Four Solutions Manufacturers Should Consider For Retail and Specialty-lite Products

Today’s guest post comes from Michael Carr, CoAssist Group Vice President at AssistRx

Michael discusses patient support challenges that are unique to specialty-lite pharmaceuticals. He goes on to describe four new categories of patient solutions and pharmacy models specific to this growing market segment.

To learn more about CoAssist and AssistRx specialty therapy initiation and patient support services, click here to schedule a meeting with AssistRx at the Asembia Specialty Pharmacy Summit on May 2-5, 2022.

Read on for Michael’s insights.

Four Solutions Manufacturers Should Consider For Retail and Specialty-lite Products
By Michael Carr, RPh, CoAssist Group Vice President, AssistRx

In the last decade, the U.S. Food and Drug Administration (FDA) approved more drugs annually on average than it did in the prior two decades, resulting in increased competition for specialty and retail drugs alike. Specialty-lite drugs—or products positioned between retail and specialty products—are set to dominate growth in the space.

Not quite retail, specialty-lite drugs often require some specialty services, like access and reimbursement support. However, their often lower-than-specialty wholesale acquisition cost (WAC) limits the effectiveness and financial feasibility of full-time employee (FTE) models typically leveraged for specialty drug support. Additionally, life sciences organizations offering specialty-lite products are experiencing the same gross-to-net squeeze as their specialty drug manufacturer counterparts.

A Drug Channels Institute analysis of company reports found that the unweighted average gross-to-net gap in drug prices was -6.0% for 2020. Prices for brand-name drugs dropped, and drug makers sold their products for less than half of the list price. Factors driving this trend include distribution fees, discounts to hospitals, rebates and more. Regardless, the cascade effect of this gross-to-net squeeze can induce cost shifting onto the patient.

Compounding these factors, healthcare providers (HCPs) and patients are more often facing access challenges such as prior authorizations (PAs). According to an American Medical Association (AMA)-conducted survey, 83% of physicians across specialties and practice settings reported an increase in the number of PAs required for prescription medications and medical services over the last five years. Further, health plans report that “zero percent of primary care services are subject to PA,” but according to AMA’s survey, 64% of primary care physicians (PCPs) disagree with this claim. Even low-WAC, primary care drugs are challenged by new/additional PA requirements.

Patient access, affordability and adherence challenges are just some of the obstacles faced by specialty-lite products. This underserved segment of the market needs a non-traditional model that supports patients and HCPs at an attainable cost. Life sciences organizations providing these products must strike the perfect balance between delivering differentiated patient support services and cost-effective solutions.

To meet the nuanced needs of this growing market segment, four new categories of patient solutions and pharmacy models are looking to disrupt the status quo. Vying for the attention of life sciences organizations launching specialty-lite products are:

1. Digital Pharmacies.

Perhaps most visible within the industry and to consumers is the digital pharmacy. This model tends to focus on retail and lifestyle drugs. Driven by patients, digital pharmacies leverage an e-commerce model and lean on patients to self-serve throughout their journey. Digital pharmacies often encourage patients to use telehealth services and are usually cash-payment focused to give patients additional flexibility when evaluating affordability options.

In the February 2021 Drug Channels article, The Promise and Limits of Digital Pharmacies, it was asserted that digital pharmacies’ biggest impact will come from forcing the industry incumbents to improve their business and patient-centric approach. However, it also said that it was unclear how far this “niche opportunity can expand into new-to-therapy prescribing for medically complex conditions.” While digital pharmacies are not ideal for specialty-lite products, some of their characteristics—such as cash-payment dispensing and simplified prescribing for HCPs—are appealing to specialty-lite product brand teams.

2. Alternate Specialty-lite Pharmacies

While this model is similar to specialty pharmacies, alternate specialty-lite pharmacies focus on leveraging technology to speed access to therapy. Though these pharmacies deliver some electronic support services like e-benefit verification (e-BV) and e-PA, these services may have limited reach and technology-first functionality when compared to other solutions on the market. Further, leveraging a single pharmacy entity may create concern for steerage.

3. Hub-lite Services

This model provides some e-services like e-BV and e-PA, but hub-lite providers may struggle to evolve their service offerings alongside the specialty-lite drug’s lifecycle without costly system and process changes.

4. Digital Patient Services

CoAssist answers to market demand for tech-first, cost-effective digital patient services with solutions and features tailored to the needs of specialty-lite programs. It is differentiated from digital pharmacies, alternate specialty-lite pharmacies and hub-lite services with the ability to kick-off advanced and automated real-time e-support services at prescription intake from the EHR – an important distinction, as it meets HCPs within their established workflow. e-Support Services also include real-time e-BV, e-PA, e-Consent, e-Enrollment and more, which leverage multiple data sources and proprietary algorithms to outperform industry standards.

The CoAssist platform also features a limited pharmacy network, which helps alleviate the steerage concerns associated with the use of a single pharmacy. It also features its own consignment pharmacy to support the clinical decision and gain visibility to the patient journey CoAssist identifies the best affordability option for the patient, allowing for cash-dispense if optimal. Further, the CoAssist platform is supported by the necessary technology and expertise to evolve the program alongside the product lifecycle, providing the flexibility to enable different services at the launch phase versus at the near-loss-of-exclusivity phase.

Learn more about CoAssist and AssistRx specialty therapy initiation and patient support services by meeting with us at Asembia's Specialty Pharmacy Summit on May 2-5, 2022. Schedule your meeting here.

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