians, pharmacists, nurses, and other healthcare providers collaborate to treat patients. Retail pharmacies are also opening in-store medical and wellness clinics, asking pharmacists to help provide care, and offering alternatives to primary care physicians.

Still, Ms. Rosato said few ACOs are utilizing pharmacists as providers and medication management experts for patients. However, she and Mr. Moules said pharmacists would likely become more important members of care teams that work together, assume risk, and share in savings generated by keeping patients healthy and cutting costs.

“It seems like the timing is right [to have pharmacists become recognized as providers],” Mr. Moules said. “It has been talked about, but we are seeing more things being shifted to the pharmacist on the retail side, as well, having to take on that [provider] role more and more…One of the things that is really incumbent for the healthcare system is having care delivered in the most cost-efficient way in the appropriate setting. If a pharmacist can operate at the top of their license and deliver that care more efficiently or more cost-effectively than a different setting, then that is what should be enabled. And, that is true of every level of healthcare professional—the ability to operate and practice at the top of their license.”

Managed Care Implications of Trends Results

Ms. Rosato said the trends assessment report could be particularly helpful for payers, especially in helping them deal with the increasing trend toward expensive specialty drugs. Since Ms. Rosato was named AMCP’s CEO in October 2011, she has made specialty pharmaceuticals a priority. Prior to the start of this year’s meeting, AMCP had a 2-day conference focused exclusively on specialty medications and management.

“Today, managed care and the way we deliver care in managed care pharmacy is even more important with the advent of all these specialty drugs coming out that are so costly to the system,” Ms. Rosato said. “Everybody is trying to figure out how can we pay for this? How can we make sure that patients [who] need this medication to have a better quality of life and a better health outcome…how do we provide these drugs to these patients? I think cost will start to become much more important as we move down this trajectory of how we are going to be delivering healthcare in the future.”

With the healthcare delivery system undergoing significant changes, Ms. Rosato hopes the report will help inform payers, providers, and patients on what to expect in the future.

“[The trends] are not going to be things that are happening today,” she said. “There is a lot of innovation in the marketplace, and a lot of innovation is not even being communicated. That is what we are hoping to capture.”