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Value of Analytics in Managing Expensive Drugs
San Diego, CA—As specialty pharmacy spend continues to skyrocket, payers will need to implement innovative strategies that minimize cost, increase plan value, and improve overall member health outcomes. These strategies must also address comorbidities, manage possible side effects, and monitor patient adherence.
Payers can expect a greater than 20% specialty cost trend in the next few years, according to Andrea Marks, vice president, chief analytics officer, Catamaran, who discussed managing high cost drugs during a sessions at AMCP. Catamaran is a pharmacy benefit manager (PBM) serving more than 32 million members. “This is a train that is coming. [We need] to have awareness and use of analytics to drive change,” she said.
PBMs can support payers with sophisticated models that analyze and predict patient behavior. These models draw on demographic, profile, and novel data sets to create risk analyses for specialty pharmacy patients.
Ms Marks noted 3 phases of analytics (traditional, advanced, and prescriptive) currently impacting the industry and referred to “prescriptive”as the “new wave of analytics.” It includes 4 approaches: (1) intersection of in- sights and interventions; (2) focus on actionable information; (3) promotion of enhanced engagement; and (4) drive better outcomes.
She described the rising cost of specialty medications and the impact on a payer’s specialty trend, sharing data from the Catamaran Book of Business 2014. The analysis found that specialty members represent 2% of all utilizers or 28% of total cost. Specialty patients have an average of 2 comorbidities, most commonly cardiovascular disease and pain management, she said. Furthermore, members often receive care from multiple physicians. For example, members who receive care from 4 to 6 prescribers represented 38.2%.
Analysts also predict that the specialty trend will increase significantly in the coming years. Catamaran forecasted that specialty costs would increase from 26% in 2014 to 43% in 2020. The IMS Institute for Healthcare Informatics report titled The Global Use of Medicine: Outlook through 2018 looked at the cost of 7 specialty drug categories (Table). Ms Marks explained the prevalence of nonadherence among specialty patients. They represent 34% of total cost with nonadherence being a leading contributor to the rising costs. Another report from IMS Specialty Solutions titled Understanding and Improving Adherence for Specialty Products found that nonadherence results in 125,000 deaths in the United States per year and $177 billion in direct and indirect health care expenditures. The causes of nonadherence include lack of efficacy, side effect profiles, cost of medications, cessation of symptoms, and comorbidities. The consequences of nonadherence include suboptimal health outcomes, patients being escalated to additional lines of therapy, increased costs, and drug wastage.
“Predictive analytics for patients new to therapy can help identify patients at risk for low adherence,” she said.
She concluded with a discussion on how personalized patient interventions and engagement strategies can help predict outcomes. Engagement spans all industries, said Ms Marks referencing the 6 top trends in customer engagement in 2015: (1) customer content, (2) social media, (3) human-to-human relationships, (4) customer communities, (5) market segmentation, and (6) customer appearances. She also highlighted an article by Boyle et al published in July 2014 in Gallup Business Journal that found “the most successful engagement strategies create emotional connections and use data to continuously evolve practices to stay ahead of customers’ needs.”
She stressed that engagement is important for ongoing patient management. A highly personalized approach begins before the patient’s first prescription and continues throughout their course of treatment. Leveraging technology is another approach to tailor engagement and make it more relevant for each patient. Examples include live video consultations with a pharmacist, mobile apps with push messaging, condition-specific online communities, nursing management programs, and survival kits.
Ms Marks highlighted a Catamaran study that looked at high-touch engagement models to improve sofosbuvir ad- herence in patients with hepatitis C. The study found that high-touch models increased medication adherence 9.1% and drug wastage per patient decreased $7402. She also mentioned a separate study by the PBM that examined the impact of telepharmacy on specialty medication adherence among patients taking medications for hepatitis C, rheumatoid arthritis, and multiple sclerosis. On a live video consult, the patient and pharmacist discussed how to take medications, the importance of medication adherence, side effect management, and the importance of lab and doctor appointments. The findings showed that patients were twice as likely to be adherent if they received a video consult.
“Technology drives engagement, which drives adherence and adherence drives down costs,” she said.—Eileen Koutnik- Fotopoulos
