Specialty Pharmacy Trends Report: HIV/AIDS

HIV is a retrovirus that leads to AIDS, a disease that causes severe damage to the immune system. According to UNAIDS, 35.3 million people are living with HIV/AIDS worldwide; more than 1.1 million people are living with HIV in the United States. Of the 35.3 million people living with HIV/AIDS, only 9.7 million patients are accessing treatment. By 2015, the annual US investment from all resources for HIV/AIDS is estimated to reach between $22 billion and $24 billion.

Currently, there are 5 classes of HIV drugs, each attacking the virus at different points in its life cycle. Typically, HIV treatment regimens include 3 different antiretroviral drugs from 2 different classes. Taking 3 different drugs is the most effective method for controlling the amount of virus in the body and protecting the immune system, as well as protecting against HIV drug resistance. Recent trends in HIV treatment include a single-pill medication containing fixed doses of multiple antiretroviral drugs.
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When the survey participants were asked if they are involved in reporting adherence and/or compliance on the use of HIV/AIDS medications obtained through specialty pharmacy, 40.74% responded “never,” 20.37% responded a “great deal,” and 14.81% responded “rarely” (Figure 1).

A significant majority of the survey participants (72.22%) responded 0% to 25% when asked what percentage of specialty pharmaceuticals for the treatment of HIV/AIDS require in-office administration of the drug (Figure 2).

The survey respondents were asked how long they typically treat HIV/AIDS patients, and 48.15% said they were unsure, 14.81% said 21 to 30 years, and another 14.81% said ≥31 years (Figure 3).

When asked what percentage of patients receiving treatment for HIV/AIDS are >50 years of age,
25.93% said 26% to 50%, 14.81% said 0% to 25%, and 12.96% said 51% to 75%. The remaining 46.3% said they were unsure (Figure 4).

Specialty pharmacy is a burgeoning field that continues to be of importance for managed care professionals. With the rates of chronic, high-cost conditions increasing, payers are eager to find ways to diffuse costs, while also providing patients with the best care possible. First Report Managed Care partnered with the National Association of Specialty Pharmacy to put together this Specialty Pharmacy Trends Report.

The information for this trends report was generated through a comprehensive survey developed via the collaborative efforts of an Advisory Panel of key thought leaders and the First Report Managed
Care editorial staff. This survey was then sent to a diverse pool of specialty pharmacy professionals. This is part 2 of a 3-part series we bring to you on the climate of specialty pharmacy as it relates to the managed markets. We hope that you find the information presented to be practical, informative, and compelling. We hope the survey results serve as a resource you can use in making future management decisions.

Survey Participant Demographics

Key thought leaders in the field of specialty pharmacy have provided the information collected in this Specialty Pharmacy Trends Report series. The following are the demographic responses, providing a snapshot of the survey participants and the organizations for which they are affiliated.

The Northeast is home to most of the survey participants (33.93%), while 28.57% of participants are in the Midwest, 10.71% in the Southeast, 10.71% in the Pacific, 10.7% in National regions, 3.57% in the Mountain region, and 1.79% said “not applicable.”

The majority of the survey respondents (60.71%) have a PharmD degree, while 39.29% have a BS in
Pharmacy, 17.86% have an MBA, 10.71% have an MS, and 5.36% have a PhD. A significant majority of survey participants (53.57%) have an RPh certification, while 17.86% have a BCPS, and 12.5% have a CSP.

When asked how long they have been in the specialty pharmacy field, 35.71% of survey participants said 0 to 5 years, while 28.57% said 11 to 20 years, and 26.79% said 6 to 10 years.

Mail-order specialty pharmacy is the primary facility of work for 23.21% of the survey participants. An additional 16.07% said their primary facility of work is an academic institution (not a university hospital), another 16.07% said a managed care organization, 14.29% said a retail specialty pharmacy,
and 10.71% said a consulting firm.

When asked what type of specialty pharmacy they are involved with, 26.79% of the survey respondents said independently owned (nonretail) and another 26.79% said pharmacy benefits manager. Another 16.07% of the survey respondents are involved with a health plan-owned specialty pharmacy and 14.29% are retail pharmacy owned.

Most of the survey respondents (39.29%) reported that they have 1% to 25% of patient interaction time on a monthly basis, while 28.57% said their role does not currently involve patient interaction.

When the survey participants were asked to select the top 5 therapeutic categories with which they are most involved, and with the option to select up to 5 areas, the results were the following:
     • Oncology (69.64%)
     • Rheumatoid arthritis (67.86%)
     • Hepatitis C (64.29%)
     • Multiple sclerosis (50%)
     • Diabetes (37.5%)
     • Crohn’s disease (35.71%)
     • Psoriasis/Psoriatic arthritis (35.71%)
     • HIV/AIDS (25%)
     • Hemophilia (23.21%)
     • Immunoglobulins (12.5%)
     • Cystic fibrosis (8.93%)
     • Hereditary angioedema (5.36%)
     • Gout (3.57%)
     • Infertility (1.79%)