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GREAT NECK, N.Y. — Rep. Tom Suozzi (D., N.Y.) gauged cost dynamics of the specialty pharmacy market in a tour of oncology pharmacy Onco360 here with members of the National Association of Specialty Pharmacy (NASP).
Seeking insight on what’s driving skyrocketing drug costs and the impact on patients, Suozzi met with Sheila Arquette, executive director of NASP; Paul Jardina, president and chief executive officer of Onco360, an independent specialty pharmacy serving cancer patients; and Timothy Ward, president of distributor Hercules Pharmaceuticals, which serves the independent and community pharmacy sector.
“We’re all concerned about affordability for consumers, and this was an opportunity to support some of the independent and smaller operators in the country,” Suozzi said.
The myriad of factors influencing high drug pricing make the issue a tough nut to crack for Congress, consumers and industry stakeholders, the freshman congressman noted.
“It’s incredibly complex. I don’t think people do understand how complicated it is. If it was easy, someone would have solved it already,” Suozzi said. “We need to have more of a considered, deliberative process where Democrats and Republicans work together to get input from experts to drill down to the real answers to these problems, as opposed to just trying to find someone to blame all the time, which is happening much too often in our country.”
Suozzi is the vice chairman of the bipartisan Problem Solvers Caucus in Congress. Earlier this month, he was one of 54 lawmakers to sign a nonpartisan letter to the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to ensure that rebates and discounts in Medicare Part D help rein in escalating out-of-pocket drug costs for patients.
Also in the letter, lawmakers urged Acting HHS Secretary Don Wright and CMS Administrator Seema Verma to preserve specialty pharmacy choice for patients and prescribers and address rising direct and indirect remuneration (DIR) fees from pharmacy benefit managers (PBMs) and misapplied Part D performance metrics, which align with Star Rating measures instead of the complex diseases treated by prescribed specialty drugs.
“The purpose of Congressman Suozzi’s visit is to allow him to tour Onco360 and get a firsthand experience of what happens at a specialty pharmacy and how it’s different from other pharmacy practice settings — all of the high-touch, coordinated patient care that accompanies the dispensing of the medications to the patient,” said Arquette of NASP, which has 250 specialty pharmacy members.
“We also wanted to thank the congressman for his support in signing the letter, which asked HHS and CMS to look at some of the business practices of the PBMs with respect to DIR fees and ‘any willing pharmacy’ provisions, things that are negatively impacting specialty pharmacies’ ability to service Medicare patients,” she added. “We appreciate his support that we need to take a second look at this. We want to ensure that Medicare beneficiaries have access to the life-saving and life-altering drugs that they need, that they can afford them and that they’re provided by the pharmacy they and their physicians choose.”
According to IMS Health data, drug spending continues to shift from traditional to specialty medicines, with
Specialty medications’ share of U.S. drug spending climbed from 23.6% in 2007 to 42.9% in 2016, NASP reported, citing data from QuintilesIMS. In the discussion at the Onco360 tour, it was estimated that specialty’s share of drug expenditures will top 50% within the next several years.
Among the complex and chronic conditions treated by specialty drugs are cancer, hepatitis C, infectious diseases, infertility, Crohn’s disease, rheumatoid arthritis, psoriasis, HIV/AIDS, multiple sclerosis, cystic fibrosis, organ transplants, human growth hormone deficiencies and hemophilia.
“We’re trying to educate legislators across the country about specialty pharmacy and what it takes to accept an order from a physician for a specialty pharmaceutical and get it all the way through to fulfillment and support the patient moving forward — an appreciation for the level of work it takes to provide great care,” Onco360’s Jardina said.
Dispensing to cancer patients nationally, Louisville, Ky.-based Onco360 has four specialty pharmacy locations: in its hometown of Louisville; Great Neck and Buffalo, N.Y.; and Waltham, Mass.
According to NASP, a recent paper published in JAMA Internal Medicine finds that because of Part D benefit design, rebates and remunerations — including DIR fees — actually hike patients’ out-of-pocket costs. The association noted that the author of the JAMA report, Dr. Peter Bach, described the current Medicare system as “absolutely devastating for people on high-cost specialty drugs.”
“We’re trying to get a playing field where we can get measured based on the things we can actually influence and make a difference in the ultimate quality of care,” Onco360’s Jardina said. “If you look at Star Ratings, they are geared toward traditional drugs. But it’s projected that next year over half of the drug market will be specialty drugs. So you have a system that’s geared toward non-specialty drugs that’s being applied to 100% of the dispenses. And we don’t think that’s very good for the health care system.”
Ward of Port Washington, N.Y.-based Hercules Pharmaceuticals decried DIR fees as “defunding the system” for pharmacies and their patients.
“The misuse of DIR Fees by PBMs is taking money out of the wallets of our sick and elderly, as well as out of the cash registers of the hard-working community pharmacies who serve them,” he said in a statement. “We must remove the calibrated distortions, which benefit entrenched PBM interests, hurt the patients and undermine the market.”
To highlight the impact of DIR fees, NASP has launched StopDIRfees.com, which has an online petition and contact information for constituents to call or write elected officials.
