In a recent video from Drug Channels Institute’s, The State of Specialty Pharmacy 2020: Market Data and Trends, CEO Adam Fein reviews the role of specialty drugs in the pharmacy industry, Drug Channels Institute’s largest data on specialty pharmacy accreditation and commentary on PBM’s role in the specialty industry.
Specialty drugs are the fastest growing in the pharmaceutical market. Specialty pharmacy drugs have grown from 29 percent in 2015 to 36 percent of the market in 2019. The number of healthcare provider specialty pharmacies has and continues to grow. Of all the different types of specialty pharmacies (independent, healthcare provider, retail/LTC chain, PBM/health plan and wholesaler); 45 percent are independently owned, and 32 percent are through healthcare providers, which includes hospital systems, health care systems, private practices, etc. The number of specialty pharmacies owned through retail/LTC chains is 11 percent, PBM/health plans is 11 percent and wholesalers is 1 percent. Though the retail/LTC chains, PBM/health plans and wholesalers are at a lower percentage, they have the most control because they can choose which pharmacies they dispense to and why.
Covered entities, such as hospitals and FQHCs, may partner with specialty pharmacies to dispense 340B drugs to their patients. Fein estimates that 15 to 20 percent of specialty medications are 340B drugs and are run through specialty pharmacies today. He believes that COVID-19’s impact on specialty pharmacies will:
- Enhance the overall position of specialty pharmacy.
- Payer mix shift away from employer-sponsored insurance.
- Create business and profit risks for PBM-owned pharmacies.
- Generate new opportunities for smaller pharmacies and industry de-consolidation.
As unemployment increases, because Americans lost their jobs and therefore insurance, the participation in Medicaid has and may continue to increase. While 340B specialty pharmacies and covered entities must determine which of the three (contracted specialty pharmacy, covered entity or state) is going to carve the Medicaid discount in or out, the influx of Medicaid participation may affect 340B drug pricing. This is because some states decide if the Medicaid discount is carved in or out from the covered entities operating within its state lines and governance.