Prime expert showcases medical specialty drug management solutions

Discussion centered on payer channel management and biosimilar strategies

May 13, 2022

Prime Therapeutics’ (Prime) Chris Ford, assistant vice president, strategy and innovation, was a featured speaker at Asembia’s 2022 Specialty Pharmacy Summit. On May 4, Ford participated in a panel-style presentation named “Specialty Pharmacy Supply Chain Dynamics: Payer and Manufacturer Perspectives.”

There were 28 specialty drugs approved by the Food and Drug Administration (FDA) in 2021. Only a small percent of members utilize specialty drugs, but that use accounts for more than half of drug spend. Additionally, there’s a rich specialty biosimilar pipeline with an opportunity to realize approximately $100 billion savings in the next five years. Ford provided the payer perspective on the value of supply chain strategies to best manage this important issue for health plans and employers looking to reduce specialty cost and improve member outcomes.

Ford and his fellow panelist discussed topics ranging from biosimilar opportunities and their management through formulary and other strategies to payer channel management strategies.

Key topics of interest

Medical Specialty Drug Management
Collaboration is needed between payers and providers to create a better model that lowers total cost of care while simultaneously improving health outcomes. Ford said, “It’s unlikely for such collaboration to occur when there’s conflict between payer/PBMs and providers around earning margin on medical specialty drugs.” Ford added, “Fortunately Prime doesn’t have that same conflict.” As an example, Ford pointed to white bagging programs that prevent hospitals and physician offices from earning margin on drugs they infuse as they previously had in a buy-and-bill setup. This model effectively reduces drug reimbursement for the plan sponsor and creates a new margin opportunity for the specialty pharmacy but is highly abrasive for providers.  “Prime, on the other hand, is in the final innings of developing a new innovative product that allows hospitals and physician offices to continue earning margin on medical drug utilization, but at a more rationale price, comparable to pharmacy benefit reimbursement.”

Biosimilar Opportunities
“All eyes are on 2023 Humira biosimilars and what, if anything, we can learn from the biosimilars that have come to market over the last seven or so years that will influence what plays out with Humira,” said Ford. Given the in-market biosimilars are all on the medical benefit, and the dynamics are very different than what will play out with Humira on the pharmacy benefit, one can’t deduce Humira’s future performance based on past biosimilar performance.

“I received many audience questions about Prime’s channel independent approach – the very one that enables programs like IntegratedRx™,” said Ford. “It’s one shining example of a Prime program aimed at delivering a member- and provider-centric experience without driving to an owned specialty pharmacy. Allowing clients, members and providers the freedom to choose the model that suits them best, without compromising care, differentiates Prime in the industry and positions us well for future provider collaborations.”

Around 200 conference-goers attended the panel presentation. Ford noted the audience makeup was a broad group of participants spanning all major stakeholders including pharma, payers and PBMs, consultants, specialty pharmacies, hospitals and more.

“It was validating to field dozens of questions on Prime’s supply chain strategies both during and after the presentation,” said Ford. “The energetic discussion reinforced the need to create a better specialty model, one that enables provider collaboration to lower total cost of care and improve health outcomes. Fortunately, Prime is positioned to deliver this given our channel independent approach.”

Ford’s fellow panelist was Tom Moore, vice president, market access, contracting and trade for Amgen. AJ Ally, pharmacy management consultant for Milliman served as facilitator.

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