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January 13, 2021
While 2020 was a year that most of us would like to forget, a lot of movement happened in the world of pharmacy and pharmacy benefits. We at Team Apex saw several themes in 2020 and summarize many of our pharmacy-related posts in this look-back synopsis of trends we saw during the year that was by key players in pharmacy benefits and drugs.
Major Trend One: COVID-19
The first obvious trend we followed this year was COVID-19.
This impacted so much of what we do in healthcare that our approach in pharmacy looked at a variety of aspects affecting pharmacy benefits. The clinical trials with COVID-19 vaccines was an early discussion on The Point Podcast with Edye Edens, along with a supply chain discussion on pharmacy and prescription drugs with Rosemary Gibson, author of ChinaRx, which we know has been strained with drug shortages and now distribution of the COVID-19 vaccine with ultra-low temperatures required.
We were faced with mental and behavioral health issues skyrocketing in the US. The opioid crisis did not decrease, and we discussed this other public health crisis and how we can mitigate it during the pandemic. Telehealth was a silver lining of the 2020 pandemic as well, particularly for mental and behavioral health treatment.
Last, many unfortunately lost their jobs and healthcare benefits along with the pandemic. We created a post on how to save on drug spend if employers had to make tough decisions for their employees during this crisis.
We also shared what happened in prescription benefits during the COVID-19 lock down periods and continue to follow this, and supply this information to our clients and in professional presentations. If you’d like us to share at your upcoming event for 2021, please contact us.
Major Trend Two: Specialty Drugs & New Therapies
The second major trend in pharmacy during 2020 was that of specialty drug spend.
This will continue to be a major issue in healthcare plans moving forward as well. Because this area is complex and only getting more complicated, we began with a few primers – such as the universe of specialty drugs, and more in depth explanations of subcategories of specialty drugs, like J code (medical) drugs.
We also hosted through our podcast miniseries to salute pharmacy in October an episode on specialty drugs, orphan drugs and gene therapies of Ryan Atkinson, PharmD, MBA.
We at Team Apex also watch the drug FDA approvals and pipelines for orphan drugs, specialty drugs, and gene therapies to understand what is to come, and how these new therapies will impact pharmacy benefits plan spend moving forward. For the first half of 2020, we analyzed newly approved FDA drugs, how to curb specialty drug spend, and what to do if employers need to make tough choices and exclude certain categories of specialty drugs from a healthcare and pharmacy benefit plan.
Major Trend Three: Pharmacies & Pharmacy Benefit Managers
The third major trend we watched inside pharmacy benefits in 2020 was pharmacies and pharmacy benefit managers (PBMs) and how they are changing.
One of the big stories this year was the debut of Amazon Pharmacy, and continued consolidation and vertical integration of pharmacies and PBMs. Also, as fans of Indiana-based businesses, we wrote a post on going local with pharmacy and PBM vendors right in Indiana.
We also noted that bigger pharmacy benefit managers aren’t always the best solution for our clients, and why remaining agnostic and inclusive with all PBMs is important when serving our employer clients.
Drug formulary management is also a key to keeping drug costs low. We introduced a couple of tools throughout the year on options for plan administrators to reduce costs, such as closed formularies and their benefits, prior authorization, and adherence packaging of prescription and OTC medications.
We rounded out the year with an assessment of a breakthrough Supreme Court Case with Rutledge vs. PCMA, in which the Supreme Court held that states may regulate PBMs moving forward, which will cause a mix of issues in years to come for plans, as well as ensuring that your broker isn’t being paid by your PBM on your plan without your knowledge.
Major Trend Four: The Apex Pharmacy Specialist Difference
Last, we focused on why it is very important to work with a broker with in-depth knowledge of pharmacy benefits—as they are complex and not easy to understand.
Team Apex was the first broker in the world in 2020 to re-certify with the Certified Pharmacy Benefits Specialist Certification (CPBS), and we culturally also culturally support life-long learning with other certifications.
While it was a challenging year, we at Apex continue to keep our eyes on the long term game for pharmacy benefits.